Carbapenemases-producing Klebsiella pneumoniae in hospitals of two regions of Southern Italy
Carbapenemases-producing Klebsiella pneumoniae in hospitals of two regions of Southern Italy
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DOI：
10.1111/apm.12666
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发表时间：
2017-05-01
期刊：
影响因子：
2.8
通讯作者：
Monno, Rosa
中科院分区：
文献类型：
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作者：
Calia, Carla;Pazzani, Carlo;Monno, Rosa
据报道，在世界其他地方，耐碳青霉烯肺炎克雷伯菌感染的频率越来越高，这是一个令人担忧的全球卫生现象。在意大利，关于产碳青霉烯酶肠杆菌科和肺炎克雷伯菌的扩散和类型有热点数据，特别是来自意大利南部阿普利亚和巴西利卡塔两个地区的数据很少。本研究旨在通过表型和基因型方法对分离自意大利南部阿普利亚和巴西利卡塔几家医院的碳青霉烯耐药肺炎克雷伯菌进行鉴定。同时进行抗生素敏感性评价。采用脉冲场凝胶电泳（PFGE）方法对产碳青霉烯酶肺炎克雷伯菌进行亲缘性鉴定。在150株肺炎克雷伯菌碳青霉烯酶产生菌中，KPC-3基因型最多（95%），其次是VIM-1基因型（5%）。未发现其他基因型，也未发现两种碳青霉烯酶基因共存在。观察到表型和基因型试验结果完全一致。所有菌株均对包括碳青霉烯类在内的β -内酰胺类抗生素耐药，在所检测的抗生素中，只有四环素和庆大霉素的耐药比例较低（分别为18%和15%）。17.3%的菌株对粘菌素耐药。碳青霉烯酶阳性菌株的PFGE分析显示，在鉴定的5个（A ~ E）主要组中，1组(B)最流行，几乎在所有医院都有检测到，而其他组则是随机分布的。检测到3种不同的序列类型（ST 307、ST 258和ST 512），其中大部分分离株属于ST 512。我们的结果表明肺炎克雷伯菌KPC-3在考虑的地区广泛扩散，表型和基因型测试之间具有良好的一致性。庆大霉素和粘菌素对这些菌株有良好的抑制作用。
Carbapenem-resistant Klebsiella pneumoniae infections are reported with increasing frequency elsewhere in the world, representing a worrying phenomenon for global health. In Italy, there are hotspot data on the diffusion and type of carbapenemase-producing Enterobacteriaceae and K. pneumoniae in particular, with very few data coming from Apulia and Basilicata, two regions of Southern Italy. This study was aimed at characterizing by phenotypic and genotypic methods carbapenem-resistant K. pneumoniae isolated from several Hospitals of Apulia and Basilicata, Southern Italy. Antibiotic susceptibility was also evaluated. The relatedness of carbapenemase-producing K. pneumoniae strains was established by pulsed-field gel electrophoresis (PFGE). Among the 150 K. pneumoniae carbapenemase producers, KPC-3 genotype was the most predominant (95%), followed by VIM-1 (5%). No other genotypes were found and no co-presence of two carbapenemase genes was found. A full concordance between results obtained by both the phenotypic and the genotypic tests was observed. All strains were resistant to beta-lactam antibiotics including carbapenems, and among antibiotics tested, only tetracycline and gentamycin showed low percentage of resistance (18% and 15%, respectively). Resistance to colistin was detected in 17.3% of strains studied. The analysis of PFGE profiles of the carbapenemases-positive strains shows that one group (B) of the five (A to E) main groups identified was the most prevalent and detected in almost all the hospitals considered, while the other groups were randomly distributed. Three different sequence types (ST 307, ST 258, and ST 512) were detected with the majority of isolates belonging to the ST 512. Our results demonstrated the wide diffusion of K. pneumoniae KPC-3 in the area considered, the good concordance between phenotypic and genotypic tests. Gentamicin and colistin had a good activity against these strains.