The Complex Epidemiology of Carbapenem-Resistant Enterobacter Infections: A Multicenter Descriptive Analysis
The Complex Epidemiology of Carbapenem-Resistant Enterobacter Infections: A Multicenter Descriptive Analysis
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DOI：
10.1017/ice.2015.186
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发表时间：
2015-11-01
影响因子：
4.5
通讯作者：
Marchaim, Dror
中科院分区：
文献类型：
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作者：
Lazarovitch, Tsilia;Amity, Keren;Marchaim, Dror
背景。耐碳青霉烯类肠杆菌科细菌 (CRE) 的流行主要是由于产生 blaKPC 的肺炎克雷伯菌的克隆传播。因此，经过彻底研究的 CRE 队列主要由肺炎克雷伯菌组成。 目的。对碳青霉烯类耐药肠杆菌进行广泛的流行病学分析。 (CREn) 来自两个地方性和地理上不同的中心。方法。 CREn 在以色列中心（Assaf Harofeh 医疗中心，2007 年 1 月至 2012 年 7 月）和美国中心（底特律医疗中心，2008 年 9 月至 2009 年 9 月）进行了调查。通过聚合酶链式反应查询blaKPC基因。使用重复的基因外回文聚合酶链反应和脉冲场凝胶电泳来确定遗传相关性。结果。在这项分析中，纳入了 68 名独特的 CREn 患者。 16 个分离株（24%）来自伤口，33 个分离株（48%）仅代表定植。所有分离株均表现出阳性改良霍奇检验，但只有 93%（29 株中的 27 株）含有 blaKPC。 43 株（63%）来自老年人，5 株（7.4%）来自新生儿。 27 名患者在医院死亡（占感染患者的 40.3%）。肠杆菌菌株由来自 Assaf Harofeh 医疗中心的 4 个独立克隆和来自底特律医疗中心的 4 个不同克隆组成。结论。这项在两个不同的 CRE 流行地区进行的研究中，CREn 具有独特的流行病学特征：(i) 多克隆性，(ii) 新生儿占队列的 7% 以上，(iii) 高定植率（几乎所有病例的一半为定植）。由于肠杆菌属的改良霍奇试验出现假阳性。是常见的，密切监测肠杆菌属中的碳青霉烯类耐药机制（特别是碳青霉烯酶的产生）。很重要。
BACKGROUND. The pandemic of carbapenem-resistant Enterobacteriaceae (CRE) was primarily due to clonal spread of blaKPC producing Klebsiella pneumoniae. Thus, thoroughly studied CRE cohorts have consisted mostly of K. pneumoniae.OBJECTIVE. To conduct an extensive epidemiologic analysis of carbapenem-resistant Enterobacter spp. (CREn) from 2 endemic and geographically distinct centers.METHODS. CREn were investigated at an Israeli center (Assaf Harofeh Medical Center, January 2007 to July 2012) and at a US center (Detroit Medical Center, September 2008 to September 2009). blaKPC genes were queried by polymerase chain reaction. Repetitive extragenic palindromic polymerase chain reaction and pulsed-field gel electrophoresis were used to determine genetic relatedness.RESULTS. In this analysis, 68 unique patients with CREn were enrolled. Sixteen isolates (24%) were from wounds, and 33 (48%) represented colonization only. All isolates exhibited a positive Modified Hodge Test, but only 93% (27 of 29) contained blaKPC. Forty-three isolates (63%) were from elderly adults, and 5 (7.4%) were from neonates. Twenty-seven patients died in hospital (40.3% of infected patients). Enterobacter strains consisted of 4 separate clones from Assaf Harofeh Medical Center and of 4 distinct clones from Detroit Medical Center.CONCLUSIONS. In this study conducted at 2 distinct CRE endemic regions, there were unique epidemiologic features to CREn: (i) polyclonality, (ii) neonates accounting for more than 7% of cohort, and (iii) high rate of colonization (almost one-half of all cases represented colonization). Since false-positive Modified Hodge Tests in Enterobacter spp. are common, close monitoring of carbapenem resistance mechanisms (particularly carbapenemase production) among Enterobacter spp. is important.