Clonal Spread of Colistin-Resistant Klebsiella pneumoniae Coproducing KPC and VIM Carbapenemases in Neonates at a Tunisian University Hospital
Clonal Spread of Colistin-Resistant Klebsiella pneumoniae Coproducing KPC and VIM Carbapenemases in Neonates at a Tunisian University Hospital
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DOI：
10.1089/mdr.2016.0175
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发表时间：
2017-06-01
影响因子：
2.6
通讯作者：
Fendri, Chedlia
中科院分区：
文献类型：
--
作者：
Battikh, Hajer;Harchay, Chiraz;Fendri, Chedlia
在这项研究中，我们试图报告第一个克隆传播的粘菌素耐药肺炎克雷伯菌，同时产生KPC和Vim碳青霉烯酶在新生儿病房的Rabta教学医院突尼斯（突尼斯）。本回顾性研究于2014年1月1日至2014年12月31日在突尼斯Rabta大学医院的微生物实验室进行。21株非复制型粘菌素耐药K.从19名新生儿病房住院患者和2名成人重症监护室（ICU）患者中分离出肺炎。大多数菌株分离自侵袭性标本。对blaKPC和blaVIM基因进行脉冲场凝胶电泳（PFGE）、PCR分析和核苷酸测序。92%的病例报告死亡。所有菌株均对粘菌素耐药（最低抑菌浓度[MIC]范围为8 - 12 mg/L）。亚胺培南对K. 13株肺炎克雷伯氏菌的浓度范围为3 ~ 256 mg/L，表现为中间或耐药。19株耐药菌株对厄他培南的MIC均大于32 mg/L。所有菌株对替加环素和氯霉素敏感。PFGE分析显示两个克隆（I和II）。在21株耐粘菌素、耐碳青霉烯类抗生素的克雷伯氏菌中，pneumoniae菌株属于克隆I。只有一个菌株与克隆II相关。PCR分析和核苷酸序列测定结果表明，20株分离株均属于克隆I，同时产生blaKPC和blaVIM基因。在ICU中分离的单一菌株（克隆II）不产生KPC和Vim碳青霉烯酶。所有菌株均不产生OXA-48。
In this study, we have attempted to report the first clonal spread of colistin-resistant Klebsiella pneumoniae coproducing KPC and VIM carbapenemases in the neonatal unit of Rabta Teaching Hospital of Tunis (Tunisia). This retrospective study was performed from January 1, 2014 to December 31, 2014 in the Microbiology Laboratory at the Rabta University Hospital of Tunis. Twenty-one nonreplicate colistin-resistant K. pneumoniae were isolated from 19 patients hospitalized in the neonatal unit and 2 patients in the adult intensive care unit (ICU). Most of the strains were isolated from invasive specimens. Pulsed-field gel electrophoresis (PFGE) and PCR analysis and nucleotide sequencing of the blaKPC and blaVIM genes were performed. Mortality was reported in 92% of cases. All the strains were resistant to colistin (minimum inhibitory concentration [MICs] ranged from 8 to 12 mg/L). The MICs for imipenem of K. pneumoniae isolates ranged from 3 to 256 mg/L for 13 strains that were characterized as intermediate or resistant. The MICs for ertapenem were higher than 32 mg/L for the 19 resistant strains. All the isolates were sensitive to tigecycline and chloramphenicol. PFGE analysis revealed two clones (I and II). Twenty of the 21 colistin-resistant, carbapenem-resistant K. pneumoniae isolates belonged to clone I. Only one strain was related to clone II. PCR analysis and nucleotide sequencing revealed that the 20 isolates belonged to clone I, coproduced the blaKPC and blaVIM genes. A single strain (clone II), which was isolated in the ICU, did not produce KPC and VIM carbapenemases. All strains did not produce OXA-48.