Klebsiella pneumoniae: Development of Carbapenem Resistance due to Acquisition of bla NDM-1 During Antimicrobial Therapy in Twin Infants with Pneumonia.
Klebsiella pneumoniae: Development of Carbapenem Resistance due to Acquisition of bla NDM-1 During Antimicrobial Therapy in Twin Infants with Pneumonia.
复制标题
肺炎克雷伯菌：肺炎双生婴儿在抗菌治疗期间由于获得 bla NDM-1 而产生碳青霉烯类耐药性。
DOI：
10.3389/fmicb.2015.01399
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发表时间：
2015
影响因子：
5.2
通讯作者：
Hu F
中科院分区：
文献类型：
--
作者：
Zhu J;Ding B;Xu X;Zhu D;Yang F;Zhang H;Hu F
目的：明确肺炎克雷伯菌体内产生碳青霉烯类耐药性的机制。方法：从患有肺炎的双胞胎婴儿中获得七株肺炎克雷伯菌的连续分离株。采用琼脂稀释法进行药敏试验。使用表型方法初步筛选包括KPC和MβL在内的碳青霉烯酶，并通过聚合酶链反应和扩增子测序鉴定碳青霉烯酶编码基因。通过 S1 脉冲场凝胶电泳 (PFGE) 估计所有临床分离株的质粒和耐药分离株的接合子。通过XbaI消化基因组DNA的PFGE进行分子分型并进行多位点序列分型。结果：对于老兄，第一和第三分离株对美罗培南敏感，而第二和第四分离株对美罗培南耐药（MIC 16 mg/L）。来自弟弟的第一个和第二个分离株对美罗培南敏感，而第三个分离株对美罗培南具有耐药性。所有耐药菌株均产生 NDM-1 金属-β-内酰胺酶。 XbaI 消化 DNA 的 PFGE 显示几乎相同的模式，所有 7 个分离株的相似性指数均超过 92%。所有分离株具有相同的序列类型，命名为序列类型37（ST37）。结论：据我们所知，这是第一个有记录的在用美罗培南治疗肺炎期间肺炎克雷伯菌中NDM-1金属-β-内酰胺酶介导的体内产生碳青霉烯耐药性的病例。
Objectives: To identify the mechanism of in vivo development of carbapenem resistance in Klebsiella pneumoniae.Methods: Seven sequential isolates of K. pneumoniae were obtained from twin infants with pneumonia. Antimicrobial susceptibility testing was performed by agar dilution method. Carbapenemases including KPC and MβL were initially screened using phenotypic methods, and carbapenemase-encoding genes were identified by polymerase chain reaction and amplicon sequencing. Plasmids of all clinical isolates and the conjugants of resistant isolates were estimated by S1 pulsed-field gel electrophoresis (PFGE). Molecular typing were conducted by PFGE of XbaI-digested genomic DNA and multilocus sequence typing.Results: For old brother, the first and third isolates were susceptible to meropenem, whereas the second and fourth isolates were resistant (MICs 16 mg/L). The first and second isolates from the young brother were susceptible to meropenem whereas the third isolate was resistant. All the resistant isolates produced NDM-1 metallo-β-lactamase. PFGE of XbaI-digested DNA revealed almost identical patterns with similarity indices of above 92% for all the seven isolates. All the isolates had the same sequence type named sequence type 37 (ST37).Conclusion: To our knowledge, this is the first documented case of development of carbapenem resistance in vivo mediated by NDM-1 metallo-β-lactamase in K. pneumoniae during treatment of pneumonia with meropenem.