Spread of Klebsiella pneumoniae isolates producing OXA-48 β-lactamase in a Tunisian university hospital.
Spread of Klebsiella pneumoniae isolates producing OXA-48 β-lactamase in a Tunisian university hospital.
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产生 OXA-48 β-内酰胺酶的肺炎克雷伯菌分离株在突尼斯大学医院传播。
DOI：
10.1093/jac/dkr181
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
A. Hammami
中科院分区：
文献类型：
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作者：
S. Ktari;B. Mnif;Fadoua Louati;S. Rekik;Sonda Mezghani;F. Mahjoubi;A. Hammami
主席先生，含有碳青霉烯酶的肺炎克雷伯氏菌的出现和扩散是一个严重的问题。自从2001年首次报道来自土耳其的肺炎克雷伯菌中的OXA-48酶以来，世界上许多国家已经报告了1个OXA-48生产者。2-4目前的报告表明，OXA-48生产商分布广泛，主要来自地中海国家以及欧洲其他国家。2-4在北非，摩洛哥和突尼斯已确定OXA-48生产商。3、4土耳其多个城市爆发了产OXA-48肺炎克雷伯菌分离株，一次在英国，最近在法国。4在本报告中，我们描述了OXA-48与产生CMY-4和CTX-M-14的肺炎克雷伯菌临床分离株在斯法克斯大学医院的传播情况。在6个月的时间里(2009年10月至2010年3月)，斯法克斯大学医院发现153株对超广谱头孢菌素和/或亚胺培南敏感性降低的肺炎克雷伯菌临床分离株。其中21株(13.7%)携带blaOXA-48基因。这些分离株是从八个不同病房的患者身上分离出来的。纸片扩散法测得的药敏图谱和琼脂稀释法测定的最低抑菌浓度(MICs)及欧洲药敏试验委员会(EUCAST)对替卡西林(MICS)的药敏结果均显示所有菌株对替卡西林耐药。2048 mg/L)(表1)。除1株外，其余菌株均对超广谱头孢菌素耐药，包括头孢他啶(MICs4~1024 mg/L)、头孢他啶(MICs0.5~256 mg/L)和头孢吡肟(MICs2~64 mg/L)。除1株Kp11菌株对亚胺培南敏感外，其余菌株均对亚胺培南敏感(MIC90/2 mg/L；5-8 mg/L)。分离株Kp11对亚胺培南有中间作用，但对超广谱头孢菌素敏感。但所有菌株均对厄他培南耐药(MIC90/8 mg/L；MIC2~32 mg/L)。用聚合酶链式反应检测β-内酰胺酶基因，测序结果显示21株OXA-48阳性。肺炎分离株：blaOXA-48(1株)，blaOXA-48+blaCMY-4+
Sir, The emergence and dissemination of Klebsiella pneumoniae isolates harbouring carbapenemases is a serious problem. Since the initial report of the OXA-48 enzyme in a K. pneumoniae isolate from Turkey in 2001, 1 OXA-48 producers have been reported in many countries of the world. 2–4 Current reports indicate that OXA-48 producers are widespread, mostly from Mediterranean countries as well as other countries in Europe. 2–4 In North Africa, OXA-48 producers have been identified in Morocco and Tunisia. 3, 4 The outbreaks of OXA-48-producing K. pneumoniae isolates have been described in several cities in Turkey, once in the UK and recently in France. 4 In the present report, we describe the spread of OXA-48 associated with CMY-4-and CTX-M-14-producing K. pneumoniae clinical isolates in Sfax University Hospital.During a 6 month period (October 2009–March 2010), 153 clinical isolates of K. pneumoniae with reduced susceptibility to extended-spectrum cephalosporins and/or imipenem were recovered in Sfax University Hospital. Among these isolates, 21 (13.7%) produced the blaOXA-48 gene. These isolates were recovered from patients in eight different wards. The antibiogram determined by the disc diffusion method and MICs determined by agar dilution and interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) revealed that all isolates were resistant to ticarcillin (MICs. 2048 mg/L)(Table 1). All but one isolate were resistant to extended-spectrum cephalosporins, including cefotaxime (MICs 4–1024 mg/L), ceftazidime(MICs 0.5–256 mg/L) and cefepime (MICs 2–64mg/L). All isolates but one (Kp11) were susceptible to imipenem(MIC90 ¼2 mg/L; MIC range¼0. 5–8 mg/L). This isolate, Kp11, was intermediate to imipenem but susceptible to extended-spectrum cephalosporins. However, all isolates were resistant to ertapenem (MIC90 ¼8 mg/L; MIC range¼2–32 mg/L). The b-lactamase genes detected by PCR as described previously and sequencing in the 21 OXA-48-positiveK. pneumoniae isolates were as follows: blaOXA-48 (1 isolate); blaOXA-48+ blaCMY-4+