Outbreak of NDM-5-Producing Proteus mirabilis During the COVID-19 Pandemic in an Argentine Hospital.

IF 4.3 2区 医学 Q1 INFECTIOUS DISEASES
Barbara Ghiglione, Ana Paula Rodriguez, María Sol Haim, Laura Esther Friedman, Nilton Lincopan, María Eugenia Ochiuzzi, José Alejandro Di Conza
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引用次数: 0

Abstract

Background: During the COVID-19 pandemic, the emergence of multidrug-resistant (MDR) pathogens, driven by heightened antibiotic usage and device-associated infections, has posed significant challenges to healthcare. This study reports an outbreak of Proteus mirabilis producing NDM-5 and CTX-M-15 β-lactamases in a hospital in Buenos Aires, Argentina, from October 2020 to April 2021. To our knowledge, this represents the first documented outbreak of NDM-5-producing P. mirabilis in the country. Methods: A total of 82 isolates were recovered from 40 patients, with 41.5% from blood cultures and 18.3% from respiratory and urinary samples, among others. Antimicrobial susceptibility testing, PCR-based methods, and MALDI-TOF MS cluster analysis were conducted. Whole genome sequencing (WGS) was performed to characterize the MLST, resistome and plasmid content. Biofilm formation assays and in vitro rifampicin susceptibility tests were also conducted. Result: Most isolates exhibited resistance to carbapenems, cephalosporins, aminoglycosides, and fluoroquinolones, while retaining susceptibility to aztreonam. Genetic analysis confirmed the co-presence of the blaNDM-5 and blaCTX-M-15 genes. Clonal relationships was supported by PCR-based typing and MALDI-TOF MS cluster analysis. WGS revealed a resistome comprising 25 resistance genes, including rmtB and both β-lactamases, as well as the presence of an incomplete IncQ1 replicon associated with multiple resistance determinants. MLST classified this clone as belonging to ST135. Despite the biofilm-forming capacity observed across strains, rifampicin demonstrated potential for disrupting established biofilms at concentrations ≥32 µg/mL in vitro. The MDR profile of the outbreak strain significantly limited therapeutic options. Conclusions: This study highlights the growing threat of NDM-producing P. mirabilis in Argentina. The absence of surveillance cultures from the index case limits insights into the outbreak's origin. These findings underscore the importance of integrating genomic surveillance into infection control protocols to mitigate the spread of MDR pathogens.

2019冠状病毒病大流行期间阿根廷一家医院爆发产生ndm -5的奇异变形杆菌
背景:在2019冠状病毒病大流行期间,抗生素使用量增加和器械相关感染导致耐多药(MDR)病原体的出现,给医疗保健带来了重大挑战。本研究报告了2020年10月至2021年4月在阿根廷布宜诺斯艾利斯一家医院爆发的产生NDM-5和CTX-M-15 β-内酰胺酶的奇异变形杆菌。据我们所知,这是该国第一次有记录的产生ndm -5的奇异假单胞菌暴发。方法:从40例患者中共分离出82株,其中血液培养中分离出41.5%,呼吸道和尿液中分离出18.3%。进行药敏试验、pcr方法和MALDI-TOF质谱聚类分析。采用全基因组测序(WGS)对MLST、抗性组和质粒含量进行鉴定。同时进行了生物膜形成试验和体外利福平敏感性试验。结果:多数分离株对碳青霉烯类、头孢菌素类、氨基糖苷类和氟喹诺酮类药物耐药,对氨曲南保持敏感性。遗传分析证实blaNDM-5和blaCTX-M-15基因共同存在。克隆关系通过pcr分型和MALDI-TOF MS聚类分析得到支持。WGS发现了一个由25个耐药基因组成的抵抗组,包括rmtB和两种β-内酰胺酶,以及与多个耐药决定因素相关的不完整IncQ1复制子的存在。MLST将此克隆分类为属于ST135。尽管观察到菌株之间的生物膜形成能力,但利福平在体外浓度≥32 μ g/mL时显示出破坏已建立的生物膜的潜力。暴发菌株的耐多药特征显著限制了治疗选择。结论:本研究强调了阿根廷产生ndm的奇异假单孢菌日益增长的威胁。指示病例缺乏监测培养物限制了对疫情起源的深入了解。这些发现强调了将基因组监测纳入感染控制方案以减轻耐多药病原体传播的重要性。
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来源期刊
Antibiotics-Basel
Antibiotics-Basel Pharmacology, Toxicology and Pharmaceutics-General Pharmacology, Toxicology and Pharmaceutics
CiteScore
7.30
自引率
14.60%
发文量
1547
审稿时长
11 weeks
期刊介绍: Antibiotics (ISSN 2079-6382) is an open access, peer reviewed journal on all aspects of antibiotics. Antibiotics is a multi-disciplinary journal encompassing the general fields of biochemistry, chemistry, genetics, microbiology and pharmacology. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on the length of papers.
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