Increasing Prevalence of Escherichia coli and Klebsiella pneumoniae Producing CTX-M-Type Extended-Spectrum Beta-Lactamase, Carbapenemase, and NDM-1 in Patients from a Rural Community with Community Acquired Infections: A 3-Year Study.
Increasing Prevalence of Escherichia coli and Klebsiella pneumoniae Producing CTX-M-Type Extended-Spectrum Beta-Lactamase, Carbapenemase, and NDM-1 in Patients from a Rural Community with Community Acquired Infections: A 3-Year Study.
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DOI：
10.4103/ijabmr.ijabmr_360_19
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发表时间：
2020-07
影响因子：
1.1
通讯作者：
Chattopadhya D
中科院分区：
文献类型：
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作者：
Devi LS;Broor S;Rautela RS;Grover SS;Chakravarti A;Chattopadhya D
据报道，由于大肠杆菌和肺炎克雷伯菌产生广谱β-内酰胺酶（ESBL），特别是头孢噻肟-慕尼黑（CTX-M）型、碳青霉烯酶和新德里金属-β-内酰胺酶（NDM），社区获得性感染（CAIs）的流行率不断上升，在全球范围内构成了严重的公共卫生威胁，使革兰氏阴性细菌感染的治疗策略复杂化。虽然这方面的大多数报告都是基于来自城市社区的住院患者，但缺乏农村社区的cai数据。采用双盘协同试验对3年内从CAIs患者中分离的1275株大肠杆菌和肺炎克雷伯菌进行ESBL检测；碳青霉烯酶改良霍奇试验；金属β-内酰胺酶（MBL）测定；和blaTEM、blaSHV、blaCTX-M、blaNDM基因聚合酶链反应。在研究期间分离的1275株大肠杆菌和肺炎克雷伯菌中，分别检出773株（60.6%）、102株（8%）和28株（2.2%）产生ESBL、碳青霉烯酶和MBL。773株ESBL产生物中，635株（82.1%）携带blaCTX-M基因，102株碳青霉烯酶产生物中，12株（11.8%）携带blaNDM基因。12株ndm阳性分离株基因测序均显示blaNDM-1基因。esbll阳性分离株的抗生素耐药模式显示对非头孢菌素类抗生素（如阿莫克拉夫、复方新诺明、氯霉素和氟喹诺酮类药物）具有高度的共耐药。本研究显示，包括CTX-M品种、大肠杆菌和肺炎克雷伯菌分离株产生碳青霉烯酶在内的ESBL患病率不断上升，NDM-1在印度北部农村社区患者中传播。
Increasing prevalence of community-acquired infections (CAIs) due to Escherichia coli and Klebsiella pneumoniae producing extended-spectrum beta-lactamase (ESBL), especially the Cefotaxime-Munich (CTX-M) type, carbapenemase, and New Delhi metallo-β-lactamase (NDM), has been reported globally posing a serious public health threat that has complicated treatment strategies for Gram-negative bacterial infections. While most of the reports in this regard are based on hospitalized patients from the urban community, there is a paucity of data in a rural community presenting with CAIs. A total of 1275 strains of E. coli and K. pneumoniae isolated over a period of 3 years from patients with CAIs were subjected to the detection of ESBL by double-disc synergy test; carbapenemase by modified Hodge test; metallo-β-lactamase by MIC test strip metallo-β-lactamase (MBL); and blaTEM, blaSHV, blaCTX-M, and blaNDM genes by polymerase chain reaction. Among 1275 E. coli and K. pneumoniae isolated during the study period, 773 (60.6%), 102 (8%), and 28 (2.2%) isolates were detected as ESBL, carbapenemase and MBL producers, respectively. Of the 773 ESBL producers, 635 (82.1%) were found to harbor blaCTX-M genes, and of the 102 carbapenemase producers, 12 (11.8%) were found to harbor blaNDM genes. Gene sequencing of all the 12 NDM-positive isolates revealed blaNDM-1 genes. Antibiotic resistance pattern of the ESBL-positive isolates revealed a high degree of co-resistance to noncephalosporin antibiotics such as amoxyclav, co-trimoxazole, chloramphenicol, and fluoroquinolones. The present study showed the increasing the prevalence of ESBL including CTX-M variety, carbapenemase production by E. coli and K. pneumoniae isolates, and spread of NDM-1 in the patients from the rural community of North India.