Sonnevend Ágnes, Ghazawi Akela A, Hashmey Rayhan, Jamal Wafaa, Rotimi Vincent O, Shibl Atef M, Al-Jardani Amina, Al-Abri Seif S, Tariq Waheed U Z, Weber Stefan, Pál Tibor
Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Department of Medicine, Tawam Hospital, Al Ain, United Arab Emirates.
PLoS One. 2015 Jun 25;10(6):e0131372. doi: 10.1371/journal.pone.0131372. eCollection 2015.
To establish the role of local transmission versus possible pathogen import due to previous foreign exposure in infections caused by carbapenem non-susceptible Enterobacteriaceae in the Arabian Peninsula, 200 independent isolates collected in 16 hospitals of Saudi Arabia, Kuwait, Oman and the United Arab Emirates were studied. All strains were multidrug resistant; 42.5% of them also qualified as extremely drug resistant. The frequency of various carbapenemases varied according to the participating countries, but in the collection, as a whole, blaNDM-1 was the most frequently encountered carbapenemase gene (46.5%) followed by blaOXA-48-like gene (32.5%). A comparatively high rate (8.9%) of multi-clonal strains carrying both blaNDM and blaOXA-48-like genes in the United Arab Emirates, representing the most resistant subgroup, was encountered. No KPC-expressing isolates were detected. Three major clones of blaNDM-1 carrying Klebsiella pneumoniae of ST152 (n = 22, Saudi Arabia), ST14 (n = 7, United Arab Emirates) and ST147 types (n = 9, Oman) were identified, the latter two clones carrying similar, but not identical HI1b incompatibility type plasmids of >170 kb. While from 78.6% of the cases with documented foreign hospitalization blaNDM positive strains were isolated, these strains formed only 25.6% of all the isolates expressing this enzyme. In fact, 56.8% of the NDM, 75.7% of OXA-48-like and 90.9% of VIM positive strains were recovered from patients without documented foreign exposure, neither in the form of travel or prior hospitalization abroad, suggesting a high rate of autochthonous infections. This, considering the extensive links of these countries to the rest of the world, predicts that trends in the local epidemiology of carbapenem resistant strains may increasingly affect the spread of these pathogens on the global scale. These results call for improved surveillance of carbapenem resistant Enterobacteriaceae in the countries of the Arabian Peninsula.
为确定在阿拉伯半岛碳青霉烯类不敏感肠杆菌科细菌引起的感染中，本地传播与既往国外接触导致病原体输入的可能作用，对沙特阿拉伯、科威特、阿曼和阿拉伯联合酋长国16家医院收集的200株独立分离株进行了研究。所有菌株均对多种药物耐药；其中42.5%还属于极度耐药。不同碳青霉烯酶的频率因参与研究的国家而异，但总体而言，blaNDM - 1是最常遇到的碳青霉烯酶基因（46.5%），其次是blaOXA - 48样基因（32.5%）。在阿拉伯联合酋长国发现了携带blaNDM和blaOXA - 48样基因的多克隆菌株的比例相对较高（8.9%），这是耐药性最强的亚组。未检测到表达KPC的分离株。鉴定出携带blaNDM - 1的肺炎克雷伯菌的三个主要克隆，分别为ST152型（n = 22，沙特阿拉伯）、ST14型（n = 7，阿拉伯联合酋长国）和ST147型（n = 9，阿曼），后两个克隆携带相似但不完全相同的大于170 kb的HI1b不相容型质粒。虽然在有国外住院记录的病例中，78.6%分离出blaNDM阳性菌株，但这些菌株仅占所有表达该酶的分离株的25.6%。事实上，56.8%的NDM阳性菌株、75.7%的OXA - 48样阳性菌株和90.9%的VIM阳性菌株是从没有国外接触记录的患者中分离出来的，既不是以出国旅行的形式，也不是以前在国外住院的形式，这表明本地感染率很高。考虑到这些国家与世界其他地区的广泛联系，这预示着碳青霉烯耐药菌株的本地流行病学趋势可能越来越多地影响这些病原体在全球范围内的传播。这些结果呼吁加强对阿拉伯半岛各国碳青霉烯耐药肠杆菌科细菌的监测。
