War Wound Treatment Complications Due to Transfer of an IncN Plasmid Harboring blaOXA-181 from Morganella morganii to CTX-M-27-Producing Sequence Type 131 Escherichia coli
War Wound Treatment Complications Due to Transfer of an IncN Plasmid Harboring blaOXA-181 from Morganella morganii to CTX-M-27-Producing Sequence Type 131 Escherichia coli
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DOI：
10.1128/aac.04442-14
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发表时间：
2015-06-01
影响因子：
4.9
通讯作者：
Lesho, Emil P.
中科院分区：
文献类型：
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作者：
McGann, Patrick;Snesrud, Erik;Lesho, Emil P.
一名22岁男性在爆炸伤后发生了与嵌入式弹片相关的复发性骶骨脓肿。培养物生长产超广谱β-内酰胺酶（ESBL）、碳青霉烯类敏感性大肠埃希菌。给予厄他培南，但每次抗生素疗程后感染复发。最初的手术干预是不成功的，随后的培养产生了E。大肠杆菌和摩氏摩根菌对碳青霉烯类抗生素不敏感。分离株Carba NP试验阴性，改良Hodge试验结果不明确，实时PCR扩增bla（OXA 48）样基因。所有E.大肠杆菌分离株为序列型131（ST 131），在IncF质粒上携带9个耐药基因（包括bla（CTX-M-27）），通过基因组测序，除碳青霉烯类不敏感分离株的质粒DNA为150 kb外，其余均相同。其中60份由M分享。morganii，代表含有bla（OXA-181）的IncN质粒。in m. morganii中，该基因侧翼为IS3000和ISKpn 19，但在除一株外的所有E.在含有bla（OXA-181）的大肠杆菌分离株中，ISKpn 19的第二个拷贝插入到IS3000附近。据我们所知，这是第一次报告bla（OXA-181）在有毒的ST 131克隆组和携带的混杂IncN家族的质粒。M. morganii具有高MIC的亚胺培南、包括青霉素但不包括超广谱头孢菌素的bla（OXA-181）底物谱以及弱的碳青霉烯酶活性几乎导致bla（OXA-181）的存在被忽略。我们强调了监测所有物种碳青霉烯耐药性的重要性，即使是那些具有内在耐药性的物种，以及先进分子技术在检测细微遗传变化方面的价值。
A 22-year-old male developed a recurrent sacral abscess associated with embedded shrapnel following a blast injury. Cultures grew extended-spectrum beta-lactamase (ESBL)-producing, carbapenem-susceptible Escherichia coli. Ertapenem was administered, but the infection recurred after each course of antibiotics. Initial surgical interventions were unsuccessful, and subsequent cultures yielded E. coli and Morganella morganii, both nonsusceptible to carbapenems. The isolates were Carba NP test negative, gave ambiguous results with the modified Hodge test, and amplified the bla(OXA48)-like gene by real-time PCR. All E. coli isolates were sequence type 131 (ST131), carried nine resistance genes (including bla(CTX-M-27)) on an IncF plasmid, and were identical by genome sequencing, except for 150 kb of plasmid DNA in carbapenem-nonsusceptible isolates only. Sixty kilobases of this was shared by M. morganii and represented an IncN plasmid harboring bla(OXA-181). In M. morganii, the gene was flanked by IS3000 and ISKpn19, but in all but one of the E. coli isolates containing bla(OXA-181), a second copy of ISKpn19 had inserted adjacent to IS3000. To the best of our knowledge, this is the first report of bla(OXA-181) in the virulent ST131 clonal group and carried by the promiscuous IncN family of plasmids. The tendency of M. morganii to have high MICs of imipenem, a bla(OXA-181) substrate profile that includes penicillins but not extended-spectrum cephalosporins, and weak carbapenemase activity almost resulted in the presence of bla(OXA-181) being overlooked. We highlight the importance of surveillance for carbapenem resistance in all species, even those with intrinsic resistances, and the value of advanced molecular techniques in detecting subtle genetic changes.