Laboratory of Microbiology, University Hospital Center of Habib Bourguiba, Sfax, Tunisia.
J Antimicrob Chemother. 2013 Feb;68(2):329-32. doi: 10.1093/jac/dks386. Epub 2012 Sep 26.
To report an outbreak due to Providencia stuartii isolates carrying bla(OXA-48), bla(PER-1), bla(CMY-4) and qnrA6 in a Tunisian hospital in 2011.
Eight intensive care unit (ICU) patients infected/colonized by extended-spectrum β-lactamase (ESBL)-producing P. stuartii between March and May 2011 were included. Molecular epidemiology was studied by PFGE. Antibiotic resistance genes were analysed by PCR and sequencing and the plasmid incompatibility group by a PCR-based replicon typing scheme.
Eight patients were colonized with ESBL-producing P. stuartii isolates. All these isolates were clonally related and found to carry bla(OXA-48), bla(PER-1), bla(CMY-4), qnrA6 and aac-6'-Ib genes on the same self-conjugative IncA/C plasmid. The same strain was also cultured from environmental samples in the ICU. All these isolates were susceptible to carbapenems. Only one colonized patient developed P. stuartii pleurisy and was effectively treated with imipenem alone.
This is the first report of an outbreak due to P. stuartii isolates carrying bla(OXA-48) in Tunisia. The simultaneous expression of various resistance genes (bla(OXA-48), bla(CMY-4), bla(PER-1), qnrA and aac-6'-Ib) by P. stuartii isolates is alarming.
报告 2011 年在突尼斯一家医院中，由携带 bla(OXA-48)、bla(PER-1)、bla(CMY-4)和 qnrA6 的普罗威登斯菌属分离株引起的暴发情况。
2011 年 3 月至 5 月期间，8 例重症监护病房（ICU）患者感染/定植产超广谱β-内酰胺酶（ESBL）的斯氏普罗威登斯菌，对其进行分子流行病学研究。通过 PFGE 分析，对耐药基因进行 PCR 扩增和测序，并通过基于 PCR 的复制子分型方案分析质粒不相容性组。
8 例患者被 ESBL 产生的斯氏普罗威登斯菌定植。所有这些分离株均具有克隆相关性，发现它们携带 bla(OXA-48)、bla(PER-1)、bla(CMY-4)、qnrA6 和 aac-6'-Ib 基因，这些基因位于同一可自我转移的 IncA/C 质粒上。在 ICU 的环境样本中也培养出了相同的菌株。所有这些分离株均对碳青霉烯类药物敏感。只有一名定植患者发生斯氏普罗威登斯菌胸膜炎，单独使用亚胺培南有效治疗。
这是突尼斯首次报告由携带 bla(OXA-48)的斯氏普罗威登斯菌引起的暴发情况。斯氏普罗威登斯菌分离株同时表达各种耐药基因（bla(OXA-48)、bla(CMY-4)、bla(PER-1)、qnrA 和 aac-6'-Ib）令人警惕。
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