Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Laboratori de Referència de Catalunya, El Prat de Llobregat, Barcelona, Spain.
Servei d'Urgències i Semicrítics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Spain.
J Infect. 2017 Dec;75(6):493-498. doi: 10.1016/j.jinf.2017.09.008. Epub 2017 Sep 14.
The objectives were to determine the prevalence of colistin resistance in clinical isolates of Enterobacteriaceae, and to gain knowledge on the epidemiological and clinical features of the patients.
All colistin-resistant Enterobacteriaceae consecutively isolated from clinical samples in our institution from 2012 to 2015, were included in this cross-sectional study. Intrinsic-resistant species were excluded. Minimum inhibitory concentration was performed by gradient diffusion. Detection of plasmid-encoded colistin resistance genes mcr-1 and mcr-2 was performed by amplification. Epidemiological and clinical features were reviewed.
Of 13579 Enterobacteriaceae isolates, 91 were colistin-resistant. The overall prevalence of colistin resistance was 0.67%. The rates were higher in Enterobacter cloacae (4.2%) than Escherichia coli (0.5%) and Klebsiella pneumoniae (0.4%). One third of the isolates were multi-drug resistant (MDR). While mcr-2 was not detected, mcr-1 was detected only in E. coli. Regarding these infections, 23% were community-acquired. 89% of the patients had not received colistin previously. There were no significant differences between infections caused by mcr-1 and non-mcr-1-carrying isolates.
Colistin resistance was not restricted to MDR isolates and to clinical settings. Most patients had no record of previous administration of colistin.
确定临床分离肠杆菌科细菌对黏菌素耐药的流行率，并了解患者的流行病学和临床特征。
本横断面研究纳入了 2012 年至 2015 年我院临床标本中连续分离的所有对黏菌素耐药的肠杆菌科细菌。排除固有耐药的菌种。采用梯度扩散法测定最小抑菌浓度。采用扩增法检测质粒编码的黏菌素耐药基因 mcr-1 和 mcr-2。回顾性分析流行病学和临床特征。
在 13579 株肠杆菌科细菌中，有 91 株对黏菌素耐药。总的耐药率为 0.67%。肠杆菌属（4.2%）的耐药率高于大肠埃希菌（0.5%）和肺炎克雷伯菌（0.4%）。三分之一的分离株为多重耐药（MDR）。虽然未检测到 mcr-2，但仅在大肠埃希菌中检测到 mcr-1。在这些感染中，23%为社区获得性感染。89%的患者以前未接受过黏菌素治疗。mcr-1 携带株和非 mcr-1 携带株引起的感染之间无显著差异。
黏菌素耐药不仅限于 MDR 分离株和临床环境。大多数患者以前没有接受过黏菌素治疗的记录。
