从疑似血流感染的埃及患者中分离出的产超广谱β-内酰胺酶和碳青霉烯酶的肠杆菌科细菌
Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Isolated from Egyptian Patients with Suspected Blood Stream Infection.
作者信息
Abdallah H M, Wintermans B B, Reuland E A, Koek A, al Naiemi N, Ammar A M, Mohamed A A, Vandenbroucke-Grauls C M J E
机构信息
Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands; Department of Bacteriology, Mycology and Immunology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, Egypt.
Medical Microbiology and Infection Control, VU University Medical Center, Amsterdam, the Netherlands.
出版信息
PLoS One. 2015 May 22;10(5):e0128120. doi: 10.1371/journal.pone.0128120. eCollection 2015.
OBJECTIVES
The aim of the study was to investigate the prevalence of extended-spectrum β-lactamase and carbapenemase production among Enterobacteriaceae isolated from Egyptian patients with suspected blood stream infection.
METHODS
Ninety-four Enterobacteriaceae blood culture isolates from Egyptian patients with suspected blood stream infection were collected, one isolate per patient. Identification of bacterial isolates was performed with MALDI-TOF (MS-based Vitek MS system, bioMerieux). Screening for ESBLs and carbapenemases production was done with the Vitek 2 system (bioMérieux). ESBL production was confirmed using the combined disk diffusion method for cefotaxime, ceftazidime, and cefepime, all with and without clavulanic acid (Rosco). Real-time PCR and sequencing were used to characterize the resistance genes. The phylogenetic groups of E. coli were identified by a PCR-based method.
RESULTS
Of the 94 Enterobacteriaceae isolates 46 (48.93%) showed an ESBL phenotype. One Enterobacter spp isolate was ESBL-producer and meropenem-resistant. The genetic analysis showed that CTX-M was present in 89.13% (41/46) of the ESBL-producing Enterobacteriaceae, whereas TEM and SHV were detected in 56.52% (26/46) and 21.74% (10/46) respectively (47.83%) of the ESBL-producing isolates were multidrug resistant (MDR). Eleven out of 30 ESBL-producing E-coli isolates were assigned to phylogroup B2, followed by groups B1 (8 isolates), A (6 isolates) and D (5 isolates).
CONCLUSIONS
The high ESBL-E rates (48.93%) found in this study together with the identification of one carbapenem-resistant Enterobacter spp isolate is worrisome. Our results indicate that systems for monitoring and detection of ESBL-producing bacteria in Egyptian hospitals have to be established. Also strict hospital infection control policies with the restriction of the consumption of extended-spectrum cephalosporins are necessary.
目的
本研究旨在调查从疑似血流感染的埃及患者中分离出的肠杆菌科细菌中产超广谱β-内酰胺酶和碳青霉烯酶的情况。
方法
收集了94株来自疑似血流感染的埃及患者的肠杆菌科血培养分离株，每位患者一株。使用基质辅助激光解吸电离飞行时间质谱（基于质谱的Vitek MS系统，生物梅里埃公司）对细菌分离株进行鉴定。使用Vitek 2系统（生物梅里埃公司）筛查超广谱β-内酰胺酶和碳青霉烯酶的产生情况。使用头孢噻肟、头孢他啶和头孢吡肟的联合纸片扩散法确认超广谱β-内酰胺酶的产生，所有药物均添加和不添加克拉维酸（罗斯科公司）。采用实时聚合酶链反应和测序对耐药基因进行特征分析。通过基于聚合酶链反应的方法鉴定大肠杆菌的系统发育群。
结果
在94株肠杆菌科分离株中，46株（48.93%）表现出超广谱β-内酰胺酶表型。一株阴沟肠杆菌分离株产超广谱β-内酰胺酶且对美罗培南耐药。基因分析表明，在产超广谱β-内酰胺酶的肠杆菌科细菌中，89.13%（41/46）存在CTX-M，而TEM和SHV分别在56.52%（26/46）和21.74%（10/46）的产超广谱β-内酰胺酶分离株中被检测到。47.83%的产超广谱β-内酰胺酶分离株对多种药物耐药。30株产超广谱β-内酰胺酶的大肠杆菌分离株中，11株属于B2系统发育群，其次是B1群（8株）、A群（6株）和D群（5株）。
结论
本研究中发现的高产超广谱β-内酰胺酶肠杆菌科细菌率（48.93%）以及一株耐碳青霉烯类阴沟肠杆菌分离株的鉴定令人担忧。我们的结果表明，必须在埃及医院建立监测和检测产超广谱β-内酰胺酶细菌的系统。此外，必须制定严格的医院感染控制政策，限制使用广谱头孢菌素。
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