Extended-spectrum β-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings
Extended-spectrum β-lactamase-producing Gram-negative bacteria causing neonatal sepsis in India in rural and urban settings
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DOI：
10.1099/jmm.0.027375-0
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发表时间：
2011-04-01
影响因子：
3
通讯作者：
Panigrahi, Pinaki
中科院分区：
文献类型：
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作者：
Chandel, Dinesh S.;Johnson, Judith A.;Panigrahi, Pinaki
产广谱β -内酰胺酶（ESBL）的革兰氏阴性杆菌（GNB）在全世界所有年龄组中引起越来越多的临床关注。虽然败血症仍然是社区中印度新生儿发病率和死亡率的主要原因，但缺乏对该人群微生物特性的鉴定。这项基于人群的研究在印度的四个参与中心招募了1738名诊断为临床败血症的婴儿。各试验点进行Bactec血培养，API检测鉴定菌种，-70℃保存。252株GNB分离株中，155株（克雷伯氏菌113种、大肠杆菌21种、其他21种）进行药敏试验、ESBL表型分析和PFGE检测ESBL克隆亲缘性。结果表明，克雷伯菌和大肠杆菌是印度新生儿败血症最常见的GNB病因，在社区和医院环境中，超过三分之一是ESBL生产者。产esbl的菌株对氨基糖苷类和环丙沙星经常出现共耐药，但对亚胺培南仍敏感。PFGE分析显示，在产生esbl的分离株中存在广泛的遗传多样性，显示出多个谱（总共23个）。在所有产生esbl的分离株中，超过40%形成了三个脉冲场谱（PFPI-III），其中pfpi - ii是最大的集群（占所有产生esbl的分离株的20%），共享来自两个遥远地点的菌株。在两个地理位置遥远的中心发现一个共同的克隆表明，即使没有任何明显的暴发，也可能存在毒性增强的优势克隆。在没有住院史或抗生素使用史的社区婴儿中存在产esbl菌株，要求提高警惕并进一步研究这些微生物的生态学。
Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli (GNB) are of increasing clinical concern in all age groups worldwide. Whilst sepsis continues to be the leading cause of morbidity and mortality in Indian neonates in the community, identification of microbiological attributes in this population is lacking. This population-based study enrolled 1738 infants with a diagnosis of clinical sepsis at four participating centres in India. Each study site conducted Bactec blood culture, identified bacterial species by API test and stored isolates at -70 degrees C. From 252 GNB isolates, 155 (113 Klebsiella species, 21 Escherichia coli and 21 other) were subjected to drug susceptibility testing, ESBL phenotyping and testing for clonal relatedness of ESBL strains by PFGE. The results demonstrated that Klebsiella species and E. coli are the most common GNB causes of neonatal sepsis in India, and over one-third are ESBL producers in both community and hospital settings. ESBL-producing strains exhibited frequent co-resistance to aminoglycosides and ciprofloxacin, but remained susceptible to imipenem. PFGE analysis revealed extensive genetic diversity within the ESBL-producing isolates, showing multiple profiles (total of 23). Over 40% of all ESBL-producing isolates formed three pulsed-field profiles (PFPI-III), with PFP-II being the largest cluster (> 20% of all ESBL-producing isolates), sharing strains from two distant locations. Identification of a common clone at two geographically distant centres indicated that predominant clones with increased virulence may exist, even in the absence of any clear outbreak. The presence of ESBL-producing strains in community infants with no prior history of hospitalization or antibiotic use dictates heightened vigilance and further studies on the ecology of these organisms.