Findlay Jacqueline, Hopkins Katie L, Doumith Michel, Meunier Danièle, Wiuff Camilla, Hill Robert, Pike Rachel, Loy Richard, Mustafa Nazim, Livermore David M, Woodford Neil
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England, London NW9 5EQ, UK.
Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England, London NW9 5EQ, UK
J Antimicrob Chemother. 2016 May;71(5):1199-206. doi: 10.1093/jac/dkv476. Epub 2016 Feb 3.
Klebsiella pneumoniae carbapenemases (KPCs) have been increasingly reported in the UK since 2003. We analysed patient and isolate data for KPC-positive bacteria confirmed by the national reference laboratory from UK laboratories from August 2003 to August 2014, excluding North-West England, where the epidemiology has previously been studied.
MICs were determined by BSAC agar dilution. Carbapenem-resistant isolates lacking imipenem/EDTA synergy were tested by PCR for blaKPC. MLST and blaKPC sequencing were performed on a subset of isolates. Plasmid analysis was performed by transformation, PCR-based replicon typing and, in some cases, whole-plasmid sequencing. Patient data provided by the sending laboratories were reviewed.
Two hundred and ten isolates with KPC enzymes were submitted from 71 UK laboratories outside North-West England, representing 160 patients. All were Enterobacteriaceae, predominantly K. pneumoniae (82%; 173/210), and most (91%; 191/210) were from hospitalized patients. Analysis of 100 isolates identified blaKPC-2 (62%), blaKPC-3 (30%) and blaKPC-4 (8%). Clonal group (CG) 258 was dominant among K. pneumoniae (64%; 54/84), but 21 unrelated STs were also identified. Plasmid analysis identified a diverse range of plasmids representing >11 different replicon types and found in multiple STs and species. Most (34/35) plasmids with IncFIB/FIIK replicons exhibited >99% sequence identity to pKpQIL.
KPC enzymes are increasingly detected in Enterobacteriaceae in the UK, albeit without the major outbreaks seen in North-West England. K. pneumoniae CG258 are the dominant hosts, but plasmid spread plays a major role in KPC dissemination between other K. pneumoniae STs and enterobacterial species.
自2003年以来，英国肺炎克雷伯菌碳青霉烯酶（KPCs）的报告日益增多。我们分析了2003年8月至2014年8月期间英国各实验室（不包括此前已研究过流行病学情况的英格兰西北部地区）经国家参考实验室确认的KPC阳性细菌的患者和分离株数据。
采用英国抗菌化疗学会（BSAC）琼脂稀释法测定最低抑菌浓度（MICs）。对缺乏亚胺培南/乙二胺四乙酸（EDTA）协同作用的耐碳青霉烯类分离株进行blaKPC的聚合酶链反应（PCR）检测。对部分分离株进行多位点序列分型（MLST）和blaKPC测序。通过转化、基于PCR的复制子分型以及在某些情况下的全质粒测序进行质粒分析。对送检实验室提供的患者数据进行了审查。
来自英格兰西北部以外71家英国实验室的210株携带KPC酶的分离株被提交，代表160名患者。所有分离株均为肠杆菌科细菌，主要是肺炎克雷伯菌（82%；173/210），且大多数（91%；191/210）来自住院患者。对100株分离株的分析确定了blaKPC-2（62%）、blaKPC-3（30%）和blaKPC-4（8%）。克隆群（CG）258在肺炎克雷伯菌中占主导地位（64%；54/84），但也鉴定出21个不相关的序列型（STs）。质粒分析确定了多种质粒，代表超过11种不同的复制子类型，且存在于多个STs和菌种中。大多数（34/35）具有IncFIB/FIIK复制子的质粒与pKpQIL的序列同一性>99%。
在英国的肠杆菌科细菌中越来越多地检测到KPC酶，尽管没有出现像英格兰西北部那样的大规模暴发。肺炎克雷伯菌CG258是主要宿主，但质粒传播在KPC在其他肺炎克雷伯菌STs和肠杆菌菌种之间的传播中起主要作用。
