Cipolla Lucía, Rocca Florencia, Martinez Claudia, Aguerre Lorena, Barrios Rubén, Prieto Mónica
Servicio Bacteriología Especial, Departamento Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI)-Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Dr. Carlos G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina.
Servicio Bacteriología Especial, Departamento Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI)-Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) Dr. Carlos G. Malbrán, Ciudad Autónoma de Buenos Aires, Argentina.
Enferm Infecc Microbiol Clin (Engl Ed). 2018 Aug-Sep;36(7):431-434. doi: 10.1016/j.eimc.2017.09.002. Epub 2017 Oct 18.
Burkholderia cepacia (B. cepacia) complex is composed of 20 phylogenetically closely related bacterial species. Some species have emerged as opportunistic pathogens in immunocompromised patients and are responsible for nosocomial outbreaks. The B. cepacia complex is a recognized respiratory pathogen in patients with cystic fibrosis. Burkholderia cenocepacia and Burkholderia multivorans (B. multivorans) are the most prevalent species in the world, according to the literature. However, research groups in Argentina have described a particular local epidemiology, with prevalence of Burkholderia contaminans (B. contaminans).
A total of 68 isolates of B. cepacia complex recovered of 46 cystic fibrosis patients attended at 14 hospitals distributed in 9 provinces of the country were studied. Identification was carried out by conventional phenotypic methods and was confirmed by recA gene sequencing. Sequences were analysed using the BLASTN program and comparing with B. cepacia complex type strains sequences deposited in GenBank. Antibiotic susceptibility tests were performed on isolates of the most prevalent species according to CLSI M45 guidelines.
The prevalent specie was B. contaminans (49%, n = 33) followed by B. cenocepacia (25%; n = 17). The remaining species were Burkholderia seminalis (B. seminalis) (7%, n = 5), B. cepacia (7%, n = 5), B. multivorans (6%, n = 4), Burkholderia vietnamensis (5%, n=3) and Burkholderia pyrrocinia (1%; n = 1). The 46% of B. contaminans isolates were resistant to SXT and 76% sensitive to MIN, MEM and CAZ. The isolates of B. cenocepacia were 100% resistant to SXT and MIN and 47% to CAZ and MEM. B. seminalis showed high levels of resistance to TMS (80%), CAZ (60%) and MIN (60%), and 60% of the isolates showed intermediate sensitivity to MEM.
Previous reports have described the prevalence of B. contaminans isolation from cystic fibrosis patients in Argentina, Spain and Portugal, and a case of two patients with cystic fibrosis in Ireland has recently been reported. Due to the high frequency with which B. contaminans is isolated in our country, it is necessary to promote the investigation of possible sources of infection and to understand the factors and mechanisms involved in the apparent greater transmissibility of this species. Different antimicrobial resistance profiles were detected between the species.
洋葱伯克霍尔德菌复合体由20种系统发育关系密切的细菌物种组成。一些物种已成为免疫功能低下患者的机会致病菌,并导致医院内感染暴发。在囊性纤维化患者中,洋葱伯克霍尔德菌复合体是一种公认的呼吸道病原体。根据文献,洋葱伯克霍尔德菌和多源伯克霍尔德菌是世界上最常见的物种。然而,阿根廷的研究小组描述了一种特殊的当地流行病学情况,即污染伯克霍尔德菌较为常见。
对从该国9个省份14家医院就诊的46例囊性纤维化患者中分离出的68株洋葱伯克霍尔德菌复合体菌株进行了研究。通过传统的表型方法进行鉴定,并通过recA基因测序进行确认。使用BLASTN程序分析序列,并与GenBank中保存的洋葱伯克霍尔德菌复合体标准菌株序列进行比较。根据CLSI M45指南对最常见物种的分离株进行抗生素敏感性测试。
最常见的物种是污染伯克霍尔德菌(49%,n = 33),其次是洋葱伯克霍尔德菌(25%;n = 17)。其余物种为浅黄伯克霍尔德菌(7%,n = 5)、洋葱伯克霍尔德菌(7%,n = 5)、多源伯克霍尔德菌(6%,n = 4)、越南伯克霍尔德菌(5%,n = 3)和吡咯伯克霍尔德菌(1%;n = 1)。46%的污染伯克霍尔德菌分离株对复方新诺明耐药,76%对米诺环素、美罗培南和头孢他啶敏感。洋葱伯克霍尔德菌的分离株对复方新诺明和米诺环素的耐药率为100%,对头孢他啶和美罗培南的耐药率为47%。浅黄伯克霍尔德菌对替卡西林/棒酸(80%)、头孢他啶(60%)和米诺环素(60%)表现出高耐药水平,60%的分离株对美罗培南表现出中度敏感性。
先前的报告描述了在阿根廷、西班牙和葡萄牙从囊性纤维化患者中分离出污染伯克霍尔德菌的情况,最近在爱尔兰也报告了一例涉及两名囊性纤维化患者的病例。由于在我国分离出污染伯克霍尔德菌的频率较高,有必要促进对可能的感染源进行调查,并了解该物种明显更高传播性所涉及的因素和机制。在不同物种之间检测到了不同的抗菌药物耐药谱。