Dramatic rise in the proportion of ESBL-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates identified in Canadian hospital laboratories from 2007 to 2016
Dramatic rise in the proportion of ESBL-producing Escherichia coli and Klebsiella pneumoniae among clinical isolates identified in Canadian hospital laboratories from 2007 to 2016
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DOI：
10.1093/jac/dkz289
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发表时间：
2019-08-01
影响因子：
5.2
通讯作者：
Pelletier, R.
中科院分区：
文献类型：
--
作者：
Denisuik, Andrew J.;Karlowsky, James A.;Pelletier, R.
目的：评估2007年1月至2016年12月在加拿大医院接受护理的患者感染产ESBL大肠埃希菌和肺炎克雷伯菌的患病率、抗菌药物敏感性和分子特征。coli（n=8387）和K.使用CLSI参考肉汤微量稀释法对提交给CANWARD（一项正在进行的加拿大国家监测研究）的2623例肺炎链球菌（n=2623）进行检测，以确定其对15种抗菌药物的敏感性。产ESBL E.埃希菌和pneumoniae和推定的产AmpC酶E.大肠杆菌进行PCR检测和DNA测序，以确定耐药基因。用Cochran-Armitage趋势检验分析ESBL和AmpC基因的年检出率。产ESBL的大肠埃希菌从2007年的3.4%上升到2016年的11.1%（P < 0.01），产ESBL的大肠埃希菌占大肠埃希菌总数的95%。大肠埃希菌对阿米卡星、粘菌素、厄他培南、美罗培南和替加环素敏感。K.产ESBL肺炎克雷伯氏菌从2007年的1.3%上升到2016年的9.7%（P < 0.05）。肺炎克雷伯菌对丁胺卡那霉素和美罗培南敏感。CTX-M-15是两株产ESBL大肠杆菌的优势基因型。大肠埃希菌（64.2%）和产ESBL的K.肺炎（51.0%）。E. 2007 - 2016年，产AmpC酶大肠埃希菌的检出率[年平均1.9%（范围0.3%-3.1%）]没有变化（P>0.5）。埃希菌和在研究期间，加拿大产AmpC的E.大肠埃希菌保持低水平稳定。
Objectives: To assess the prevalence, antimicrobial susceptibilities and molecular characteristics of ESBL-producing Escherichia coli and Klebsiella pneumoniae infecting patients receiving care in Canadian hospitals from January 2007 to December 2016.Methods: Clinical isolates of E. coli (n=8387) and K. pneumoniae (n=2623) submitted to CANWARD, an ongoing Canadian national surveillance study, were tested using the CLSI reference broth microdilution method to determine their susceptibility to 15 antimicrobial agents. ESBL-producing E. coli and K. pneumoniae confirmed by the CLSI phenotypic method and putative AmpC-producing E. coli underwent PCR testing and DNA sequencing to identify resistance genes. Annual proportions of isolates harbouring ESBL and AmpC genes were assessed by the Cochran-Armitage test of trend.Results: The annual proportion of isolates of E. coli that were ESBL producing increased from 3.4% in 2007 to 11.1% in 2016 (P95% of ESBL-producing E. coli were susceptible to amikacin, colistin, ertapenem, meropenem and tigecycline. The proportion of isolates of K. pneumoniae that were ESBL producing increased from 1.3% in 2007 to 9.7% in 2016 (P95% of ESBL-producing K. pneumoniae were susceptible to amikacin and meropenem. CTX-M-15 was the predominant genotype in both ESBL-producing E. coli (64.2% of isolates) and ESBL-producing K. pneumoniae (51.0%). The annual proportion of isolates of E. coli that were AmpC producing [annual proportion mean 1.9% (range 0.3%-3.1%)] was unchanged from 2007 to 2016 (P>0.5).Conclusions: The prevalence of both ESBL-producing E. coli and K. pneumoniae increased significantly in Canada during the study period while the prevalence of AmpC-producing E. coli remained low and stable.