Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States.
Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States.
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DOI：
10.1128/mbio.01191-16
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发表时间：
2016-08-30
期刊：
影响因子：
6.4
通讯作者：
Kreiswirth BN
中科院分区：
文献类型：
--
作者：
Mediavilla JR;Patrawalla A;Chen L;Chavda KD;Mathema B;Vinnard C;Dever LL;Kreiswirth BN
粘菌素越来越多地用作治疗碳青霉烯类耐药革兰氏阴性菌感染的最后一种抗生素。质粒携带的粘菌素耐药基因mcr-1最初在中国的动物和临床样本中发现，随后在全球范围内报告，包括美国。特别值得关注的是mcr-1在碳青霉烯类耐药菌中的传播，从而产生接近泛耐药的菌株。虽然mcr-1的几份报告涉及碳青霉烯类耐药菌株，但在美国尚未描述此类分离株。在此，我们报告了从一名近期未在美国境外旅行的患者的尿样中分离和鉴定出一株携带mcr-1和碳青霉烯酶基因blaNDM-5的大肠埃希菌菌株。该菌株对粘菌素和碳青霉烯类抗生素耐药，但对阿米卡星、氨曲南、庆大霉素、呋喃妥因、替加环素和甲氧苄啶-磺胺甲恶唑敏感。对携带mcr-1和blaNDM-5的质粒进行了完全测序，结果显示与中国先前报告的质粒高度相似。本报告中的菌株于2014年8月首次分离，强调了mcr-1在美国的存在时间早于之前的认识。粘菌素已成为治疗由对多种抗生素具有耐药性的革兰氏阴性菌引起的感染的最后一道防线，特别是耐碳青霉烯类肠杆菌科（CRE）。由质粒携带基因mcr-1编码的粘菌素耐药性于2015年11月首次在中国的动物和临床样本中发现，随后在许多其他国家报告。2016年4月，在美国临床样本的碳青霉烯类敏感大肠埃希菌菌株中鉴定出mcr-1，随后在2015年5月首次分离的碳青霉烯类敏感大肠埃希菌菌株中进行了第二次报告。我们报告了一种携带粘菌素（mcr-1）和碳青霉烯（blaNDM-5）耐药基因的大肠杆菌菌株的分离和鉴定，该菌株最初于2014年8月从复发性尿路感染患者的尿液中分离。据我们所知，这是美国第一份同时具有粘菌素和碳青霉烯类耐药的临床细菌分离株的报告，强调了积极监测粘菌素和碳青霉烯类耐药微生物的重要性。
Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States. Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States. Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States. The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole. The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China. The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized. Colistin has become the last line of defense for the treatment of infections caused by Gram-negative bacteria resistant to multiple classes of antibiotics, in particular carbapenem-resistant Enterobacteriaceae (CRE). Resistance to colistin, encoded by the plasmid-borne gene mcr-1, was first identified in animal and clinical samples from China in November 2015 and has subsequently been reported from numerous other countries. In April 2016, mcr-1 was identified in a carbapenem-susceptible Escherichia coli strain from a clinical sample in the United States, followed by a second report from a carbapenem-susceptible E. coli strain originally isolated in May 2015. We report the isolation and identification of an E. coli strain harboring both colistin (mcr-1) and carbapenem (blaNDM-5) resistance genes, originally isolated in August 2014 from urine of a patient with recurrent urinary tract infections. To our knowledge, this is the first report in the United States of a clinical bacterial isolate with both colistin and carbapenem resistance, highlighting the importance of active surveillance efforts for colistin- and carbapenem-resistant organisms.