Karlowsky James A, Lob Sibylle H, Kazmierczak Krystyna M, Badal Robert E, Young Katherine, Motyl Mary R, Sahm Daniel F
Department of Medical Microbiology, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
International Health Management Associates, Inc., Schaumburg, Illinois, USA
J Clin Microbiol. 2017 Jun;55(6):1638-1649. doi: 10.1128/JCM.02316-16. Epub 2017 Mar 15.
The Study for Monitoring Antimicrobial Resistance Trends (SMART) global surveillance program collected 103,960 isolates of from 2008 to 2014. From this isolate collection, all ertapenem-nonsusceptible isolates (MIC, ≥1 μg/ml; = 3,428) and 9,371 isolates of , , , and with an ertapenem-susceptible extended-spectrum-β-lactamase (ESBL)-positive phenotype were assessed for the presence of common carbapenemase genes using a Check-MDR CT101 microarray (Check-Points, Wageningen, the Netherlands) and published multiplex PCR assays. Testing identified 1,493 isolates that harbored a carbapenemase gene (1,485 ertapenem-nonsusceptible isolates and 8 ertapenem-susceptible ESBL-positive isolates) and accounted for 1.4% (1,493/103,960) of all isolates of The most frequently identified carbapenemase genes were the KPC ( = 794), OXA-48-like ( = 300), and NDM ( = 290) genes. Carbapenemase genes were most frequently identified in ( = 1,127), ( = 149), and ( = 110). Among the carbapenemase-positive isolates, 66.7% (2/3), 37.0% (111/300), 20.0% (8/40), 3.3% (3/92), 2.3% (18/794), and 0% (0/290) of the isolates with genes for GES, OXA-48-like, IMP, VIM, KPC, and NDM, respectively, were susceptible to imipenem (MIC, ≤1 μg/ml). Isolates that tested as susceptible to imipenem were not uncommon among carbapenemase-positive isolates (9.4%, 141/1,493) and most frequently carried OXA-48-like enzymes (78.7%; 111/141); however, overall, these isolates remained rare (0.1%, 141/103,960). The practice of screening clinical isolates of that test as susceptible to carbapenems for the presence of carbapenemase genes remains controversial and requires further study.
监测抗菌药物耐药性趋势(SMART)全球监测项目在2008年至2014年期间收集了103,960株分离株。从这些分离株中,使用Check-MDR CT101微阵列(荷兰瓦赫宁根的Check-Points公司)和已发表的多重PCR检测方法,对所有厄他培南不敏感分离株(MIC≥1μg/ml;n = 3,428)以及9,371株具有厄他培南敏感的超广谱β-内酰胺酶(ESBL)阳性表型的大肠埃希菌、肺炎克雷伯菌、奇异变形杆菌和阴沟肠杆菌分离株进行常见碳青霉烯酶基因检测。检测发现1,493株携带碳青霉烯酶基因的分离株(1,485株厄他培南不敏感分离株和8株厄他培南敏感的ESBL阳性分离株),占所有分离株的1.4%(1,493/103,960)。最常检测到的碳青霉烯酶基因是KPC(n = 794)、OXA-48样(n = 300)和NDM(n = 290)基因。碳青霉烯酶基因在肺炎克雷伯菌(n = 1,127)、大肠埃希菌(n = 149)和奇异变形杆菌(n = 110)中最常被检测到。在碳青霉烯酶阳性分离株中,分别携带GES、OXA-48样、IMP、VIM、KPC和NDM基因的分离株对亚胺培南敏感(MIC≤1μg/ml)的比例为66.7%(2/3)、37.0%(111/300)、20.0%(8/40)、3.3%(3/92)、2.3%(18/794)和0%(0/290)。在碳青霉烯酶阳性分离株中,对亚胺培南检测为敏感的分离株并不罕见(9.4%,141/1,493),且最常携带OXA-48样酶(78.7%;111/141);然而,总体而言,这些分离株仍然很少见(0.1%,141/103,960)。对碳青霉烯类药物敏感的临床大肠埃希菌分离株进行碳青霉烯酶基因筛查的做法仍存在争议,需要进一步研究。