马德里(西班牙)一家三级医院出现产多种碳青霉烯酶的肠杆菌:一种新的流行病学情况。

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES
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引用次数: 0

摘要

导言:产多种碳青霉烯酶的肠杆菌(M-CPE)越来越多。我们对两年内(2021-2022 年)在我院(西班牙马德里)发现的 M-CPE 分离菌进行了前瞻性鉴定:我们从临床和监测样本中收集了 796 株耐碳青霉烯类肠杆菌(CRE)。通过表型(免疫层析、磁盘扩散)和分子(PCR、WGS)技术确认了碳青霉烯酶的产生。抗菌药敏感性采用标准肉汤微量稀释法进行评估。收集了临床和人口统计学数据:总体而言,从 17 名患者(3% 患有 CPE,每 1000 例住院患者中有 0.27 例)中分离出 23 个 M-CPE (10 个肺炎克雷伯菌、6 个弗氏复合柠檬酸杆菌、3 个大肠埃希菌、2 个氧合克雷伯菌和 2 个荷尔玛氏肠杆菌)。OXA-48+KPC-3 (7/23) 和 KPC-3+VIM-1 (5/23) 是最常见的碳青霉烯酶组合。所有患者都曾接触过抗生素,包括碳青霉烯类(8/17)。对头孢他啶/阿维巴坦(14/23)、亚胺培南/雷巴坦(16/23)和美罗培南/伐巴内酰胺(7/23)的耐药率较高。头孢唑肟/阿维巴坦+阿卓萘胺组合对所有金属-β-内酰胺酶产生者均有协同作用。发现了克隆和非克隆相关分离株,尤其是肺炎双球菌(5 株 ST29、3 株 ST147、3 株 ST307)和弗氏球菌(3 株 ST8、2 株 ST125、1 株 ST563)。NDM-1+OXA-48 是与一名乌克兰病人转院时感染的 ST147-K.肺炎球菌高危克隆一起引入的。我们发现了四种可能发生在具有相同碳青霉烯酶组合的同一克隆(KPC-3+VIM-1-ST29-K. pneumoniae、NDM-1+OXA-48-ST147-K. pneumoniae 和 KPC-2+VIM-1-ST145-K. oxytoca)患者之间的院内克隆传播事件。除 VIM-1+KPC-2-ST145-K. oxytoca 外,碳青霉烯酶编码基因位于不同的质粒上。研究发现,肺炎克雷伯菌与产生 OXA-48+KPC-3 的大肠杆菌之间存在跨种传播和可能的超时获取:结论:M-CPE 是我们医院新出现的一种威胁。不同碳青霉烯酶(包括金属-β-内酰胺酶)的共同产生限制了治疗方案的选择,说明有必要加强感染控制措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Occurrence of multi-carbapenemase-producing Enterobacterales in a tertiary hospital in Madrid (Spain): A new epidemiologic scenario

Introduction

Multi-carbapenemase-producing Enterobacterales (M-CPE) are increasingly described. We characterized the M-CPE isolates prospectively recovered in our hospital (Madrid, Spain) over two years (2021–2022).

Methods

We collected 796 carbapenem resistant Enterobacterales (CRE) from clinical and surveillance samples. Carbapenemase production was confirmed with phenotypic (immunochromatographic, disk diffusion) and molecular (PCR, WGS) techniques. Antimicrobial susceptibility was evaluated by a standard broth microdilution method. Clinical and demographic data were collected.

Results

Overall, 23 M-CPE (10 Klebsiella pneumoniae, 6 Citrobacter freundii complex, 3 Escherichia coli, 2 Klebsiella oxytoca, and 2 Enterobacter hormaechei) isolates were recovered from 17 patients (3% with CPE, 0.26-0.28 cases per 1000 admissions). OXA-48 + KPC-3 (7/23) and KPC-3 + VIM-1 (5/23) were the most frequent carbapenemase combinations. All patients had prior antibiotics exposure, including carbapenems (8/17). High resistance rates to ceftazidime/avibactam (14/23), imipenem/relebactam (16/23) and meropenem/vaborbactam (7/23) were found. Ceftazidime/avibactam + aztreonam combination was synergistic in all metallo-β-lactamase producers. Clonal and non-clonal related isolates were found, particularly in K. pneumoniae (5 ST29, 3 ST147, 3 ST307) and C. freundii (3 ST8, 2 ST125, 1 ST563). NDM-1 + OXA-48 was introduced with the ST147-K. pneumoniae high-risk clone linked to the transfer of a Ukrainian patient. We identified four possible nosocomial clonal transmission events between patients of the same clone with the same combination of carbapenemases (KPC-3 + VIM-1-ST29-K. pneumoniae, NDM-1 + OXA-48-ST147-K. pneumoniae and KPC-2 + VIM-1-ST145-K. oxytoca). Carbapenemase-encoding genes were located on different plasmids, except for VIM-1 + KPC-2-ST145-K. oxytoca. Cross-species transmission and a possible acquisition overtime was found, particularly between K. pneumoniae and E. coli producing OXA-48 + KPC-3.

Conclusion

M-CPE is an emerging threat in our hospital. Co-production of different carbapenemases, including metallo-β-lactamases, limits therapeutic options and depicts the need to reinforce infection control measures.

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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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