先天性心脏缺陷婴儿中肺炎克雷伯菌的携带和产生的碳青霉烯酶的分子结构

Q4 Medicine
Dmitriy A. Popov, R. A. Osokina, T. Yu. Vostrikova
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The isolation of extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases producing K. pneumoniae in the absence of symptomatic infection was considered as colonization. K. pneumoniae strains were considered as «problematic» in the absence of susceptibility to three or more groups of antimicrobials: the third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides. The profile of antibiotic resistance, carbapenemases production and their molecular type were determined in the isolated strains. Results. K. pneumoniae carriage with «problematic» sensitivity was detected in 252 out of 1445 (17.4%) patients: 153 out of 1445 (10.6%) children were colonized by only ESBLs producers, and 99 out of 1445 (6.9%) children – by both ESBLs and carbapenemases producers. In dynamics, the number of ESBLs producers carriers decreased by 1.5 times (50 out of 448 – 11.2% and 37 out of 506 – 7.3% in 2020 and 2022, respectively). 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引用次数: 0

摘要

目标。目的评价先天性心脏缺陷患儿心外科住院阶段肺炎克雷伯菌在咽直肠粘膜的定植频率,动态分析肺炎克雷伯菌碳青霉烯酶的产生频率和分子结构。材料与方法。回顾性分析2020年1月1日至2022年12月31日期间,共有1445例具有危险因素的先天性心脏缺陷(CHDs)手术治疗患者(术前抗生素治疗、急诊住院、外院转院)。中位年龄为1.08个月(0 - 12个月)。入院后不迟于72小时取咽直肠粘膜涂片(2890份)进行微生物学检查。在没有症状感染的情况下,分离出广谱β -内酰胺酶(ESBLs)和/或产生肺炎克雷伯菌的碳青霉烯酶被认为是定植。肺炎克雷伯菌菌株被认为对三组或三组以上抗菌素(第三代和第四代头孢菌素、碳青霉烯类药物、氟喹诺酮类药物、氨基糖苷类药物)不敏感,是“有问题的”。测定了分离菌株的耐药情况、碳青霉烯酶产量及其分子类型。结果。1445例患者中有252例(17.4%)检测到具有“问题”敏感性的肺炎克雷伯菌携带;1445例儿童中有153例(10.6%)仅被ESBLs生产者定植,1445例儿童中有99例(6.9%)被ESBLs和碳青霉烯酶生产者定植。在动态方面,ESBLs生产商的数量减少了1.5倍(2020年和2022年分别为448家中的50家(11.2%)和506家中的37家(7.3%))。同时产生ESBLs和碳青霉烯酶携带者的肺炎克雷伯菌数量增加了4.9倍(2020年和2022年分别为448 / 11(2.5%)和62 / 62(506 / 12.3%)),2022年比仅产生ESBLs携带者的比例增加了1.7倍。碳青霉烯酶的分子结构以OXA-48碳青霉烯酶(44 / 99 - 44.5%)、NDM金属酶(35 / 99 - 35.4%)、OXA-48和NDM组合(13 / 99 - 13.1%)、KPC(3 / 99 - 3%)、NDM、KPC和OXA-48、NDM和KPC组合分别为3 / 99 - 3%和1 / 99 - 1%。在动态上,产生OXA-48碳青霉烯酶的分离株数量增加了34.8%(分别从2020年和2022年的18.2%增加到53%),NDM碳青霉烯酶和OXA-48、NDM共同产生的分离株数量分别减少了25.9%(从2020年和2022年的54.5%减少到28.6%)和19.1%(从2020年和2022年的27.3%减少到8.2%)。2022年,首次鉴定出产KPC型碳青霉烯酶的菌株以及产OXA-48、NDM和KPC型碳青霉烯酶的共产菌株。结论。获得的数据表明,耐碳青霉烯类肺炎克雷伯菌患者的初始定植频率增加,它们产生的碳青霉烯类酶结构扩大,如果不采取感染控制措施,可能会增加由它们引起的感染频率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Carriage of K. pneumoniae and molecular structure of produced carbapenemases in infants with congenital heart defects
Objective. To evaluate frequency of pharyngeal and rectal mucosa colonization by K. pneumoniae strains in infants with congenital heart defects at the stage of cardiosurgical hospital admission, as well as dynamic analysis of production frequency and molecular structure of K. pneumoniae carbapenemases. Materials and Methods. A total of 1445 patients with risk factors (antibiotic therapy in the anamnesis, emergency hospitalization, transfer from other hospitals) admitted for surgical treatment of congenital heart defects (CHDs) between January 1, 2020 and December 31, 2022 were included in the retrospective analysis. Median age was 1.08 months (between 0 and 12 months). Smears from the pharyngeal and rectal mucosa (2890 samples) were taken for microbiological examination no later than 72 h after admission. The isolation of extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases producing K. pneumoniae in the absence of symptomatic infection was considered as colonization. K. pneumoniae strains were considered as «problematic» in the absence of susceptibility to three or more groups of antimicrobials: the third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides. The profile of antibiotic resistance, carbapenemases production and their molecular type were determined in the isolated strains. Results. K. pneumoniae carriage with «problematic» sensitivity was detected in 252 out of 1445 (17.4%) patients: 153 out of 1445 (10.6%) children were colonized by only ESBLs producers, and 99 out of 1445 (6.9%) children – by both ESBLs and carbapenemases producers. In dynamics, the number of ESBLs producers carriers decreased by 1.5 times (50 out of 448 – 11.2% and 37 out of 506 – 7.3% in 2020 and 2022, respectively). The number of K. pneumoniae producing both ESBLs and carbapenemases carriers increased by 4.9 times (11 out of 448 – 2.5% and 62 out og\f 506 – 12.3% in 2020 and 2022, respectively), in 2022 exceeding the proportion of only ESBLs producers carriers by 1.7 times. The molecular structure of carbapenemases was represented by OXA-48 carbapenemases (44 out of 99 – 44.5%), NDM metalloenzymes (35 out of 99 – 35.4%), OXA-48 and NDM combinations (13 out of 99 – 13.1%), KPC (3 out of 99 – 3%), NDM, KPC and OXA-48, NDM and KPC combinations: 3 out of 99 – 3% and 1 out of 99 – 1% of carriers, respectively. In dynamics, the number of isolates with the production of OXA-48 carbapenemases increased by 34.8% (from 18.2% to 53% in 2020 and 2022, respectively), NDM carbapenemases and co-producers of OXA-48, NDM decreased by 25.9% (from 54.5% to 28.6% in 2020 and 2022) and 19.1% (from 27.3% to 8.2% in 2020 and in 2022), respectively. In 2022, strains with the production of KPC carbapenemases and co-producers of carbapenemases of three classes (OXA-48, NDM and KPC) were identified for the first time. Conclusions. The data obtained indicate an increase in the frequency of initial colonization of patients with carbapenem-resistant K. pneumoniae, an expansion of the structure of carbapenemases produced by them, that, if infection control measures are not followed, can increase the frequency of infections caused by them.
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