Epidemiology of Carbapenem Resistance Determinants Identified in Meropenem-Nonsusceptible Enterobacterales Collected as Part of a Global Surveillance Program, 2012 to 2017
Epidemiology of Carbapenem Resistance Determinants Identified in Meropenem-Nonsusceptible Enterobacterales Collected as Part of a Global Surveillance Program, 2012 to 2017
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DOI：
10.1128/aac.02000-20
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发表时间：
2021-07-01
影响因子：
4.9
通讯作者：
Sahm, Daniel F.
中科院分区：
文献类型：
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作者：
Kazmierczak, Krystyna M.;Karlowsky, James A.;Sahm, Daniel F.
为了估计耐碳青霉烯类肠杆菌(CRE)的发病率，从2012年到2017年，对全球收集的81781株监测分离的肠杆菌属进行了研究，这些菌株来自五个地理区域的39个国家的患者。总体而言，3.3%的分离株对美罗培南不敏感(MIC>；=2微克/毫升)，按地区划分，从1.4%(北美)到5.3%(拉丁美洲)不等。对美罗培南不敏感的菌株以肺炎克雷伯菌最多(76.7%)。对美罗培南不敏感的肠杆菌主要携带KPC型碳青霉烯酶(47.4%)、金属β-内酰胺酶(20.6%)或OXA-48型β-内酰胺酶(19.0%)。检测到43个碳青霉烯酶序列变异(8个KPC-型、4个GES-型、7个OXA-48类、5个NDM-型、7个IMP-型和12个VIM-型)，其中KPC-2、KPC-3、OXA-48、NDM-1、IMP-4和VIM-1是每种碳青霉烯酶最常见的变异体。导致美罗培南不敏感的耐药机制因地区而异。在所有碳青霉烯酶阳性的菌株中，共有67.3%的菌株至少携带一种额外的质粒介导或染色体编码的超广谱β-内酰胺酶、AmpC酶或碳青霉烯酶。美罗培南不敏感肠杆菌的总比例从2012年至2014年的2.7%上升到2015年至2017年的3.8%。这一增长可以归因于所观察到的碳青霉烯酶阳性菌株比例的增加，最明显的是在亚洲/南太平洋、欧洲和拉丁美洲携带NDM型MBLS的菌株；在欧洲、中东/非洲和亚太地区携带OXA-48类碳青霉烯酶的菌株；在欧洲的VIM型MBLS；以及在拉丁美洲的KPC型碳青霉烯酶。持续的CRE监测与全球抗菌素管理战略、灵敏的临床实验室检测方法以及遵守感染控制做法相结合，才能阻止CRE的传播。
To estimate the incidence of carbapenem-resistant Enterobacterales (CRE), a global collection of 81,781 surveillance isolates of Enterobacterales collected from patients in 39 countries in five geographic regions from 2012 to 2017 was studied. Overall, 3.3% of isolates were meropenem-nonsusceptible (MIC >= 2 mu g/ml), ranging from 1.4% (North America) to 5.3% (Latin America) of isolates by region. Klebsiella pneumoniae accounted for the largest number of meropenem-nonsusceptible isolates (76.7%). The majority of meropenem-nonsusceptible Enterobacterales carried KPC-type carbapenemases (47.4%), metallo-beta-lactamases (MBLs; 20.6%) or OXA-48-like beta-lactamases (19.0%). Forty- three carbapenemase sequence variants (8 KPC-type, 4 GES-type, 7 OXA-48-like, 5 NDM-type, 7 IMP-type, and 12 VIM-type) were detected, with KPC-2, KPC-3, OXA- 48, NDM-1, IMP-4, and VIM-1 identified as the most common variants of each carbapenemase type. The resistance mechanisms responsible for meropenem-nonsusceptibility varied by region. A total of 67.3% of all carbapenemase-positive isolates identified carried at least one additional plasmidmediated or intrinsic chromosomally encoded extended-spectrum beta-lactamase, AmpC beta-lactamase, or carbapenemase. The overall percentage of meropenem-nonsusceptible Enterobacterales increased from 2.7% in 2012 to 2014 to 3.8% in 2015 to 2017. This increase could be attributed to the increasing proportion of carbapenemase-positive isolates that was observed, most notably among isolates carrying NDM-type MBLs in Asia/South Pacific, Europe, and Latin America; OXA-48-like carbapenemases in Europe, Middle East/Africa, and Asia/South Pacific; VIM-type MBLs in Europe; and KPC-type carbapenemases in Latin America. Ongoing CRE surveillance combined with a global antimicrobial stewardship strategy, sensitive clinical laboratory detection methods, and adherence to infection control practices will be needed to interrupt the spread of CRE.