Servicio de Microbiología and Unidad de Investigación, Hospital Son Dureta, Institut Universitari de Investigació en Ciències de la Salut (IUNICS), Palma de Mallorca, Spain.
J Antimicrob Chemother. 2010 Mar;65(3):474-8. doi: 10.1093/jac/dkp491. Epub 2010 Jan 12.
OBJECTIVES: To study the prevalence, nature, involved genetic elements and epidemiology of metallo-beta-lactamase (MBL)-producing Pseudomonas aeruginosa and Pseudomonas putida isolated in a Spanish hospital between 2005 and 2008. METHODS: Etests were used for susceptibility testing and screening for MBLs, confirmed through bla(VIM) PCRs and sequencing. Clonal relatedness was evaluated by PFGE and multilocus sequence typing (MLST). MBL-carrying plasmids were characterized by restriction fragment length polymorphism, Southern blot and electroporation. MBL genetic elements were studied by cloning and sequencing. RESULTS: MBL-producing P. putida was detected in eight patients (one clone each; two harbouring bla(VIM-1) and six harbouring bla(VIM-2)), representing 14% of all the infections by the P. putida/fluorescens group. MBLs were detected in only 0.3% of P. aeruginosa infections (11 patients) during the same period. PFGE revealed four P. aeruginosa clones: one producing bla(VIM-13) (two patients); and three producing bla(VIM-2) (two patients, six patients and one patient, respectively). MLST indicated that the VIM-13 clone was the internationally spread sequence type (ST)235, while the major VIM-2 lineage corresponded to ST179, which is associated with chronic respiratory infections. The VIM-1 integron was shown to have both plasmid and chromosomal location, while the VIM-13 integron was only chromosomal. The VIM-2 integron was located in the same transposon (Tn402/Tn5053-like) in all P. aeruginosa and P. putida isolates, suggesting its crucial role in the dissemination of VIM-2. CONCLUSIONS: The high diversity and proportion of MBL-positive P. putida suggests an environmental reservoir of these resistance determinants. Dissemination of these multidrug resistance elements to successful P. aeruginosa clones presents a major epidemiological and clinical threat.
目的:研究 2005 年至 2008 年间在一家西班牙医院分离的产金属β-内酰胺酶(MBL)铜绿假单胞菌和恶臭假单胞菌的流行率、性质、涉及的遗传元件和流行病学。
方法:使用 E 试验进行药敏试验和 MBL 筛选,通过 bla(VIM)PCR 和测序进行确认。通过 PFGE 和多位点序列分型(MLST)评估克隆相关性。通过限制片段长度多态性、Southern 印迹和电穿孔分析鉴定 MBL 携带质粒。通过克隆和测序研究 MBL 遗传元件。
结果:在 8 名患者(每个克隆 1 例;2 例携带 bla(VIM-1),6 例携带 bla(VIM-2))中检测到产 MBL 的恶臭假单胞菌,占同期所有荧光假单胞菌/铜绿假单胞菌组感染的 14%。同期仅在 0.3%的铜绿假单胞菌感染患者中检测到 MBL(11 例)。PFGE 显示 4 个铜绿假单胞菌克隆:1 个产生 bla(VIM-13)(2 例);3 个产生 bla(VIM-2)(2 例、6 例和 1 例)。MLST 表明,VIM-13 克隆是国际传播的 ST235 型,而主要的 VIM-2 谱系与慢性呼吸道感染相关的 ST179 型相对应。VIM-1 整合子显示出质粒和染色体位置,而 VIM-13 整合子仅位于染色体上。所有铜绿假单胞菌和恶臭假单胞菌分离株中的 VIM-2 整合子均位于相同的转座子(Tn402/Tn5053 样)中,表明其在 VIM-2 的传播中起着至关重要的作用。
结论:产 MBL 阳性恶臭假单胞菌的多样性和比例较高,提示这些耐药决定因素存在于环境中。这些多药耐药元件向成功的铜绿假单胞菌克隆的传播带来了重大的流行病学和临床威胁。
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