Epidemiological typing of klebsiellae with extended-spectrum β-lactamases from European intensive care units
Epidemiological typing of klebsiellae with extended-spectrum β-lactamases from European intensive care units
复制标题
DOI：
10.1093/jac/41.5.527
复制
发表时间：
1998-05-01
影响因子：
5.2
通讯作者：
Livermore, DM
中科院分区：
文献类型：
--
作者：
Yuan, MF;Aucken, H;Livermore, DM
广谱β -内酰胺酶（ESBLs）日益成为对氧亚胺-氨基噻唑类头孢菌素产生耐药性的原因，特别是在南欧和西欧35个重症监护病房（icu）的克雷伯菌中。本研究考察了这种分布在多大程度上反映了流行病菌株的传播，而不是ESBL基因在不相关菌株中的分布。所有220个ESBL生产者进行了荚膜血清分型和脉冲场凝胶DNA电泳（PFGE）。在三次或三次以上分离的菌株中对β -内酰胺酶进行分型，重点是SHV酶，因为它们比TEM变体更常见。血清分型和PFGE分型确定了85种不同的菌株，来自35个参与中心中的23个。在提供5个或更多ESBL生产者的14个中心中，所有中心都提供了17-21个产生ESBL的分离株的不同菌株。然而，流行菌株（定义为由三个或更多分离株代表的菌株）占收集的大多数（61%）。52株具有SHV-4 β -内酰胺酶的相同血清型K25（偶尔为囊状）菌株在法国的两家医院和比利时的一家医院被回收。法国的其他人也发现了这种菌株，并且已经变得特别普遍。在两个独立的葡萄牙中心发现了另一种菌株，许多个别医院有一种或多种流行菌株，以及分散的各种ESBL生产商。菌株间抗生素谱和质粒谱存在较大差异，菌株内β -内酰胺酶类型存在一定差异。这些数据意味着一种不稳定的情况，阻力决定因素正在获得、修改或失去。ESBL生产者的地方性令人不安，因为它通过阻止菌株传播限制了控制的潜力，而菌株内部的多样性令人不安，因为它使抗生素政策的设计复杂化，即使在“单一菌株”暴发期间。
Extended-spectrum beta-lactamases (ESBLs) are an increasing cause of resistance to oxyimino-aminothiazolyl cephalosporins, especially in klebsiellae from 35 intensive care units (ICUs) in southern and western Europe. The present study examined the extent to which this distribution reflected epidemic strain spread, as against the distribution of ESBL genes into unrelated strains. All 220 ESBL producers were subjected to capsular serotyping and pulsed-field gel DNA electrophoresis (PFGE). beta-Lactamases were typed for strains isolated on three or more occasions, with the emphasis on SHV enzymes, as these were commoner than TEM variant. Serotyping and PFGE typing defined 85 distinct strains, from 23 of the 35 participating centres. Of 14 centres that contributed five or more ESBL producers, all sent different strains in contributions of 17-21 ESBL-producing isolates. Nevertheless, epidemic strains-defined as those represented by three or more isolates-accounted for a majority (61%) of the collection. Fifty-two isolates of the same serotype K25 (occasionally acapsular) strain with SHV-4 beta-lactamase were recovered at two French hospitals and one in Belgium. This strain has been found by others in France, and has been become particularly widespread. Another single strain was found in two separate Portuguese centres, and many individual hospitals had one or more epidemic strain(s), as well as a scatter of diverse ESBL producers. Major variation in antibiogram and plasmid profile was apparent within strains, with some intra-strain variation in beta-lactamase type. These data imply a fluid situation, with resistance determinants being gained, modified or lost. The endemicity of ESBL producers is disturbing since it limits the potential for control by blocking strain spread, while the diversity within strains is disturbing because it complicates the design of antibiotic policies even during 'single strain' outbreaks.