Nucleo Elisabetta, Spalla Melissa, Piazza Aurora, Caltagirone Maria Sofia, Asticcioli Sara, Debiaggi Maurizia, Matti Carolina, Daturi Rossana, Navarra Antonella, Labonia Maria, Migliavacca Roberta
Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Microbiology, University of Pavia, Italy.
New Microbiol. 2013 Jul;36(3):279-82. Epub 2013 Jun 30.
We report the emergence of VIM-1 MBL and CTX-M-15-producing K. pneumoniae isolates collected from patients at two acute care hospitals (I.R.C.C.S. "S. Matteo" and "Casa Sollievo della Sofferenza" Hospital) and a long-term rehabilitation facility in Northern Italy (I.R.C.C.S. "S. Maugeri"). Between February 2007 and October 2008, 30 K. pneumoniae strains showing decreased susceptibility to carbapenems were collected. PCR and sequencing experiments revealed the presence of blaVIM-1 gene in 14/30 isolates. All the above isolates carried the blaSHV-5 determinant as well; interestingly, 8/14 VIM positive isolates were also CTX-M-1- like producers. VIM-1 positive strains were present in all hospitals. PFGE genomic profiles of the 14/30 isolates showed that 2 different clones, A and B, were responsible for outbreaks. The coexistence in the same bacterial cell of compatible plasmids carrying epidemiologically important emerging resistance genes, such as MBLs and CTX-Ms, is worrisome since it could predict the generation and spread of pan-resistant bacteria and the consequent treatment option limitations that can lead to significant morbidity and mortality. Control measures should be applied to detect MBL-producing strains and to contrast the vertical and plasmidic diffusion of carbapenem-resistant K. pneumoniae in acute care and rehabilitation facilities.
我们报告了从意大利北部两家急症医院（I.R.C.C.S. “圣马泰奥”医院和“索尔利耶沃·德拉索费伦扎之家”医院）以及一家长期康复机构（I.R.C.C.S. “圣毛杰里”）的患者中分离出的产VIM-1金属β-内酰胺酶（MBL）和CTX-M-15的肺炎克雷伯菌菌株。在2007年2月至2008年10月期间，收集了30株对碳青霉烯类药物敏感性降低的肺炎克雷伯菌菌株。PCR和测序实验显示，30株分离株中有14株存在blaVIM-1基因。上述所有分离株还携带blaSHV-5决定簇；有趣的是，14株VIM阳性分离株中有8株也是CTX-M-1样产酶株。VIM-1阳性菌株在所有医院均有出现。30株分离株中的14株的脉冲场凝胶电泳（PFGE）基因组图谱显示，2个不同的克隆A和B导致了暴发。携带具有重要流行病学意义的新出现耐药基因（如MBL和CTX-M）的相容质粒在同一细菌细胞中共存令人担忧，因为这可能预示着泛耐药菌的产生和传播，以及随之而来的治疗选择受限，进而导致显著的发病率和死亡率。应采取控制措施来检测产MBL的菌株，并对抗碳青霉烯类耐药肺炎克雷伯菌在急症医院和康复机构中的垂直传播和质粒扩散。
