埃塞俄比亚住院患者中产超广谱β-内酰胺酶肠杆菌科细菌的高胃肠道定植率：产碳青霉烯酶肺炎克雷伯菌的出现
High Gastrointestinal Colonization Rate with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Emergence of Carbapenemase-Producing K. pneumoniae in Ethiopia.
作者信息
Desta Kassu, Woldeamanuel Yimtubezinash, Azazh Aklilu, Mohammod Halima, Desalegn Dawit, Shimelis Damte, Gulilat Dereje, Lamisso Biruk, Makonnen Eyasu, Worku Alemayehu, Mannerqvist Kerstin, Struwe Johan, Aspevall Olov, Aklillu Eleni
机构信息
Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
出版信息
PLoS One. 2016 Aug 30;11(8):e0161685. doi: 10.1371/journal.pone.0161685. eCollection 2016.
We investigated the gastrointestinal colonization rate and antibiotic resistance patterns of Extended-Spectrum Beta-Lactamase (ESBL)- producing Escherichia coli and Klebsiella pneumoniae in hospitalized patients admitted at Ethiopia's largest tertiary hospital. Fecal samples/swabs from 267 patients were cultured on chrome agar. ESBL. Bacterial species identification, verification of ESBL production and antibiotic susceptibility testing were done using Vitek 2 system (bioMérieux, France). Phenotype characterization of ESBL-E.coli and ESBL- K.pneumoniae was done using Neo-Sensitabs™. ESBL positivity rate was much higher in K. pneumoniae (76%) than E. coli (45%). The overall gastrointestinal colonization rate of ESBL producing Enterobacteriaceae (ESBL-E) in hospitalized patients was 52% (95%CI; 46%-58%) of which, ESBL-E. coli and K.pneumoniae accounted for 68% and 32% respectively. Fecal ESBL-E carriage rate in neonates, children and adults was 74%, 59% and 46% respectively. Gastrointestinal colonization rate of ESBL-E.coli in neonates, children and adults was 11%, 42% and 42% respectively. Of all E. coli strains isolated from adults, children and neonates, 44%, 49% and 22% were ESBL positive (p = 0.28). The prevalence of ESBL-K.pneumoniae carriage in neonates, children and adults was 68%, 22% and 7% respectively. All K. pneumoniae isolated from neonates (100%) and 88% of K. pneumoniae isolated from children were ESBL positive, but only 50% of K.pneumoniae isolated from adults were ESBL positive (p = 0.001). Thirteen patients (5%) were carriers of both ESBL-E.coli and ESBL-KP. The overall carrier rate of ESBL producing isolates resistant to carbapenem was 2% (5/267), all detected in children; three with E.coli HL cephalosporinase (AmpC), resistant to ertapenem and two with K. pneumoniae Carbapenemase (KPC) resistant to meropenem, ertapenem and impenem. We report a high gastrointestinal colonization rate with ESBL-E and the emergence of carbapenems-resistant K. pneumoniae in Ethiopia. Urgent implementation of infection control measures, and surveillance are urgently needed to limit the spread within healthcare facilities and further to the community.
我们调查了埃塞俄比亚最大的三级医院住院患者中产超广谱β-内酰胺酶（ESBL）的大肠杆菌和肺炎克雷伯菌的胃肠道定植率及抗生素耐药模式。对267例患者的粪便样本/拭子在铬琼脂上进行培养。采用Vitek 2系统（法国生物梅里埃公司）进行ESBL细菌种类鉴定、ESBL产生的验证及抗生素敏感性测试。使用Neo-Sensitabs™对产ESBL大肠杆菌和产ESBL肺炎克雷伯菌进行表型特征分析。肺炎克雷伯菌的ESBL阳性率（76%）远高于大肠杆菌（45%）。住院患者中产ESBL肠杆菌科细菌（ESBL-E）的总体胃肠道定植率为52%（95%CI：46%-58%），其中产ESBL大肠杆菌和肺炎克雷伯菌分别占68%和32%。新生儿、儿童和成人的粪便ESBL-E携带率分别为74%、59%和46%。新生儿、儿童和成人中产ESBL大肠杆菌的胃肠道定植率分别为11%、42%和42%。从成人、儿童和新生儿分离出的所有大肠杆菌菌株中，ESBL阳性率分别为44%、49%和22%（p = 0.28）。新生儿、儿童和成人中产ESBL肺炎克雷伯菌的携带率分别为68%、22%和7%。从新生儿分离出的所有肺炎克雷伯菌（100%）以及从儿童分离出的88%的肺炎克雷伯菌为ESBL阳性，但从成人分离出的肺炎克雷伯菌中只有50%为ESBL阳性（p = 0.001）。13例患者（5%）同时携带产ESBL大肠杆菌和产ESBL肺炎克雷伯菌。对碳青霉烯类耐药的产ESBL分离株的总体携带率为2%（5/267），均在儿童中检测到；3例为产大肠杆菌HL头孢菌素酶（AmpC），对厄他培南耐药，2例为产肺炎克雷伯菌碳青霉烯酶（KPC），对美罗培南、厄他培南和亚胺培南耐药。我们报道了埃塞俄比亚产ESBL-E的高胃肠道定植率以及耐碳青霉烯类肺炎克雷伯菌的出现。迫切需要实施感染控制措施和监测，以限制其在医疗机构内的传播并进一步传播至社区。
Zotero 插件