In Vitro Antimicrobial Susceptibility Differences Between Carbapenem-Resistant KPC-2-Producing and NDM-1-Producing Klebsiella pneumoniae in a Teaching Hospital in Northeast China
In Vitro Antimicrobial Susceptibility Differences Between Carbapenem-Resistant KPC-2-Producing and NDM-1-Producing Klebsiella pneumoniae in a Teaching Hospital in Northeast China
复制标题
东北某教学医院耐碳青霉烯类KPC-2和NDM-1肺炎克雷伯菌体外药敏差异
DOI：
10.1089/mdr.2018.0398
复制
发表时间：
2019-08-21
影响因子：
2.6
通讯作者：
Liu, Shuang
中科院分区：
文献类型：
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作者：
Lin, Lin;Xiao, Xiaoguang;Liu, Shuang
耐碳青霉烯类肺炎克雷伯菌（CRKP）已成为临床治疗和公共卫生面临的严峻挑战。结果表明，产KPC-2的K. pneumoniae（KPC-KP）和产NDM-1的K.肺炎双球菌（NDM-KP）在东北某教学医院流行。本研究的主要目的是比较KPC-KP和NDM-KP之间的抗菌药物敏感性差异，并通过PCR和测序阐明KPC-KP和NDM-KP的复杂耐药基因型。在2015年1月至2016年12月分离的82株CRKP中，59株为KPC-KP，23株为NDM-KP。59株KPC-KP对庆大霉素、妥布霉素、左氧氟沙星、环丙沙星均不敏感，对丁胺卡那霉素、磷霉素的敏感率分别为3.39%、8.47%，而NDM-KP对上述抗生素的敏感率分别为21.74%、13.04%、17.39%、17.39%、69.57%、73.91%。NDM-KP对替加环素和多粘菌素B的敏感率分别为95.65%和73.91%，高于KPC-KP的84.75%和69.49%，但差异无统计学意义。KPC-KP和NDM-KP对氨曲南-阿维巴坦的MIC 90分别为4和2 μ g/mL。82例CRKP均携带2 ~ 3种超广谱β-内酰胺酶（ESBL）基因，79例携带AmpC基因bla（FOX）。KPC-KP和NDM-KP的氨基糖苷类耐药基因rmtB检出率分别为96.61%和21.74%。在这项研究中，KPC-KP似乎比NDM-KP对抗生素更耐药，因此针对KPC-KP的可用治疗方案非常有限。对于KPC-KP和NDM-KP，氨曲南-阿维巴坦可能是一种有前景和有价值的选择。
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious challenge for clinical treatment and public health. We found that both KPC-2-producing K. pneumoniae (KPC-KP) and NDM-1-producing K. pneumoniae (NDM-KP) are epidemic in a teaching hospital in Northeast China. The main aim of the present study was to compare antimicrobial susceptibility differences between KPC-KP and NDM-KP and elucidate complex resistant genotypes of the KPC-KP and NDM-KP by PCR and sequencing. Among 82 CRKP isolated between January 2015 and December 2016, 59 isolates were KPC-KP and 23 isolates were NDM-KP. All 59 KPC-KP had no susceptibility to gentamicin, tobramycin, levofloxacin, and ciprofloxacin, had very low susceptibility to amikacin (3.39%) and fosfomycin (8.47%), whereas the susceptibility of NDM-KP to the above antibiotics was 21.74%, 13.04%, 17.39%, 17.39%, 69.57%, and 73.91%, respectively. Although the susceptibility of NDM-KP to tigecycline (95.65%) and polymyxin B (73.91%) was higher than that of KPC-KP (84.75% and 69.49%, respectively), the difference was not statistically significant. The MIC90 of KPC-KP and NDM-KP to aztreonam-avibactam were 4 and 2 mu g/mL, respectively. All 82 CRKP carried 2 or 3 Extended Spectrum Beta-Lactamase (ESBL) genes, and 79/82 CRKP carried the AmpC gene bla(FOX). The aminoglycoside resistance gene rmtB was detected in 96.61% of KPC-KP and in 21.74% of NDM-KP. It seems that KPC-KP was more resistant to antibiotics than NDM-KP in this study, so that available therapeutic regimens against KPC-KP are very limited. Aztreonam-avibactam may be a promising and valuable option against both KPC-KP and NDM-KP.