Clinical relevance and plasmid dynamics of mcr-1-positive Escherichia coli in China: a multicentre case-control and molecular epidemiological study
Clinical relevance and plasmid dynamics of mcr-1-positive Escherichia coli in China: a multicentre case-control and molecular epidemiological study
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中国 mcr-1 阳性大肠杆菌的临床相关性和质粒动态：多中心病例对照和分子流行病学研究
DOI：
10.1016/s2666-5247(20)30001-x
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发表时间：
2020-05-01
期刊：
影响因子：
38.2
通讯作者：
Yu, Yunsong
中科院分区：
文献类型：
--
作者：
Jiang, Yan;Zhang, Ying;Yu, Yunsong
背景 尽管质粒介导的粘菌素抗性基因 mcr-1 的出现引起了全球关注，但人们对其临床意义和随时间的传播特征知之甚少。我们的目的是研究mcr-1阳性大肠杆菌分离株感染的临床相关性，并研究长期质粒动态。方法我们对mcr-1阳性大肠杆菌感染进行了多中心病例对照研究和分子流行病学调查。收集2008年至2017年中国四家医院的大肠杆菌分离株，通过PCR和桑格测序对mcr-1进行筛查。 mcr-1阳性大肠杆菌感染患者和mcr-1阴性大肠杆菌感染匹配对照以1:4的比例纳入，在回归模型中考虑年龄、性别、生活环境、合并症、使用的抗菌药物和临床样本类型作为潜在危险因素。还观察到 28 天死亡率。对所有 mcr-1 阳性大肠杆菌的基因组进行测序，以探索其遗传背景并绘制 ISApl1 元件图谱。携带 mcr-1 的质粒通过其耐药性和不相容性群体进行表征。研究结果在研究期间从所有医院收集了 29 100 个分离株，其中 300 个（1.03%）为 mcr-1 阳性大肠杆菌。 mcr-1 阳性分离株的总体比例从 2008 年的 0.42%（240 株中的 1 株）显着增加至 1.39%（4748 株中的 66 株；p
Background Although the emergence of the plasmid-mediated colistin resistance gene, mcr-1, caused global concern, little is known about its clinical implications and transmission characteristics over time. We aimed to investigate the clinical relevance of infection with mcr-1-positive Escherichia coli isolates and to investigate long-term plasmid dynamics.Methods We did a multicentre case-control study and molecular epidemiological survey of mcr-1-positive E coli infections. E coli isolates from four hospitals in China in 2008 to 2017 were collected and screened for mcr-1 by PCR and Sanger sequencing. Patients with mcr-1-positive E coli infections and matched controls with mcr-1-negative E coli infections were included in a 1:4 ratio, considering age, sex, living environment, comorbidities, antimicrobials used, and clinical sample type as potential risk factors in a regression model. 28-day mortality was also observed. The genomes of all mcr-1-positive E coli were sequenced to explore their genetic background and map ISApl1 elements. Plasmids carrying mcr-1 were characterised by their resistance profile and incompatibility group.Findings 29 100 isolates were collected across all hospitals and during the study period, 300 (1.03%) of which were mcr-1-positive E coli. The overall proportion of mcr-1-positive isolates significantly increased from 0.42% (1 of 240) in 2008 to 1.39% (66 of 4748; p