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通讯作者:

刘晓秋,E-mail:xiaoqiulliu@njmu.edu.cn;

于鑫焱,xyyu@njmu.edu.cn

中图分类号:R378.21

文献标识码:A

文章编号:1007-4368(2022)08-1065-09

DOI:10.7655/NYDXBNS20220803

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目录contents

    摘要

    目的:分析多耐药大肠杆菌J2_5的进化分群、耐药基因及毒力基因,为临床诊断及用药提供理论依据。方法:采用高通量测序法对J2_5进行全基因组测序,并使用多种生物信息学工具和数据库进行数据比对分析。结果:该菌的全基因组总长度为4.7 Mb,GC含量为50.78%。多位点序列分型(MLST)分析发现其ST型为ST2491,和大肠杆菌野生株 MG1655分型ST10 不同。系统发育树进一步分析表明J2_5与MG1655的亲缘关系较近。抗生素耐药性综合数据库(CARD)分析发现该菌有65 个耐药基因,主要通过4类耐药机制(抗生素外排泵、抗生素失活、抗生素靶点改变、降低对抗生素的渗透性)产生耐药性。毒力因子数据库(VFDB)分析发现该菌有7类40个毒力基因,编码黏附素、侵袭、自主转运蛋白等毒素蛋白。使用Prophage Hunt⁃ er网上工具发现J2_5基因组存在3个前噬菌体,并且前噬菌体上带有1个毒力基因。结论:全基因组测序结果表明J2_5携带更多的毒力基因及耐药基因,是其致病性强和具有多种抗生素耐药性的原因。

    Abstract

    Objective:A novel multidrug resistant(MDR)Escherichia coliE.coli )strain J2_5 was isolated from a patient’s mid ⁃ stream urine sample. According to the genome sequence of J2_5,we analyzed its evolutionary classification,drug resistance genes and virulence genes,providing theoretical basis for clinical diagnosis and drug selection for drug resistant bacterial infection. Methods: Genome DNA of J2_5 was isolated and sequenced by high ⁃ throughput sequencing technology,after analyzed the high ⁃ throughput sequencing data and compared it with known databases by a variety of bioinformatics tools,a high integrity genome of J2_5 was obtained. Results:The total length of the whole genome of J2_5 was 4.7Mb and GC content was 50.78%. Phylogenetic tree analysis showed that J2_ 5’genome was closely related to that of wild type E. coli strain MG1655. But Multilocus sequence typing(MLST)analysis revealed ST type of J2_5 was ST2491,which was different from that of MG1655(ST10). Furthermore,CARD database analysis showed that the genome of J2_5 encodes 65 drug resistance genes,which make the strain obtain drug⁃resistant ability through four different mechanisms (antibiotic efflux pump,antibiotic inactivation,antibiotic target change,reduced permeability to antibiotics). VFDB database analysis showed that there were 40 virulence genes in 7 categories,encoding adhesive proteins,invasion proteins,autonomic transporters and other toxin proteins. After analyzing the whole genome of J2_5 through the Prophage Hunter online tool,we found that there were three prophages in the genome of J2_5,and a virulence gene was carried by one of the prophages. Conclusion:The whole genome sequencing results showed that J2_5 carries some virulence genes and drug resistance genes,which makes the strain obtain strong pathogenicity and resistance ability to a variety of antibiotics.

  • 细菌是导致感染性疾病的最常见病因。近年来,由于抗生素滥用带来的选择压力,加速了致病菌对抗生素产生耐药性[1],临床分离到的多耐药菌及全耐药菌的菌株数量急剧攀升。抗生素耐药性(AMR)细菌严重威胁人类的生命健康,给社会经济造成沉重负担[2]。临床常见的耐药菌有大肠杆菌(E.coli)、肺炎克雷伯菌、金黄色葡萄球菌、鲍曼不动杆菌和铜绿假单胞菌等,其中在革兰阴性杆菌中,大肠杆菌耐药问题最为严重。尿路致病性大肠杆菌(UPEC)是泌尿道感染的主要致病菌[3],可引起败血症和新生儿脑膜炎等并发症[4],大肠杆菌是导致新生儿侵袭性全身感染的三大常见致病菌之一[5]。大肠杆菌对多种抗生素呈交叉耐药,是全世界迄今为止报告的耐药率最高的细菌之一[6],其导致的临床感染治疗难度大。

  • 针对β⁃内酰胺类抗生素耐药的大肠杆菌在临床上最常见。β⁃内酰胺类抗生素是目前临床使用率很高的抗生素,占抗生素总使用量的30%~40%[7]。β⁃ 内酰胺类药物的作用机制是通过抑制细菌细胞壁黏肽合酶的产生,阻止黏肽的产生,进而破坏细菌的细胞壁[8]。产生超广谱β⁃内酰胺酶(ESBL)的大肠杆菌菌株对多种β⁃内酰胺类药物具有耐药性[9],常见的ESBL编码基因包括CTX⁃M、SHV、TEM[10]。在过去10年中,TEM和SHV型是最常见的 β⁃内酰胺酶基因类型,但近年来,CTX⁃M型在世界范围内广泛传播[11]。与对β⁃内酰胺类敏感的大肠杆菌感染相比,ESBL大肠杆菌感染的临床治疗效果更差[12]。从2003年到2018年,在全球范围内,社区中ESBL大肠杆菌的肠道携带率增加了8倍[13]。因此,需要新的治疗方法和公共卫生策略来预防ESBL大肠杆菌的传播扩散。

  • 耐药的致病性大肠杆菌还携带多种毒力因子 (细菌定植相关基因、黏附素、毒素、铁获取因子、脂多糖、侵袭素等),通常毒力基因可由致病岛(PAI)、质粒和其他可移动遗传元件编码[14]。对致病性大肠杆菌的传播动力学和毒性克隆选择的机制仍然知之甚少,因此对其耐药分子及毒力基因的研究具有重要的流行病学意义。

  • 目前,全基因组测序在公共卫生关注的病原体监测中已经广泛应用[15]。通过全基因组测序可以监测流行病学进展,同时可以检测新基因型大肠杆菌的毒力基因和耐药基因[16-17]。因此,本研究使用Illumina HiSeq平台对一株新分离的临床多重耐药的ESBL大肠杆菌J2_5进行高通量测序,利用生物信息学工具进行数据拼接、注释和分析,获得基因组草图,并对该菌的耐药基因、毒力基因、菌株序列型进行了全面的分析。

  • 1 材料和方法

  • 1.1 材料

  • 大肠杆菌MG1655菌株由实验室保存,J2_5菌株分离自南京医科大学第一附属医院患者的临床样本,该菌株为ESBL(+)菌,对多种抗生素产生耐药。研究已通过南京医科大学伦理审核[批准文号是:南医大伦审(2021)478号]。所有菌株均在Luria⁃Bertani(LB)培养基中于37℃培养。

  • 酵母抽提物(Oxiod公司,英国),氯化钠(北京中国国药集团),胰蛋白胨(Oxiod公司,英国),琼脂粉(上海生工),2×Taq PCR Master Mix、琼脂糖(上海翊圣),恒温培养振荡器(上海智城),PCR扩增仪 (Eppendorf,德国),琼脂糖水平电泳仪(北京六一生物),凝胶成像仪(伯乐公司,美国)。

  • 1.2 方法

  • 1.2.1 J2_5菌株基因组测序

  • J2_5的基因组DNA用TIANamp Bacteria DNA Kit(Tiangen Biotech)提取,并使用Illumina HiSeq技术进行测序。使用ABySS v2.0.2拼接软件对序列进行拼接,使用GapCloser v1.12软件对组装结果进行局部填充和碱基校正。基因预测由GeneMarkS v4.6b软件进行,将预测基因的蛋白序列分别与Nr、 Genes、eggNOG和GO数据库进行blast比对,从而获得预测基因的注释信息。

  • 1.2.2 系统发育分析

  • 使用MLST Finder 2.0用于多位点序列分型 (MLST)[18],对来自16个大肠杆菌的7个管家基因 (adk、fumC、gyrB、icd、mdh、purArecA)检索并导出序列,使用MEGA7.0软件进行多序列比对、整理、对齐,再使用邻接算法构建系统发育分析树,用Boot⁃ strap重复抽样1 000次验证。

  • 1.2.3 细菌耐药基因与毒力基因预测

  • 为预测大肠杆菌J2_5菌株中的耐药基因和毒力基因,使用毒力因子数据库(VFDB)(网址:http://www.mgc.ac.cn/cgi ⁃ bin/VFs/v5/main.cgi?func=VFana⁃ lyzer)检测其毒力基因,使用抗生素耐药性综合数据库(CARD)(网址:https://card.mcmaster.ca/analyze/rgi)确定大肠杆菌J2_5菌株基因组序列中的抗生素抗性基因。

  • 1.2.4 原噬菌体预测与分析

  • 使用Prophage Hunter网络服务器(网址:https://pro⁃hunter.genomics.cn/)对大肠杆菌菌株J2_ 5的全基因组进行查询,通过与已存入参考数据库的元素比较检测原噬菌体元素相似性,预测前噬菌体相关的区域。预测的前噬菌体活跃的概率由0到1的活动分数提供。

  • 1.2.5 扩增原噬菌体引物设计

  • 根据预测的原噬菌体基因序列,使用软件Prim⁃ er5.0设计引物序列,每个原噬菌体分别设计3对,设计的引物序列见表1。

  • PCR反应体系为20 μL,up、down引物各1 μL,2 ×Taq PCR Master Mix 10 μL,去离子水7 μL,模板1 μL。扩增参数为:95℃ 5min;95℃ 30s,55℃ 30s, 72℃ 40s,30个循环;72℃延伸10min。产物使用1%琼脂糖凝胶进行电泳,使用凝胶成像系统观察,记录结果。引物合成和PCR产物测序均委托南京擎科生物科技公司完成,测序结果用BLAST进行序列分析。

  • 表1 本研究所使用的引物

  • Table1 Primers used in this study

  • 1.2.6 基因组登录号

  • J2_5全基因组序列已提交至美国国立生物技术信息中心(NCBI)的SRA数据库,登录号为: SRR18067191。

  • 2 结果

  • 2.1 基因组测序与组装

  • 使用Illumina⁃HiSeq 2000对J2_5菌株进行全基因组测序,经组装和整合优化,得到161个Scaffolds, J2_5基因组总长度为4 701 041bp,GC含量为50.78%, N50长度为98 796bp,N90长度为18 306bp,最长的片段为294 915bp,最短的片段为509bp。使用GeneMarkS软件对J2_5基因组进行编码基因预测,共得到4 609个编码基因,总长度为4 131 945bp,占基因组全长的87.90%,平均长度为896bp。这些数据证明该次高通量测序的数据质量较高,可用于后续生物信息学分析。

  • 2.2 J2_5菌株基因组功能注释

  • 通过将J2_5菌株的基因序列与COG数据库进行比对,得到注释结果后对蛋白功能进行分类。如图1所示,共有3 672个蛋白获得COG功能注释。其中,参与氨基酸运输与代谢(E,amino acid transport and metabolism)和碳水化合物运输和代谢(G,carbo⁃ hydrate transport and metabolism)的蛋白含量最丰富,共占比例18.6%。参与能量产生和传递(C,ener⁃ gy production and conversion)、细胞壁/细胞膜/包膜合成(M,cell wall/membrane/envelope biogenesis)、无机离子的转运和代谢(P,inorganic ion transport and metabolism)、复制/重组/修复(L,replication,recombi⁃ nation and repair)、转录(K,transcription)/翻译/核糖体结构和合成(J,translation,ribosomal structure and biogenesis)的蛋白占据较大比例,分别为8.4%、7.0%、6.9%、6.7%、5.3%、5.0%。

  • 2.3 MLST分型

  • 使用MLST Finder 2.0多位点序列分型网上工具,提取了J2_5全基因组序列中 adk、fumC、gyrB、 icd、mdh、purA、recA 等7个基因的序列,与大肠杆菌MLST分型数据比对,显示J2_5菌株ST型为ST2491,与大肠杆菌MG1655菌株ST分型(ST10)不同。7个管家基因序列中6个基因序列没有明显变化,但是发现 mdh 基因发生了突变,基因座位号最接近mdh_7,与大肠杆菌BL21(DE3)最相似(表2)。

  • 图1 基于COG数据库的E.coli J2_5基因注释类别分布

  • Fig.1 E.coli J2_5gene annotation category distribution based on COG database

  • 2.4 系统发育分析

  • 为研究J2_5的详细进化史,根据BLAST分析的结果,将J2_5基因组中的管家基因与从不同地区分离的16株大肠杆菌的7个管家基因按照adk、fumC、 gyrB、icd、mdh、purA、recA的顺序串联后使用MEGA7程序绘制系统发育树(图2)。基于系统发育树结果发现,J2_5与大肠杆菌MG1655、大肠杆菌BL21 (DE3)亲缘关系较近。以上表明J2_5是一株新的变异大肠杆菌菌株。

  • 表2 MLST分析结果

  • Table2 MLST analysis results

  • ST结果:ST2491

  • 图2 E.coli J2_5基于MLST分型的系统发育树

  • Fig.2 E.coli J2_5phylogenetic tree based on MLST typing

  • 2.5 耐药基因预测

  • 通过抗生素耐药性综合数据库(CARD)对 E.coli J2_5基因组进行抗性基因识别。结果显示,该菌基因组共有65个耐药基因,可分别通过抗生素外排泵、抗生素失活、抗生素靶点改变、降低对抗生素的渗透性等4类机制使细菌产生耐药性(表3)。其中通过参与抗生素外排使细菌产生耐药性的基因有45个,占比68%。主要为编码抗性结节分化 (RND)抗生素外排泵基因aceA等21个、编码主要易化子超家族(MFS)抗生素外排泵基因 mdtH 等14个、编码ATP结合盒(ABC)抗生素外排泵 Yojl 等2个基因和编码小型多药耐药(SMR)抗生素外排泵基因 emrE。使抗生素通透性降低的基因有 marA 和soxS。改变抗生素靶点的基因有 PmrF 等15个基因。使抗生素灭活的基因有ampH等9个基因。与大肠杆菌MG1655相比,J2_5多编码17个耐药基因,分别是改变抗生素靶点基因(dfrA17、GlpT、gyrA、 parC、sul1、sul2)、抗生素外排基因[aceA、oqxA、oqxB、 tetA)、qacEdelta1]、抗生素灭活基因[AAC3⁃IV、 mphA、aadA5、APH(4)⁃Ia、TEM⁃1、CTX⁃M⁃65]。

  • 在J2_5基因组中发现的这些耐药基因大部分使菌株能够获得对多种抗生素的耐药性,它们分别编码了绝大部分临床常用抗生素耐药性基因,包括氨基糖苷类抗性基因[acrD、cpxA、baeR、baeS、mdtB、 aadA5、APH4⁃Ia、mdtC、mdtA、kdpE、AAC3⁃IV]、氟喹诺酮类抗性基因(mdtH、emrB、emrA、emrR、gy⁃ rA、parC)、肽类抗性基因(Yojl、PmrF、bacA、eptA、 ugd)、磷霉素抗性基因(mdtG、GlpT)、大环内酯类抗性基因(mphA、emrE)、四环素类抗性基因[tetA)]、耐埃尔法霉素类抗性基因(EF⁃Tu)、甲氧苄啶类抗性基因(dfrA17)、磺胺类抗性基因(sul1、sul2)、核苷类抗性基因(mdtN、mdtP、mdtO)、β⁃内酰胺酶抗性基因(ampH、ampC、ampC1、CTX⁃M⁃65、TEM⁃1)、硝基咪唑类抗性基因(msbA)。

  • 2.6 毒力基因预测

  • 将J2_5全基因组通过VFDB数据库比对来搜寻毒力基因,最终共检索到40个毒力基因,包括黏附素、侵袭、自主转运蛋白、非LEE编码的TTSS效应子、分泌系统、生物膜形成、菌毛黏附决定因子等7类毒力基因。在E.coli J2_5所有毒力基因中,属于黏附与侵袭类的毒力相关基因数量最多,包括编码大肠杆菌共生菌毛(E.coli common pilus,ECP)、 CFA/I菌毛(CFA/I fimbriae)、Ⅰ型菌毛(type I fimbri⁃ ae)、大肠杆菌层黏蛋白结合菌毛(E.coli laminin ⁃ binding fimbriae,ELF)、出血性大肠杆菌菌毛(hem⁃ orrhagic E.coli pilus,HCP)、脑内皮细胞侵袭素(in⁃ vasion of brain endothelial cells,Ibes)、P菌毛(P fim⁃ briae)的7种25个毒力基因。通过VFDB数据库对大肠杆菌MG1655与J2_5的毒力基因进行比对,结果见图3。在J2_5中发现了一些在大肠杆菌MG1655中没有的毒力因子,包括编码P菌毛的基因(papA、papC、papD)、编码CFA/I菌毛的基因(cfaA、 cfaB、cfaC、cafD/E)、编码自主转运蛋白的基因(aa⁃ tA、cah、cdiA)、编码脑内皮细胞侵袭基因(ibeB、 ibeC)、编码TTSS效应器分泌系统基因(espL1、espL4、 espR1、espX1、espX4、espX5)、编码ACE T6SS效应器分泌系统基因aec15、编码类似鼠疫耶尔森菌鞭毛的 fliC基因、编码与生物膜形成有关的adeG、及编码菌毛黏附决定因子的pegB、stcC等。其中,adeG、pegB、 stcC 3个编码基因为J2_5菌株独有,在其他大肠杆菌中(如 E.coli O157:H7str.EDL933、E.coli APEC O1、E.coli CFT073等21株大肠杆菌)均未发现。

  • 表3 E.coli J2_5耐药基因分析结果

  • Table3 Analysis results of E.coli J2_5drug resistance gene

  • 2.7 原噬菌体的预测及验证

  • 本研究使用Prophage Hunter噬菌体预测工具对大肠杆菌J2_5的基因组进行BLAST搜索分析(表4),预测到J2_5基因组中存在3个前噬菌体(从上到下依次命名为YZ3、YZ24、YZ58),同时对大肠杆菌MG1655基因组搜索分析,搜索到7个前噬菌体。 J2_5基因组与MG1655基因组上不存在相同的噬菌体相关区域。对J2_5基因组上预测到的噬菌体相关区域进行毒力基因检测,在scaffold24区域只有1个编码自主转运蛋白相关毒力基因aatA。此外,本研究检测了前噬菌体区域是否存在抗生素抗性相关基因,在3个前噬菌体区域中均未发现抗生素抗性相关基因。因此认为,噬菌体不是大肠杆菌J2_5中抗生素抗性基因的载体,而是毒力相关基因的载体。

  • 使用设计的引物对预测的原噬菌体YZ3、 YZ24、YZ58编码序列进行PCR鉴定,结果如图4所示。从图中可以看到引物3⁃1up/3⁃1down、3⁃2up/3⁃ 2down、3⁃3up/3⁃3down、24⁃1up/24⁃1down、24⁃2up/24⁃ 2down、24⁃3up/24⁃3down、58⁃1up/58⁃1down、58⁃2up/58⁃2down、58⁃3up/58⁃3down可以扩增出J2_5基因组中原噬菌体DNA上的目的条带,且大小一致。将PCR扩增产物进行测序鉴定,鉴定结果与J2_5基因组中相应序列进行比较,结果证实,扩增出的序列的确是预测到的原噬菌体编码序列。

  • 图3 E.coli str.K⁃12substr.MG1655与E.coli J2_5毒力因子比较

  • Fig.3 Comparison of virulence factors in E.coli str.k⁃12substr.MG1655and E.coli J2_5

  • 3 讨论

  • 细菌出现耐药性的原因有多种,其中流行最广的耐药机制就是获得性耐药。大肠杆菌能够积累AMR基因,并将这些基因水平传递给其他物种[19]。耐药基因在不同菌种间的快速水平传递会导致多重耐药菌株、全耐药菌株的大量出现,使得很多抗生素的疗效不断下降[20],耐药基因的携带和耐药性产生及传递的机制成为临床治疗所重点关注的问题之一[21]。运用高通量测序技术和生物信息学分析相结合,可以一次性得到整个细菌基因组的信息[22],同时可检出病原体型别、毒力基因和耐药基因,该技术在微生物检验领域有重要应用前景[23],有助于耐药菌感染的临床诊断和治疗,以及研究设计新的药物和疫苗等。本研究新鉴定了一株临床多耐药大肠杆菌J2_5,通过高通量测序技术获得了J2_5的全基因组序列。运用多种生物信息学分析方法,对其编码基因进行了分析预测,得到基因注释结果,共编码4 609个基因。

  • 表4 E.coli MG1655与E.coli J2_5基因组原噬菌体比较

  • Table4 Comparison of E.coli MG1655and E.coli J2_5genomic prophages

  • 图4 对原噬菌体进行PCR鉴定电泳图谱

  • Fig.4 Identification of prophage by PCR

  • MLST是一种经典的细菌基因分型技术,用于识别细菌不同克隆间的关系[24],广泛应用于监测爆发感染的病原菌[25]。随着全基因组测序技术的发展,大量参考菌株的全基因组已被测序,例如已得到大肠杆菌MG1655和导致肠道感染的致病菌株O157:H7的全基因组序列,另外还有至少20种大肠杆菌菌株的完整基因组序列已被测定[2426]。已获得的大肠杆菌全基因组序列中包括了7个管家基因,基于确定所选管家基因序列和菌株的等位基因类型,使用MLST网上工具就能直接获得目标菌株的序列类型(ST)[27]。此外,MLST序列分型还能准确地探索大肠杆菌物种的系统发育结构。本研究对大肠杆菌J2_5进行基因组测序后,得到7个管家基因序列,分析序列类型,得到其ST型为ST2491,并基于MLST多位点序列分型,与16株大肠杆菌构建了系统发育树。结果显示,该菌与大肠杆菌MG1655和大肠杆菌BL21(DE3)亲缘关系较近。

  • 产生ESBL的大肠杆菌菌株具有多重耐药性,主要是因为ESBL耐药基因通常由质粒编码,这些质粒还携带其他抗生素抗性基因,如氨基糖苷类、氟喹诺酮类、氯霉素、磺胺类和四环素类耐药基因[28]。对大肠杆菌J2_5的耐药基因进行预测,共发现65个耐药基因,数量最多的为抗生素外排机制基因(占比68%)。外排机制的耐药基因可产生对多种抗生素的耐药,如 marA 基因编码蛋白具有RND外排泵功能,同时还能够降低抗生素通透性; marR、acrR基因编码蛋白参与RND外排泵,同时还能够改变抗生素靶点;evgA、evgS、H⁃NS编码蛋白兼具RND、MFS 2种外排泵功能;soxR、TolC 编码蛋白兼具ABC、RND、MFS 3种外排泵功能;soxS 编码蛋白除了具有ABC、RND、MFS 3种外排泵功能,同时还能够降低抗生素通透性、改变抗生素靶点。这些表明大肠杆菌J2_5一直处于高强度的抗生素选择压力之下,加速其产生抗生素耐药性。已有报道,多种β⁃内酰胺酶基因可以在同一分离物中共存,而CTX⁃M+TEM类型占50%[29]。本研究中J2_5检出携带有CTX⁃M⁃65、TEM⁃1 2种ESBL编码基因,结果与报道一致。J2_5携带多种耐药基因,提示临床需要重视目前耐药现状,合理使用抗生素,尽可能降低ESBL耐药菌的产生和传播。

  • 菌毛是肠外感染中的定植因素,与生物膜形成相关,如P菌毛及其相关蛋白是肠外感染中的定植因子,能刺激T淋巴细胞产生细胞因子[30]。J2_5共携带40个毒力基因,其中携带的P菌毛相关基因 (papA、papC、papD)可能是其产生致病性的主要因素之一。

  • 原噬菌体是可移动的遗传元件,可以将抗生素抗性基因(ARG)[31]、毒力因子[32] 等部分遗传物质传递给细菌宿主,导致细菌产生遗传多样性和获得新的毒力因子(如黏附素或毒素),进而导致新病原体的出现[33]。本研究在J2_5基因组中鉴定到了与大肠杆菌MG1655携带不同的前噬菌体。在噬菌体相关区域存在1个毒力基因aatA,并且该噬菌体还携带有长度为278bp的整合酶基因,提示该毒力基因可能通过可移动遗传元件在菌株间传播。

  • 综上所述,本研究使用全基因组测序技术及生物信息学分析技术,不仅深入分析了J2_5菌株的整体基因组成及蛋白功能,还发现了J2_5携带了大量耐药基因及毒力基因,同时预测到J2_5携带前噬菌体这一可移动遗传元件。研究结果有利于全面认识J2_5基因组特征,为后续比较基因组学分析、原噬菌体诱导等相关研究提供了数据支持,同时对后续ESBL菌的临床治疗及防控具有重要意义。

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  • 参考文献

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