NDM-producing Enterobacteriaceae in Poland, 2012-14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases
NDM-producing Enterobacteriaceae in Poland, 2012-14: inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases
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DOI：
10.1093/jac/dkv282
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发表时间：
2016-01-01
影响因子：
5.2
通讯作者：
Gniadkowski, M.
中科院分区：
文献类型：
--
作者：
Baraniak, A.;Izdebski, R.;Gniadkowski, M.
目的：研究2012-14年度波兰新德里地区产金属β-内酰胺酶(NDM)肠杆菌科细菌的特征。方法：采用PFGE和MLST对典型菌株进行分型。对NDM等β-内酰胺酶基因进行扩增和测序。对含有bla(Ndm)基因的质粒进行核酸酶S1+杂交分析、转移试验和基于PCR的复制子分型。结果：在2012-14年确诊的374例NDM阳性肠杆菌感染/定植病例中，40家医院、10家门诊和1家疗养院的370例病例与肺炎克雷伯菌暴发有关，中心在波兹纳阿和华沙。暴发的肺炎克雷伯菌ST11株与2013年来自捷克共和国的一株分离株相似。与捷克株一样，许多分离株都有两个携带BLA(NDM-1)的大小可变的IncFII和INCR型质粒，共享一个含有BLA(NDM-1)的片段。早期分离株也产生由INCR型质粒共编码的CTX-M-15，后来通过广泛的质粒重排而分化。2013年报告了另外四例非糖尿病病例，其中三例与来自黑山、印度或阿富汗的移民有关。印度大肠杆菌ST448 NDM-5分离物与最近来自西班牙的一株分离物相似，包括之前在波兰和法国(分别起源于刚果和印度)的大肠杆菌菌株中观察到的BLA(NDM)遗传背景。阿富汗奇异变形杆菌是该物种中第二个具有染色体blA(NDM-1)位置的分离物。结论：在波兰观察到了非流行国家最大规模的NDM暴发，这是一个令人震惊的耐药流行病学现象。
Objectives: The objective of this study was to characterize New Delhi metallo-beta-lactamase (NDM)-producing Enterobacteriaceae isolates reported in Poland in 2012-14.Methods: Representative isolates were typed by PFGE and MLST. NDM and other beta-lactamase genes were amplified and sequenced. Plasmids with bla(NDM) genes were analysed by nuclease S1 plus hybridization profiling, by transfer assays and by PCR-based replicon typing. The bla(NDM) genetic context was studied by PCR mapping assays.Results: Of 374 cases of infection/colonization with NDM-positive Enterobacteriaceae identified in 2012-14, 370 cases in 40 hospitals, 10 outpatient clinics and 1 nursing home were associated with a Klebsiella pneumoniae outbreak with epicentres in PoznaA" and Warsaw. The outbreak strain of K. pneumoniae ST11 was similar to an isolate from the Czech Republic from 2013. Like the Czech strain, many of the isolates had two bla(NDM-1)-carrying IncFII- and IncR-type plasmids of variable size, sharing a bla(NDM-1)-containing segment. The early isolates also produced CTX-M-15 co-encoded by the IncR-type plasmids, and differentiated later by extensive plasmid rearrangements. Four other NDM cases were reported in 2013, three being associated with arrivals from Montenegro, India or Afghanistan. The Indian Escherichia coli ST448 NDM-5 isolate revealed similarity to a recent isolate from Spain, including the bla(NDM) genetic context observed previously in E. coli strains in Poland and France (of Congolese and Indian origins, respectively). The Afghani Proteus mirabilis was the second isolate of this species with a chromosomal bla(NDM-1) location.Conclusions: The largest NDM outbreak in a non-endemic country has been observed, being an alarming phenomenon in resistance epidemiology in Poland.