Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka.
Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka.
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DOI：
10.1186/s13756-021-00938-3
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发表时间：
2021-04-30
影响因子：
5.5
通讯作者：
Tillekeratne LG
中科院分区：
文献类型：
--
作者：
Meredith HR;Kularatna S;Nagaro K;Nagahawatte A;Bodinayake C;Kurukulasooriya R;Wijesingha N;Harden LB;Piyasiri B;Hammouda A;Wiegmann BM;Nicholson BP;Joyce M;Woods CW;Van Vliet AHM;Thakur S;Tillekeratne LG
在耐多药肠杆菌科（multi - drug-resistant enterobacteraceae， MDRE）携带率高的地区，人们对MDRE肠道定植的时机和危险因素仍知之甚少。我们确定了斯里兰卡南部婴儿中与MDRE肠道定植相关的患病率、时间和危险因素。在斯里兰卡南部，妇女及其新生儿在分娩后48小时内进行登记。在入组时和4-6周后收集妇女和婴儿的直肠拭子。使用标准微生物学程序分离并鉴定为MDRE（扩展谱β-内酰胺酶或碳青霉烯耐药阳性）。我们使用精确方法（Fisher精确检验和Kruskal-Wallis检验）和多变量逻辑回归来确定与MDRE肠道定植相关的社会人口统计学和临床特征。对选定的MDRE分离株进行全基因组测序以确定系统群，并使用NCBI的AMRfinder工具鉴定抗生素耐药性编码基因。总共纳入了199名产后妇女和199名婴儿；148/199（74.4%）名妇女和151/199（75.9%）名婴儿随后在社区重新评估。在入组时，24/ 199（12.1%）的女性和3/199（1.5%）的婴儿显示MDRE在肠道定殖，而在重新评估时，26/148（17.6%）的女性和24/151（15.9%）的婴儿显示MDRE在肠道定殖。虽然没有与入组时婴儿定植相关的危险因素，但多变量分析表明，重新评估时婴儿定植的危险因素包括入组时母亲定植（aOR = 3.62）或重新评估时母亲定植（aOR = 4.44）、剖宫产（aOR = 2.91）和低出生体重（aOR = 5.39）。对来自婴儿的20株MDRE分离株进行测序，多位点序列分型显示6/20（30%）与在各自母亲中发现的MDRE分离株聚集在同一分支上。所有经测序的母亲分离株（47株）和婴儿分离株（20株）至少有一个产生esbl的基因。在33/47（70%）的母亲分离株和16/20（80%）的婴儿分离株中发现编码磷霉素耐药的基因，在1（2%）的母亲分离株中发现编码粘菌素耐药的基因。我们的研究结果表明，相当大比例的婴儿在出生6周内发生MDRE肠道定植，可能是由于出生后而不是出生内传播。在线版本包含补充材料，可在10.1186/s13756-021-00938-3获得。
The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka. Women and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4–6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher’s exact and Kruskal–Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI’s AMRfinder tool. Overall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers’ isolates and 16/20 (80%) of infants’ isolates and genes encoding resistance to colistin were found in one (2%) mother’s isolate. Our results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission. The online version contains supplementary material available at 10.1186/s13756-021-00938-3.
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影响因子：
4.6
作者：
Babu, Rachana;Kumar, Anil;Biswas, Raja
通讯作者：
Biswas, Raja
DOI：
10.1073/pnas.1002601107
发表时间：
2010-06-29
影响因子：
11.1
作者：
Dominguez-Bello, Maria G.;Costello, Elizabeth K.;Knight, Rob
通讯作者：
Knight, Rob
影响因子：
1.7
作者：
Bankevich, Anton;Nurk, Sergey;Pevzner, Pavel A.
通讯作者：
Pevzner, Pavel A.
DOI：
10.1097/mpg.0000000000000597
发表时间：
2015-03
影响因子：
2.9
作者：
Houghteling PD;Walker WA
通讯作者：
Walker WA
影响因子：
5.2
作者：
Denkel, Luisa A.;Schwab, Frank;Piening, Brar
通讯作者：
Piening, Brar