Temporal evolution of polymyxin B-resistant Klebsiella pneumoniae clones recovered from blood cultures in a teaching hospital during a 7-year period
Temporal evolution of polymyxin B-resistant Klebsiella pneumoniae clones recovered from blood cultures in a teaching hospital during a 7-year period
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DOI：
10.1016/j.ijantimicag.2017.08.031
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发表时间：
2018-03-01
影响因子：
10.8
通讯作者：
Gales, Ana Cristina
中科院分区：
文献类型：
--
作者：
Braun, Graziela;Cayo, Rodrigo;Gales, Ana Cristina
多粘菌素已成为治疗全世界产KPC-2肺炎克雷伯菌引起的严重感染的最后手段之一。然而，多粘菌素消费的增加有利于对这些化合物的耐药性的出现。在这项研究中，我们观察到多粘菌素B的耐药率从0增加到30.6%之间的224 K。2009年至2015年期间从血培养中回收的肺炎分离株。只有庆大霉素、替加环素和磷霉素对多粘菌素B耐药的K.肺炎（PMB-R-KPN）分离株，分为广泛耐药（XDR; 83.3%）、多药耐药（MDR; 13.9%）或泛耐药（2.8%）。大多数PMB-R-KPN克隆属于CC 258（ST 11、ST 258、ST 340和ST 437）。2014年引入了携带不同抗性决定簇（bla（SHV-11）、bla（TEM-1）、bla（CTX-M-15）、bla（CTX-M-14）、bla（KPC-2）和rmtB-1）的C7/ST 258 XDR克隆。36株PMB-R-KPN分离株中有12株表现出mgrB的破坏。未发现mcr-1阳性分离株。快速检测PMB-R-KPN分离株并实施有效的感染控制措施对于避免高风险PMB-R-KPN克隆的传播至关重要。(C)2017 Elsevier B. V.和国际化疗学会。All rights reserved.
The polymyxins have become one of the last resorts to treat serious infections caused by KPC-2-producing Klebsiella pneumoniae worldwide. However, the increase of polymyxin consumption has favored the emergence of resistance to these compounds. In this study, we observed an increase in polymyxin B resistance rates from 0 to 30.6% among 224 K. pneumoniae isolates recovered from blood cultures between 2009 and 2015. Only gentamicin, tigecycline and fosfomycin remained active against the polymyxin B-resistant K. pneumoniae (PMB-R-KPN) isolates, which were classified as extensively drug-resistant (XDR; 83.3%), multidrug-resistant (MDR; 13.9%), or pan-drug resistant (2.8%). Most PMB-R-KPN clones belonged to CC258 (ST11, ST258, ST340, and ST437). A C7/ST258 XDR clone carrying distinct resistance determinants (bla(SHV-11), bla(TEM-1), bla(CTX-M-15), bla(CTX-M-14), bla(KPC-2), and rmtB-1) was introduced in 2014. Twelve of 36 PMB-R-KPN isolates showed disruption of mgrB. No mcr-1-positive isolate was found. The rapid detection of PMB-R-KPN isolates allied to implementation of effective infection control measures are of crucial importance to avoid the dissemination of high-risk PMB-R-KPN clones. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.