Findlay Jacqueline, Hopkins Katie L, Alvarez-Buylla Adela, Meunier Daniéle, Mustafa Nazim, Hill Robert, Pike Rachel, McCrae Li-Xu, Hawkey Peter M, Woodford Neil
Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, PHE, 61 Colindale Avenue, London NW9 5EQ, UK.
PHE Public Health Laboratory Birmingham, Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK.
J Antimicrob Chemother. 2017 Apr 1;72(4):1054-1062. doi: 10.1093/jac/dkw560.
Carbapenemase-producing Enterobacteriaceae (CPE) have been increasingly reported in the UK since 2003. We analysed patient and isolate data for CPE confirmed by the national reference laboratory from laboratories in the West Midlands region from November 2007 to December 2014.
MICs were determined by BSAC agar dilution methodology and isolates exhibiting resistance to one or more carbapenems were screened for carbapenemase genes by PCR. Plasmid analyses were performed after electro-transformation of carbapenemase-encoding plasmids. WGS was performed on both transformants and clinical isolates. Patient data provided by the sending laboratories were reviewed.
During the study period, CPE ( n = 139) were submitted from 13 laboratories in the West Midlands region, originating from 108 patients and including one environmental isolate. CPE submissions increased significantly from 2009 onwards. Isolates were predominantly Klebsiella pneumoniae (89/139) obtained from inpatients. WGS was performed on all clinical isolates and transformants. After deduplication 119 isolates and 96 transformants remained for analysis. Within these, four families of carbapenemase genes were identified: bla NDM (69/119), bla KPC (26/119), bla OXA-48-like (16/119) and bla VIM (7/119); one isolate carried both bla NDM and bla OXA-48-like . Isolates represented diverse STs and plasmid replicon types. Plasmid analyses identified plasmids of different replicon types encoding bla KPC , bla NDM and bla OXA-48-like genes, found across several species and STs.
CPE have been reported increasingly in the West Midlands region over a 7 year period. bla NDM , bla KPC and bla OXA-48-like were the dominant carbapenemase genes and were found in a range of diverse genomic/plasmid environments, highlighting their ability to mobilize across different plasmids, often impeding the detection of outbreaks.
自2003年以来，英国产碳青霉烯酶肠杆菌科细菌（CPE）的报告日益增多。我们分析了2007年11月至2014年12月期间西米德兰兹地区各实验室送交国家参考实验室确诊的CPE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（MIC），对一株或多株碳青霉烯类耐药的分离株通过聚合酶链反应（PCR）筛查碳青霉烯酶基因。对编码碳青霉烯酶的质粒进行电转化后进行质粒分析。对转化子和临床分离株均进行全基因组测序（WGS）。对送交实验室提供的患者数据进行审查。
在研究期间，西米德兰兹地区13个实验室送交了139株CPE，来源于108例患者，包括1株环境分离株。自2009年起，CPE送交数量显著增加。分离株主要为肺炎克雷伯菌（89/139），来自住院患者。对所有临床分离株和转化子均进行了WGS。去除重复菌株后，剩余119株分离株和96株转化子用于分析。在这些菌株中，鉴定出了四个碳青霉烯酶基因家族：bla NDM（69/119）、bla KPC（26/119）、bla OXA - 48样（16/119）和bla VIM（7/119）；1株分离株同时携带bla NDM和bla OXA - 48样基因。分离株代表了不同的序列型（ST）和质粒复制子类型。质粒分析鉴定出不同复制子类型的质粒编码bla KPC、bla NDM和bla OXA - 48样基因，这些质粒在多个菌种和ST中均有发现。
在7年期间，西米德兰兹地区CPE报告日益增多。bla NDM、bla KPC和bla OXA - 48样是主要的碳青霉烯酶基因，存在于多种不同的基因组/质粒环境中，突出了它们在不同质粒间转移的能力，这常常阻碍暴发的检测。
