Analysis of β-Lactamase Resistance Determinants in Enterobacteriaceae from Chicago Children: a Multicenter Survey
Analysis of β-Lactamase Resistance Determinants in Enterobacteriaceae from Chicago Children: a Multicenter Survey
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DOI：
10.1128/aac.00098-16
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发表时间：
2016-06-01
影响因子：
4.9
通讯作者：
Bonomo, Robert A.
中科院分区：
文献类型：
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作者：
Logan, Latania K.;Hujer, Andrea M.;Bonomo, Robert A.
在美国儿童中，多重耐药（MDR）肠杆菌科感染正在增加;然而，在儿科肠杆菌科分离株中负责MDR表型的抗生素耐药基因的多中心分析很少。在本研究中，分析了2011年1月至2015年4月期间在三家芝加哥地区医院住院的0至18岁儿童中回收的225株表型鉴定为产超广谱β-内酰胺酶（ESBL）或碳青霉烯酶的分离株。我们使用DNA微阵列平台检测ESBL、质粒介导的AmpC酶（pAmpC）和碳青霉烯酶型β-内酰胺酶（bla）基因。进行基于重复序列的PCR和多位点序列分型（MLST）以评估分离株的相似性。进行质粒复制子分型以对质粒进行分类。患者的中位年龄为4.2岁，56%为女性，44%在门诊就诊。大多数（60.9%）的分离株是大肠埃希菌和尿源（69.8%）。在225株产ESBL或碳青霉烯酶表型的菌株中，90.7%含有bla基因。最常见的基因型是bla（CTX-M-1）组（49.8%）; 1.8%为碳青霉烯类耐药肠杆菌科（3个bla（KPC）和1个bla（IMP））。总体而言，pAmpC（bla（ACT/MIR）和bla（CMY））存在于14.2%。优势种E.大肠杆菌系统发生群为B2群（67.6%），与含有bla（CTX-M-1）群（84%）的ST 43/ST 131（Pasteur/Achtman MLST scheme）相关，质粒复制子类型为FIA、FII和FIB。K.携带bla的肺炎克雷伯氏菌（KPC）为非ST 258，复制子类型为I1和A/C。肠杆菌属携带bla（ACT/MIR）的质粒复制子FIIA。我们发现，β-内酰胺耐药的儿童是不同的，某些耐药机制不同于已知的流行区的成人流行基因型。复杂分子类型的潜在影响和耐多药肠杆菌科在易感人群中的沉默传播需要进一步研究。
Multidrug-resistant (MDR) Enterobacteriaceae infections are increasing in U.S. children; however, there is a paucity of multicentered analyses of antibiotic resistance genes responsible for MDR phenotypes among pediatric Enterobacteriaceae isolates. In this study, 225 isolates phenotypically identified as extended-spectrum beta-lactamase (ESBL) or carbapenemase producers, recovered from children ages 0 to 18 years hospitalized between January 2011 and April 2015 at three Chicago area hospitals, were analyzed. We used DNA microarray platforms to detect ESBL, plasmid-mediated AmpC (pAmpC), and carbapenemase type beta-lactamase (bla) genes. Repetitive-sequence-based PCR and multilocus sequence typing (MLST) were performed to assess isolate similarity. Plasmid replicon typing was conducted to classify plasmids. The median patient age was 4.2 years, 56% were female, and 44% presented in the outpatient setting. The majority (60.9%) of isolates were Escherichia coli and from urinary sources (69.8%). Of 225 isolates exhibiting ESBL-or carbapenemase-producing phenotypes, 90.7% contained a bla gene. The most common genotype was the bla(CTX-M-1) group (49.8%); 1.8% were carbapenem-resistant Enterobacteriaceae (three bla(KPC) and one bla(IMP)). Overall, pAmpC (bla(ACT/MIR) and bla(CMY)) were present in 14.2%. The predominant E. coli phylogenetic group was the virulent B2 group (67.6%) associated with ST43/ST131 (Pasteur/Achtman MLST scheme) containing the bla(CTX-M-1) group (84%), and plasmid replicon types FIA, FII, and FIB. K. pneumoniae harboring bla(KPC) were non-ST258 with replicon types I1 and A/C. Enterobacter spp. carrying bla(ACT/MIR) contained plasmid replicon FIIA. We found that beta-lactam resistance in children is diverse and that certain resistance mechanisms differ from known circulating genotypes in adults in an endemic area. The potential impact of complex molecular types and the silent dissemination of MDR Enterobacteriaceae in a vulnerable population needs to be studied further.