Karabay Oguz, Altindis Mustafa, Koroglu Mehmet, Karatuna Onur, Aydemir Özlem Akkaya, Erdem Ali Fuat
Department of Infectious Diseases and Clinical Microbiology, Health Sciences Institute and School of Medicine of Sakarya University, 54100, Sakarya, Turkey.
Department of Medical Microbiology, School of Medicine, Sakarya University, Sakarya, Turkey.
Ann Clin Microbiol Antimicrob. 2016 Feb 9;15:6. doi: 10.1186/s12941-016-0118-4.
Recently, new carbapenemases in Enterobacteriaceae strains and non-fermentative gram-negative bacilli have been reported. The New Delhi metallo-β-lactamase-1 (NDM-1) is a major problem around the world. The purpose of this article is to address the NDM-1 Klebsiella pneumoniae epidemic detected in eight cases in our hospital.
Bacteria identified in this epidemic were from patients already admitted to the intensive care unit of the Sakarya University Training and Research Hospital during efforts toward establishment of infection surveillance and control program. Antimicrobial susceptibility testing of strains was performed using the VITEK 2 system (bioMérieux, France), E-test gradient strips (bioMérieux, France), and the disc diffusion test. For the metallo-beta-lactamase activity, the combined disc diffusion test and modified Hodge test as phenotypic tests were performed. To identify the resistance gene, the Xpert Carba-R kit (Cepheid Inc., USA) and an in-house multiplex polymerase chain reaction (PCR) method designed for five common carbapenemase genes (IMP, VIM, KPC, NDM-1, and OXA-48) were employed. The clonal relationship of these strains was explored by the repetitive PCR (rep-PCR, DiversiLab System, bioMérieux, France) method.
During the December 2014 to March 2015 period, NDM-1 positive K. pneumoniae strains were detected in eight patients. All of these strains were found to produce NDM-1, while two of them also revealed the presence of OXA-48. The rep-PCR results reveal a clonal proximity of 95 % for six of the eight strains.
Our findings suggest the tendency of NDM-1-producing strains to spread in our country as well. A carbapenem-resistant K. pneumoniae threat may pose a great risk to our country. It is clear that more comprehensive infection control precautions should be implemented in our hospitals.
最近，已报道了肠杆菌科菌株和非发酵革兰氏阴性杆菌中的新型碳青霉烯酶。新德里金属β-内酰胺酶-1（NDM-1）是全球范围内的一个主要问题。本文旨在探讨我院检测到的8例NDM-1肺炎克雷伯菌疫情。
此次疫情中鉴定出的细菌来自萨卡里亚大学培训与研究医院重症监护病房已入院的患者，当时正在努力建立感染监测和控制项目。使用VITEK 2系统（法国生物梅里埃公司）、E-test梯度条（法国生物梅里埃公司）和纸片扩散试验对菌株进行药敏试验。对于金属β-内酰胺酶活性，进行联合纸片扩散试验和改良Hodge试验作为表型试验。为鉴定耐药基因，采用Xpert Carba-R试剂盒（美国 Cepheid公司）和为五个常见碳青霉烯酶基因（IMP、VIM、KPC、NDM-1和OXA-48）设计的内部多重聚合酶链反应（PCR）方法。通过重复PCR（rep-PCR，法国生物梅里埃公司的DiversiLab系统）方法探索这些菌株的克隆关系。
在2014年12月至2015年3月期间，8例患者中检测到NDM-1阳性肺炎克雷伯菌菌株。所有这些菌株均被发现产生NDM-1，其中两株还显示存在OXA-48。rep-PCR结果显示，8株菌株中有6株的克隆相似性为95%。
我们的研究结果表明，产NDM-1菌株在我国也有传播趋势。耐碳青霉烯肺炎克雷伯菌的威胁可能给我国带来巨大风险。显然，我国医院应实施更全面的感染控制预防措施。
