Lefebvre Brigitte, Lévesque Simon, Bourgault Anne-Marie, Mulvey Michael R, Mataseje Laura, Boyd David, Doualla-Bell Florence, Tremblay Cécile
Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada.
McGill University Health Centre and Department of Medicine, McGill University, Montréal, Québec, Canada.
PLoS One. 2015 Apr 24;10(4):e0125076. doi: 10.1371/journal.pone.0125076. eCollection 2015.
The emergence and spread of carbapenemase-producing Enterobacteriaceae (CPE) represent a major public health concern because these bacteria are usually extensively resistant to most antibiotics. In order to evaluate their dissemination in Quebec, a surveillance program was introduced in 2010. We report the molecular and epidemiological profiles of CPE isolates collected. Between August 2010 and December 2012, a total of 742 non-duplicate isolates non-susceptible to carbapenems were analysed. AmpC β-lactamase and metallo-β-lactamase production were detected by Etest and carbapenemase production by the modified Hodge test (MHT). Antibiotic susceptibility profiles were determined using broth microdilution or Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC) strains was analyzed by pulsed-field gel electrophoresis (PFGE). The presence of genes encoding carbapenemases as well as other β-lactamases was detected using PCR. Of the 742 isolates tested, 169 (22.8%) were CPE. Of these 169 isolates, 151 (89.3%) harboured a blaKPC gene while the remaining isolates carried blaSME (n = 9), blaOXA-48 (n = 5), blaNDM (n = 3), and blaNMC (n = 1) genes. Among the 93 KPC strains presenting with a unique pattern (unique PFGE pattern and/or unique antibiotics susceptibility profile), 99% were resistant to ertapenem, 95% to imipenem, 87% to meropenem, 97% to aztreonam, 31% to colistin and 2% to tigecycline. In 19 patients, 2 to 5 KPC strains from different species or with a different PFGE pattern were isolated. CPE strains were present in the province of Quebec with the majority of strains harbouring KPC. Alternately, SME, OXA-48 and NMC containing strains were rarely found.
产碳青霉烯酶肠杆菌科细菌（CPE）的出现和传播是一个重大的公共卫生问题，因为这些细菌通常对大多数抗生素具有广泛耐药性。为了评估它们在魁北克的传播情况，2010年引入了一项监测计划。我们报告了所收集的CPE分离株的分子和流行病学特征。在2010年8月至2012年12月期间，共分析了742株对碳青霉烯类不敏感的非重复分离株。通过Etest检测AmpCβ-内酰胺酶和金属β-内酰胺酶的产生，通过改良Hodge试验（MHT）检测碳青霉烯酶的产生。使用肉汤微量稀释法或Etest确定抗生素敏感性谱。通过脉冲场凝胶电泳（PFGE）分析肺炎克雷伯菌碳青霉烯酶（KPC）菌株的克隆性。使用PCR检测编码碳青霉烯酶以及其他β-内酰胺酶的基因的存在。在742株测试分离株中，169株（22.8%）为CPE。在这169株分离株中，151株（89.3%）携带blaKPC基因，其余分离株携带blaSME（n = 9）、blaOXA - 48（n = 5）、blaNDM（n = 3）和blaNMC（n = 1）基因。在呈现独特模式（独特的PFGE模式和/或独特的抗生素敏感性谱）的93株KPC菌株中，99%对厄他培南耐药，95%对亚胺培南耐药，87%对美罗培南耐药，97%对氨曲南耐药，31%对黏菌素耐药，2%对替加环素耐药。在19名患者中，分离出了来自不同物种或具有不同PFGE模式的2至5株KPC菌株。魁北克省存在CPE菌株，大多数菌株携带KPC。另外，含有SME、OXA - 48和NMC的菌株很少见。
