Antimicrobial Research Group, Blizard Institute, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Microbiology Laboratory Services, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.
Department of Bacteriology and Epidemiology, CVI of Wageningen University, Lelystad, The Netherlands.
J Glob Antimicrob Resist. 2017 Jun;9:96-99. doi: 10.1016/j.jgar.2017.02.008. Epub 2017 Apr 27.
Carbapenem-resistant Enterobacteriaceae (CRE) are identified as a major global health concern. The success of CRE is facilitated by the emergence, acquisition and spread of successful clones carrying plasmid-encoded resistance genes. In this study, an outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in patients hospitalised in Brunei Darussalam was investigated.
Over a 3-month period (May-July 2015), five multidrug-resistant K. pneumoniae were recovered from individual patients admitted to intensive care units at two hospitals (RIPAS and PMMPMHAB) in Brunei. Antimicrobial susceptibility was determined by broth microtitre dilution using a Micronaut-S β-lactamase VII kit or by Etest. Carbapenemase production was confirmed using the RAPID CARB Blue screen, and classes A-D β-lactamases were detected by multiplex PCR. Molecular typing was performed by random amplified polymorphic DNA (RAPD) PCR and multilocus sequence typing (MLST), with associated virulence and capsular types identified by PCR and sequencing. Plasmids were extracted, sized and characterised by PCR-based replicon typing.
All isolates were resistant to cephalosporins, carbapenems, aminoglycosides, quinolones and sulfonamides but remained susceptible to polymyxins. Isolates were indistinguishable by RAPD-PCR and all belonged to sequence type (ST231). Resistance was due to the production of OXA-232 and CTX-M-15 β-lactamases, with the bla carbapenemase gene located on a ColE-like plasmid.
This is the first report of plasmid-encoded OXA-232-producing CRKP in Brunei hospitals. All isolates were members of ST231, which may be representatives of a high-risk CRKP clone disseminating across Southeast Asia.
耐碳青霉烯肠杆菌科（CRE）被认为是一个主要的全球健康问题。由于携带质粒编码耐药基因的成功克隆的出现、获得和传播，CRE 的成功得到了促进。在这项研究中，对文莱达鲁萨兰国住院患者中爆发的耐碳青霉烯肺炎克雷伯菌（CRKP）感染进行了调查。
在 3 个月的时间（2015 年 5 月至 7 月）内，从文莱两家医院（RIPAS 和 PMMPMHAB）的重症监护病房的个别患者中分离出 5 株多药耐药肺炎克雷伯菌。采用肉汤微量稀释法使用 Micronaut-S β-内酰胺酶 VII 试剂盒或 Etest 测定抗菌药物敏感性。使用 RAPID CARB Blue 屏幕确认碳青霉烯酶的产生，并通过多重 PCR 检测 A-D 类β-内酰胺酶。通过随机扩增多态性 DNA（RAPD）PCR 和多位点序列分型（MLST）进行分子分型，通过 PCR 和测序鉴定相关毒力和荚膜型。通过基于 PCR 的复制子分型提取、大小和特征质粒。
所有分离株均对头孢菌素、碳青霉烯类、氨基糖苷类、喹诺酮类和磺胺类药物耐药，但对多粘菌素仍敏感。RAPD-PCR 无法区分分离株，所有分离株均属于序列型（ST231）。耐药性是由于产生 OXA-232 和 CTX-M-15 β-内酰胺酶引起的，bla 碳青霉烯酶基因位于 ColE 样质粒上。
这是文莱医院报告的首例质粒编码的 OXA-232 产 CRKP。所有分离株均为 ST231 成员，可能是传播到东南亚的高风险 CRKP 克隆的代表。
