Souverein Dennis, Boers Stefan A, Veenendaal Dick, Euser Sjoerd M, Kluytmans Jan, Den Boer Jeroen W
Department of Epidemiology and Infection Prevention, Regional Public Health Laboratory Kennemerland, Haarlem, The Netherlands.
Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, and VU University Medical Center, Amsterdam, The Netherlands.
PLoS One. 2014 Jun 27;9(6):e101212. doi: 10.1371/journal.pone.0101212. eCollection 2014.
The objective of this study was to analyze the transmission dynamics of ESBL positive Klebsiella spp. with an additional resistance towards gentamicin (ESBL-G) in a Dutch region of 650,000 inhabitants in 2012.
All patient related ESBL-G isolates isolated in 2012 were genotyped using both Amplification Fragment Length Polymorphism (AFLP) and High-throughput MultiLocus Sequence Typing (HiMLST). HiMLST was used to analyze the presence of (unidentified) clusters of ESBL-G positive patients. Furthermore, all consecutive ESBL-G isolates within patients were studied in order to evaluate the intra-patient variation of antibiotic phenotypes.
There were 38 ESBL-G isolates, which were classified into 18 different sequence types (STs) and into 21 different AFLP types. Within the STs, four clusters were detected from which two were unknown resulting in a transmission index of 0.27. An analysis of consecutive ESBL-G isolates (with similar STs) within patients showed that for 68.8% of the patients at least one isolate had a different consecutive antibiotic phenotype.
The transmission of ESBL-G in the region Kennemerland in 2012 was polyclonal with several outbreaks (with a high level of epidemiological linkage). Furthermore, clustering by antibiotic phenotype characterization seems to be an inadequate approach in this setting. The routine practice of molecular typing of collected ESBL-G isolates may help to detect transmission in an early stage, which opens the possibility of a rapid response.
本研究的目的是分析2012年在荷兰一个拥有65万居民的地区，对庆大霉素具有额外耐药性的产超广谱β-内酰胺酶（ESBL）阳性克雷伯菌属（ESBL-G）的传播动态。
使用扩增片段长度多态性（AFLP）和高通量多位点序列分型（HiMLST）对2012年分离出的所有与患者相关的ESBL-G分离株进行基因分型。HiMLST用于分析ESBL-G阳性患者（未识别的）聚集情况。此外，对患者体内所有连续的ESBL-G分离株进行研究，以评估患者体内抗生素表型的变化。
共分离出38株ESBL-G分离株，分为18种不同的序列类型（STs）和21种不同的AFLP类型。在这些STs中，检测到4个聚集群，其中2个未知，传播指数为0.27。对患者体内连续的ESBL-G分离株（具有相似的STs）分析表明，68.8%的患者至少有一株分离株具有不同的连续抗生素表型。
2012年肯内梅林地区ESBL-G的传播是多克隆的，有几次暴发（具有高度的流行病学关联性）。此外，在这种情况下，通过抗生素表型特征进行聚类似乎是一种不充分的方法。对收集的ESBL-G分离株进行分子分型的常规做法可能有助于在早期检测传播情况，从而有可能做出快速反应。
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