Mavroidi Angeliki, Katsiari Maria, Likousi Sofia, Palla Eleftheria, Roussou Zoi, Nikolaou Charikleia, Maguina Asimina, Platsouka Evangelia D
1 Department of Microbiology, General Hospital of Nea Ionia "Konstantopouleio-Patission," Athens, Greece .
2 Intensive Care Unit, General Hospital of Nea Ionia "Konstantopouleio-Patission," Athens, Greece .
Microb Drug Resist. 2016 Jul;22(5):392-8. doi: 10.1089/mdr.2015.0282. Epub 2016 Feb 3.
The emergence of colistin resistance may further contribute to treatment failure of infection caused by multidrug-resistant (MDR) Klebsiella pneumoniae. The colistin resistance rates were determined and colistin-resistant carbapenemase-producing K. pneumoniae (COL-R CP-Kp) were characterized over an 18-month period in a Greek hospital. Out of 135 carbapenemase producers, 19 isolates (14%) were categorized as resistant to colistin. Phenotypic and molecular characterization of the COL-R CP-Kp isolates revealed that all were MDR blaKPC producers and, excluding one isolate of MLST ST383, belonged to the international clonal lineage ST258. Furthermore, PCR amplification and sequencing of the mgrB locus revealed nucleotide sequences of different sizes and insertions of IS1- and IS5-like mobile elements. The majority (63%) of the COL-R blaKPC producers was recovered from patients in the intensive care unit (ICU) and clinical data indicated that all patients should have acquired these isolates in the ICU. The findings of the present study underscore a concerning evolution of colistin resistance in a setting of high K. pneumoniae carbapenemase (KPC)-Kp endemicity, such as Greece. Thus, continuous surveillance, molecular characterization, prudent use of antibiotics, and implementation of infection control measures for K. pneumoniae are urgent.
黏菌素耐药性的出现可能会进一步导致耐多药（MDR）肺炎克雷伯菌引起的感染治疗失败。在一家希腊医院，对18个月期间的黏菌素耐药率进行了测定，并对产黏菌素耐药碳青霉烯酶的肺炎克雷伯菌（COL-R CP-Kp）进行了特征分析。在135株碳青霉烯酶产生菌中，有19株（14%）被归类为对黏菌素耐药。对COL-R CP-Kp分离株的表型和分子特征分析表明，所有分离株均为产MDR blaKPC菌株，除一株序列类型为ST383的分离株外，其余均属于国际克隆谱系ST258。此外，对mgrB基因座进行PCR扩增和测序，结果显示核苷酸序列大小不同，且存在IS1和IS5样移动元件的插入。大多数（63%）产COL-R blaKPC菌株是从重症监护病房（ICU）的患者中分离得到的，临床数据表明所有患者均应是在ICU获得这些菌株的。本研究结果突显了在肺炎克雷伯菌碳青霉烯酶（KPC）-Kp高流行地区，如希腊，黏菌素耐药性令人担忧的演变情况。因此，对肺炎克雷伯菌进行持续监测、分子特征分析、谨慎使用抗生素以及实施感染控制措施迫在眉睫。
