Jamal Wafaa Y, Albert M John, Rotimi Vincent O
Department of Microbiology, Faculty of Medicine, Kuwait University and Microbiology Unit, Mubarak Al Kabir Hospital, Jabriya, Kuwait.
PLoS One. 2016 Mar 31;11(3):e0152638. doi: 10.1371/journal.pone.0152638. eCollection 2016.
The aim of the study was to determine the prevalence of New Delhi metallo-β lactamase-1 (NDM-1) producing Enterobacteriaceae in Kuwait over a one year period. Consecutive Enterobacteriaceae isolates with reduced susceptibility to carbapenems were collected from four government hospitals in Kuwait from January-December 2014. Their susceptibility to 18 antibiotics was performed by determining the minimum inhibitory concentration. Isolates resistant to carbapenems were tested by PCR for resistant genes. Finger printing of the positive isolates was done by DiversiLab®. Clinical data of patients harboring NDM-1 positive isolates were analyzed. A total of 764 clinically significant Enterobacteriaceae isolates were studied. Of these, 61 (8%) were carbapenem-resistant. Twenty one out of these 61 (34.4%) were NDM-1-producers. All patients positive for NDM-1-carrying bacteria were hospitalized. About half were females (11/21 [52.3%]), average age was 53.3 years and the majority were Kuwaitis (14/21 [66.6%]). Six patients (28.5%) gave a history of travel or healthcare contact in an endemic area. Mortality rate was relatively high (28.6%). The predominant organism was Klebsiella pneumoniae (14 [66.6%]) followed by E. coli (4 [19%]). All NDM-1-positive isolates were resistant to meropenem, ertapenem, cefotaxime, cefoxitin and ampicillin, while 95.2% were resistant to imipenem, cefepime, and piperacillin-tazobactam. They were multidrug resistant including resistance to tigecycline, but 90% remained susceptible to colistin. About two-thirds of isolates (61.9%) co-produced-extended spectrum β-lactamases. During the study period, an outbreak of NDM-1 positive K. pneumoniae occurred in one hospital involving 3 patients confirmed by DiversiLab® analysis. In conclusion, NDM-1-producing Enterobacteriaceae is a growing healthcare problem with increasing prevalence in Kuwait, especially in hospitalized patients, leaving few therapeutic options. A high prevalence of NDM-1 necessitates the implementation of strict infection control to prevent the spread of these organisms.
该研究的目的是确定科威特一年内产新德里金属β-内酰胺酶-1(NDM-1)的肠杆菌科细菌的流行情况。2014年1月至12月期间,从科威特的四家政府医院收集对碳青霉烯类药物敏感性降低的连续肠杆菌科分离株。通过测定最低抑菌浓度来检测它们对18种抗生素的敏感性。对碳青霉烯类耐药的分离株通过PCR检测耐药基因。阳性分离株的指纹图谱通过DiversiLab®完成。对携带NDM-1阳性分离株患者的临床数据进行分析。共研究了764株具有临床意义的肠杆菌科分离株。其中,61株(8%)对碳青霉烯类耐药。这61株中的21株(34.4%)产NDM-1。所有携带NDM-1细菌阳性的患者均住院治疗。约一半为女性(11/21[52.3%]),平均年龄为53.3岁,大多数为科威特人(14/21[66.6%])。6例患者(28.5%)有在流行地区旅行或接受医疗护理的病史。死亡率相对较高(28.6%)。主要菌株是肺炎克雷伯菌(14株[66.6%]),其次是大肠杆菌(4株[19%])。所有NDM-1阳性分离株对美罗培南、厄他培南、头孢噻肟、头孢西丁和氨苄西林耐药,而95.2%对亚胺培南、头孢吡肟和哌拉西林-他唑巴坦耐药。它们对多种药物耐药,包括对替加环素耐药,但90%对黏菌素仍敏感。约三分之二的分离株(61.9%)同时产超广谱β-内酰胺酶。在研究期间,一家医院发生了一起NDM-1阳性肺炎克雷伯菌的暴发,涉及3例患者,经DiversiLab®分析确诊。总之,产NDM-1的肠杆菌科细菌是一个日益严重的医疗问题,在科威特的流行率不断上升,尤其是在住院患者中,可供选择的治疗方法很少。NDM-1的高流行率使得必须实施严格的感染控制措施以防止这些细菌的传播。