Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
Service de Bactériologie-Virologie, INSERM U914 'Emerging Resistance to Antibiotics', Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris-Sud, K.-Bicêtre, France.
J Med Microbiol. 2013 Aug;62(Pt 8):1239-1244. doi: 10.1099/jmm.0.059915-0. Epub 2013 May 2.
The purpose of this study was to identify the mechanisms leading to carbapenem resistance among multidrug-resistant Enterobacteriaceae isolates recovered from hospitalized patients with nosocomial infections in Mubarak Al Kabeer Hospital, Kuwait. Fourteen carbapenem-resistant Enterobacteriaceae isolates were obtained from inpatients in different wards and intensive care units between April 2009 and February 2011. Antibiotic susceptibilities were determined using the E-test method. Genes encoding β-lactamases were characterized by specific PCR amplification, sequencing and conjugation assays. All isolates were identified as metallo-β-lactamase (MBL) producers using phenotypic and molecular methods. Eleven of the 14 isolates produced VIM-4 (six Klebsiella pneumoniae, three Escherichia coli, one Enterobacter cloacae and one Klebsiella oxytoca). Three K. pneumoniae isolates produced the MBL NDM-1 and co-produced the plasmid-encoded AmpC CMY-4. The VIM-4-producing isolates co-produced extended-spectrum β-lactamases including CTX-M-15 and some SHV derivatives. The VIM-4 gene was not transferable by conjugation studies of six selected strains. We demonstrated here the emergence of VIM-4- and NDM-1-producing isolates in the largest teaching hospital in Kuwait.
本研究旨在确定科威特穆巴拉克·卡比尔医院住院的院内感染患者中获得的多药耐药肠杆菌科分离株产生碳青霉烯类耐药的机制。2009 年 4 月至 2011 年 2 月期间，从不同病房和重症监护病房的住院患者中获得了 14 株耐碳青霉烯类肠杆菌科分离株。采用 E-试验法测定抗生素敏感性。通过特异性 PCR 扩增、测序和接合试验对编码β-内酰胺酶的基因进行了特征描述。所有分离株均采用表型和分子方法鉴定为金属β-内酰胺酶（MBL）产生菌。14 株分离株中有 11 株产生 VIM-4（6 株肺炎克雷伯菌、3 株大肠埃希菌、1 株阴沟肠杆菌和 1 株产酸克雷伯菌）。3 株肺炎克雷伯菌产生 MBL NDM-1，并且共产生质粒编码的 AmpC CMY-4。产 VIM-4 的分离株共产生包括 CTX-M-15 和一些 SHV 衍生物在内的扩展谱β-内酰胺酶。通过对 6 株选定菌株的接合研究，未发现 VIM-4 基因可转移。我们在此证明了 VIM-4 和 NDM-1 产生菌在科威特最大的教学医院中的出现。
