Intestinal co-colonization with different carbapenemase-producing Enterobacterales isolates is not a rare event in an OXA-48 endemic area
Intestinal co-colonization with different carbapenemase-producing Enterobacterales isolates is not a rare event in an OXA-48 endemic area
复制标题
DOI：
10.1016/j.eclinm.2019.09.005
复制
发表时间：
2019-10-01
影响因子：
15.1
通讯作者：
Canton, Rafael
中科院分区：
文献类型：
--
作者：
Hernandez-Garcia, Marta;Perez-Viso, Blanca;Canton, Rafael
背景资料：目前传播的碳青霉烯酶生产肠球菌（CPE）是一个巨大的concerns.Methods：我们回收198 CPE从162例患者在我院（2014年3月至2016年3月）在R-GNOSIS欧洲项目。结果：30例患者（18.5%; CI 95%= 12.5%-24.5%）表现出与产生相同碳青霉烯酶（CPE-SC）（15.4%）或不同碳青霉烯酶（CPE-DC）（4.3%）的多种CPE共定植。OXA-48（83.3%）是最常见的碳青霉烯酶，其次是Vim-1（26.7%）、NDM-1（10%）和KPC-3（3.3%）。CPE-DC-患者比其他患者住院时间更长[63天（20-107）]。此外，CPE-SC-患者中CPE检测前的住院时间比单次定植患者短[9天（5-14）]（p =0.0052）; 56%的患者在第一个阳性样本中显示共定植，尽管其中大多数患者既往入院并接受过多种抗生素治疗。CPE在来自共定植[CPE-DC（28.6%），CPE-SC（24%）]患者的临床样品中比来自具有单一CPE的患者（15.2%）更频繁地回收。在CPE-SC-OXA-48中[80%（p =0.11）]，K. pneumoniae [88%（p=0.006）]和E.大肠埃希菌[84%（P < 0.001）]是最常见的菌种。在60%的患者中，K.和E.大肠杆菌物种同时回收，通常在单一OXA-48-K之后。肺炎定植。在OXA-48-K中检测到高风险克隆（ST 11、ST 15、ST 307）。pneumoniae的克隆多样性较高，而E.杆菌由于显性质粒（IncL-pOXA-48），但也涉及相关或不相关的bla（Vim-1）-、bla（NDM-1）（）-和bla（KPC-3）-编码质粒，显示了频繁的体内跨物种质粒传播。(C)2019由Elsevier Ltd.出版
Background: The current spread of carbapenemase-producing Enterobacterales (CPE) is a great concern.Methods: We recovered 198 CPE from 162 patients admitted in our Hospital (March 2014-March 2016) during the R-GNOSIS European Project. Microbiological features and plasmid characteristics of CPE recovered from patients co-colonized with multiple CPE were studied.Findings: Thirty patients (18.5%; CI 95%= 12.5%-24.5%) presented co-colonization with multiple CPE producing the same (CPE-SC) (15.4%) or a different carbapenemase (CPE-DC) (4.3%). OXA-48 (83.3%) was the most frequent carbapenemase, followed by VIM-1 (26.7%), NDM-1 (10%) and KPC-3 (3.3%). CPE-DC-patients had longer admissions [63 days (20-107)] than the other patients. Moreover, hospital stay until CPE detection was lower [9 days (5-14)] (p =0.0052) in CPE-SC-patients than in those with a single colonization; 56% showed co-colonization in the first positive sample, although most of them had previous admissions and had received multiple antibiotic treatments. CPE were more frequently recovered in clinical samples from co-colonized [CPE-DC (28.6%), CPE-SC (24%)] patients than from patients with a single CPE (15.2%). Among CPE-SC-OXA-48 [80% (p =0.11)], K. pneumoniae [88% (p=0.006)] and E. coli [84% (p < 0.001)] were the most frequent species. In 60% of patients, K. pneumoniae and E. coli species were simultaneously recovered, frequently after a single OXA-48-K. pneumoniae colonization. High-risk clones (ST11, ST15, ST307) were detected in OXA-48-K. pneumoniae but a higher clonal diversity was found among E. coli. A frequent in-vivo cross-species plasmid transmission was shown, due to a dominant plasmid (IncL-pOXA-48), but also involving related or unrelated bla(VIM-1 )-, bla(NDM-1)( )- and bla (KPC-3)-encoding plasmids.Interpretation: CPE co-colonization status should be monitored during epidemiological surveillance cultures, as these patients might be at a higher risk for infection. (C) 2019 Published by Elsevier Ltd.