Spreading Patterns of NDM-Producing Enterobacteriaceae in Clinical and Environmental Settings in Yangon, Myanmar
Spreading Patterns of NDM-Producing Enterobacteriaceae in Clinical and Environmental Settings in Yangon, Myanmar
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DOI：
10.1128/aac.01924-18
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发表时间：
2019-03-01
影响因子：
4.9
通讯作者：
Hamadaa, Shigeyuki
中科院分区：
文献类型：
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作者：
Sugawara, Yo;Akeda, Yukihiro;Hamadaa, Shigeyuki
产碳青霉烯酶肠杆菌科（CPE）的传播导致了广泛的碳青霉烯耐药性，已成为全球关注的问题。然而，在包括缅甸在内的发展中国家，尚未深入研究碳青霉烯酶基因的特定传播模式，在这些国家，NDM型碳青霉烯酶正在临床环境中传播。在本研究中，我们对从缅甸仰光的临床（n = 77）和环境（n = 14）样本中获得的91个CPE分离株进行了表型和遗传特征分析。我们使用全基因组测序和质粒分析确定了携带NDM-1及其变体编码基因的质粒的传播。携带bla（NDM-5）的IncFII质粒和携带bla（NDM-4）或bla（NDM-7）的IncX 3质粒是分离株中鉴定的最常见的质粒类型。IncFII质粒主要由大肠杆菌的临床分离株携带，并且在医院的同一病房内观察到它们的克隆扩增。与此相反，IncX 3质粒被发现在从临床和环境样本中的分离株遗传学上的分歧分为9个物种，这表明广泛传播的质粒通过水平转移。发现一半的环境分离株具有IncX 3质粒，并且证实与IncFII质粒相比，这种类型的质粒在相对较低的温度（25 ℃）下更有效地转移到受体生物体。此外，在肺炎克雷伯菌或阴沟肠杆菌复合体的临床分离株中，鉴定出携带bla（NDM-1）的各种其他质粒类型，包括Inc-FIB、IncPII、IncL/M和印加/C-2。总的来说，我们的研究结果突出了三种不同的模式传播bla（NDM）-窝藏质粒CPE分离株在缅甸，有助于更好地了解他们的分子流行病学和传播的地方病的设置。
The spread of carbapenemase-producing Enterobacteriaceae (CPE), contributing to widespread carbapenem resistance, has become a global concern. However, the specific dissemination patterns of carbapenemase genes have not been intensively investigated in developing countries, including Myanmar, where NDM-type carbapenemases are spreading in clinical settings. In the present study, we phenotypically and genetically characterized 91 CPE isolates obtained from clinical (n = 77) and environmental (n = 14) samples in Yangon, Myanmar. We determined the dissemination of plasmids harboring genes encoding NDM-1 and its variants using whole-genome sequencing and plasmid analysis. IncFII plasmids harboring bla(NDM-5) and IncX3 plasmids harboring bla(NDM-4) or bla(NDM-7) were the most prevalent plasmid types identified among the isolates. The IncFII plasmids were predominantly carried by clinical isolates of Escherichia coli, and their clonal expansion was observed within the same ward of a hospital. In contrast, the IncX3 plasmids were found in phylogenetically divergent isolates from clinical and environmental samples classified into nine species, suggesting widespread dissemination of plasmids via horizontal transfer. Half of the environmental isolates were found to possess IncX3 plasmids, and this type of plasmid was confirmed to transfer more effectively to recipient organisms at a relatively low temperature (25 degrees C) compared to the IncFII plasmid. Moreover, various other plasmid types were identified harboring bla(NDM-1), including Inc-FIB, IncFII, IncL/M, and IncA/C-2, among clinical isolates of Klebsiella pneumoniae or Enterobacter cloacae complex. Overall, our results highlight three distinct patterns of the dissemination of bla(NDM)-harboring plasmids among CPE isolates in Myanmar, contributing to a better understanding of their molecular epidemiology and dissemination in a setting of endemicity.