Empel Joanna, Baraniak Anna, Literacka Elzbieta, Mrówka Agnieszka, Fiett Janusz, Sadowy Ewa, Hryniewicz Waleria, Gniadkowski Marek
National Medicines Institute, 00-725 Warsaw, Poland.
Antimicrob Agents Chemother. 2008 Jul;52(7):2449-54. doi: 10.1128/AAC.00043-08. Epub 2008 May 5.
The first national survey of resistance to newer beta-lactams in nosocomial populations of Enterobacteriaceae in Poland was performed. The study covered all nonrepetitive enterobacterial isolates cultured from specimens from inpatients in 13 regional secondary-care hospitals from November 2003 to January 2004. Among 2,388 isolates, the predominant species was Escherichia coli (59.6%), followed by Proteus mirabilis (14.5%) and Klebsiella spp. (8.5%). The frequency of extended-spectrum beta-lactamases (ESBLs) was very high, with ESBLs present in 11.1% of all isolates and 40.4% of Klebsiella pneumoniae isolates, the latter value greatly exceeding that for E. coli (2.5%). The contribution of outbreak isolates was significant, resulting, for example, in a particularly high rate of ESBL producers among Serratia marcescens isolates (70.8%). The pool of ESBL types was overwhelmingly dominated (81.7%) by CTX-M-like beta-lactamases CTX-M-3 (80.6%) and CTX-M-15, with SHV types (17.5%; SHV-2, SHV-5, and SHV-12) and sporadic TEM-like enzymes (0.7%; TEM-19 and TEM-48) being the next most frequent. Acquired AmpC-type cephalosporinases were observed exclusively in P. mirabilis, in 20.5% of the isolates of this species (compared with the frequency of ESBL producers of 11.5% of P. mirabilis isolates). All these cephalosporinases (CMY-12, CMY-15, and a novel variant, CMY-38) originated from Citrobacter freundii. Four isolates of E. coli (two isolates), K. pneumoniae (one isolate), and P. mirabilis (one isolate) produced class A inhibitor-resistant beta-lactamases (TEM-30, TEM-32, TEM-37, and SHV-49), being the first of such producers identified in Poland. The survey documented both specific and more global characteristics of the epidemiology of the beta-lactamase-mediated resistance in enterobacteria from Polish hospitals and demonstrated that the ESBL frequency has reached an alarming level.
波兰开展了首次针对医院内肠杆菌科细菌对新型β-内酰胺类抗生素耐药性的全国性调查。该研究涵盖了2003年11月至2004年1月期间从13家地区二级护理医院住院患者标本中培养出的所有非重复性肠杆菌分离株。在2388株分离株中，主要菌种为大肠埃希菌（59.6%），其次是奇异变形杆菌（14.5%）和克雷伯菌属（8.5%）。超广谱β-内酰胺酶（ESBLs）的出现频率非常高，在所有分离株中占11.1%，在肺炎克雷伯菌分离株中占40.4%，后者的值大大超过了大肠埃希菌（2.5%）。暴发分离株的贡献显著，例如，粘质沙雷菌分离株中ESBLs产生菌的比例特别高（70.8%）。ESBL类型库中绝大多数（81.7%）由CTX-M样β-内酰胺酶CTX-M-3（80.6%）和CTX-M-15主导，其次是SHV类型（17.5%；SHV-2、SHV-5和SHV-12）和散发性TEM样酶（0.7%；TEM-19和TEM-48）。仅在奇异变形杆菌中观察到获得性AmpC型头孢菌素酶，该菌种的分离株中有20.5%携带该酶（相比之下，奇异变形杆菌分离株中ESBLs产生菌的频率为11.5%）。所有这些头孢菌素酶（CMY-12、CMY-15和一种新型变体CMY-38）均源自弗氏柠檬酸杆菌。大肠埃希菌（2株）、肺炎克雷伯菌（1株）和奇异变形杆菌（1株）的4株分离株产生了A类抑制剂耐药β-内酰胺酶（TEM-30、TEM-32、TEM-37和SHV-49），这是波兰首次发现此类产生菌。该调查记录了波兰医院肠杆菌中β-内酰胺酶介导耐药性流行病学的具体和更普遍特征，并表明ESBL频率已达到令人担忧的水平。
