Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China
Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China
复制标题
南京地区17家医院耐碳青霉烯类肠杆菌科细菌流行病学特征
DOI：
10.1186/s13756-019-0674-4
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发表时间：
2020-01-13
影响因子：
5.5
通讯作者：
Cao, Xiaoli
中科院分区：
文献类型：
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作者：
Zhou, Hui;Zhang, Kui;Cao, Xiaoli
目的分析南京地区17家医院97株碳青霉烯类耐药肠杆菌科细菌的流行病学特征。方法采用PCR和DNA测序法检测超广谱β-内酰胺酶（ESBLs）、质粒介导的AmpC酶（pAmpCs）、质粒介导的喹诺酮类耐药基因（PMQRs）、磷霉素耐药基因和外源性16 S rRNA甲基转移酶（16 S-RMTase）的耐药基因。采用多位点序列分型法（MLST）确定CRE的序列类型。质粒图谱通过基于PCR的复制子分型（PBRT）进行检测。结果除氨曲南/阿维巴坦、米诺环素、头孢他啶/阿维巴坦、替加环素和粘菌素外，所有CRE菌株对几乎所有临床可用抗生素均显示较高的MIC 50和MIC 90。产ESBLs的菌株主要为CTX-M（76.3%）和SHV（60.8%）。另外，oqxAB（70.1%）和qnr（63.9%）是主要的PMQR，rmtB（47.4%）是主要的16 S-RMTase，fosA（76.3%）和fosA 3（37.1%）是磷霉素抗性基因。PBRT分析显示，在大多数分离株中存在IncR（66.0%）和IncFII（64.9%）复制子类型，其次是IncFIB（46.4%）和IncX 3（16.5%）。IncFII和IncR复制子类型主要存在于K. pneumoniae（68.8%），而E.大肠埃希菌分离株（100.0%）。三种主要MLST类型ST 11、ST 15和ST 268占77 K的68.0%。肺炎。在8株E.杆菌结论CRE分离株引起的感染的治疗受到多重耐药决定簇和质粒复制子的挑战。我们的结果强调了blaKPC-2携带K. pneumoniae ST 11，新发现的携带K. oxytoca ST 36以及blaIMP-4和blaNDM-1共携带E. clobacterium ST 418，这提醒我们迫切需要进行抗生素耐药性监测，以防止这些高度传播和危险的谱系的传播。
Objective In total, 97 carbapenem-resistant Enterobacteriaceae (CRE) were collected from 17 hospitals located in Nanjing, Southeast China, and analyzed for epidemiological characteristics. Methods Antimicrobial susceptibility was determined; followed by determination of the prevalence of resistance determinants, including extended-spectrum beta-lactamase (ESBLs), plasmid-mediated AmpC enzyme (pAmpCs), plasmid-mediated quinolone resistance genes (PMQRs), fosfomycin resistance gene and exogenously acquired 16S rRNA methyltransferase (16S-RMTase) using PCR and DNA sequencing. The sequence types (STs) of CRE were determined by multi-locus sequence typing (MLST). The plasmid profiles were detected by PCR-based replicon typing (PBRT). Results All the CRE strains displayed high MIC50 and MIC90 for nearly all clinical available antibiotics, except for aztreonam/avibactam, minocycline, ceftazidime/avibactam, tigecycline, and colistin. KPC-2 (79.4%) and NDM (19.6%) were the main carbapenemases, CTX-M (76.3%) and SHV (60.8%) were the predominant ESBLs. In addition, oqxAB (70.1%) and qnr (63.9%) were the major PMQRs; rmtB (47.4%) was the main 16S-RMTase; fosA (76.3%) and fosA3 (37.1%) were the fosfomycin resistance gene. PBRT analysis showed presence of IncR (66.0%) and IncFII (64.9%) replicon types in the majority of the isolates, followed by IncFIB (46.4%) and IncX3 (16.5%). The IncFII and IncR replicon-types were found mainly in K. pneumoniae (68.8%), whereas the IncX3 replicons dominated in E. coli isolates (100.0%). The three dominating MLST-types ST11, ST15 and ST268 comprised 68.0% of the 77 K. pneumoniae. Seven distinct STs were identified among 8 E. coli. Conclusions The treatment for infections caused by CRE isolates is challenged by the presence of multiple resistance determinants and plasmid replicons. Our results highlighted the expansion of blaKPC-2 carrying K. pneumoniae ST11, the new emergency of single blaNDM-5 carrying K. oxytoca ST36, as well as blaIMP-4 and blaNDM-1 co-carrying E. cloacae ST418, which alert us on the urgency for antimicrobial resistant surveillance, to prevent dissemination of these highly transmissible and dangerous lineages.