尿路感染犬猫中抗菌药物耐药性增加和主要国际高危克隆谱系的出现：16 年回顾性研究。
Increase in antimicrobial resistance and emergence of major international high-risk clonal lineages in dogs and cats with urinary tract infection: 16 year retrospective study.
机构信息
Laboratory of Resistance to Antibiotics and Biocides, CIISA, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Lisbon, Portugal.
Animal Genetic Resources, CIISA, Faculdade de Medicina Veterinária, Universidade de Lisboa (FMV-UL), Lisbon, Portugal.
出版信息
J Antimicrob Chemother. 2018 Feb 1;73(2):377-384. doi: 10.1093/jac/dkx401.
OBJECTIVES
To evaluate temporal trends in antimicrobial resistance, over 16 years, in bacteria isolated from dogs and cats with urinary tract infection (UTI) and the clonal lineages of bacteria harbouring critical antimicrobial resistance mechanisms.
METHODS
Antimicrobial susceptibility testing was conducted for 948 bacteria isolated from dogs and cats with UTI (1999-2014). Resistance mechanisms were detected by PCR, namely ESBL/AmpC in third-generation cephalosporin (3GC)-resistant Escherichia coli and Proteus mirabilis, mecA in methicillin-resistant staphylococci, and aac(6')-Ieaph(2″)-Ia and aph(2″)-1d in high-level gentamicin-resistant (HLGR) enterococci. Resistant bacteria were typed by MLST, and temporal trends in E. coli and Enterobacteriaceae antimicrobial resistance were determined by logistic regression.
RESULTS
Enterobacteriaceae had a significant temporal increase in resistance to amoxicillin/clavulanate, 3GCs, trimethoprim/sulfamethoxazole, fluoroquinolones, gentamicin and tetracycline (P < 0.001). An increase in MDR was also detected (P < 0.0001). 3GC resistance was mainly caused by the presence of blaCTX-M-15 and blaCMY-2 in E. coli and the presence of blaCMY-2 in P. mirabilis. Two major 3GC-resistant E. coli clonal lineages were detected: O25b:H4-B2-ST131 and ST648. The mecA gene was detected in 9.2% (n = 11/119) of Staphylococcus spp., including MRSA clonal complex (CC) 5 (n = 2) and methicillin-resistant Staphylococcus epidermidis CC5 (n = 4). A temporal increase in MDR methicillin-resistant Staphylococcus pseudintermedius was detected (P = 0.0069). Some ampicillin-resistant and/or HLGR Enterococcus spp. were found to belong to hospital-adapted CCs, namely Enterococcus faecalis ST6-CC6 (n = 1) and Enterococcus faecium CC17 (n = 8).
CONCLUSIONS
The temporal increase in antimicrobial resistance and in MDR bacteria causing UTI in dogs and cats creates important therapeutic limitations in veterinary medicine. Furthermore, the detection of MDR high-risk clonal lineages raises public health concerns since companion animals with UTI may contribute to the spread of such bacteria.
目的
评估 16 年来，犬猫尿路感染（UTI）分离菌的抗菌药物耐药性的时间趋势，以及携带关键抗菌药物耐药机制的细菌的克隆谱系。
方法
对 1999 年至 2014 年间 948 株犬猫 UTI 分离菌进行抗菌药物敏感性试验。通过 PCR 检测耐药机制，即第三代头孢菌素（3GC）耐药的大肠埃希菌和奇异变形杆菌中的 ESBL/AmpC、耐甲氧西林葡萄球菌中的 mecA 以及高水平庆大霉素耐药（HLGR）肠球菌中的 aac(6')-Ieaph(2″)-Ia 和 aph(2″)-1d。用 MLST 对耐药菌进行分型，用逻辑回归法确定大肠埃希菌和肠杆菌科抗菌药物耐药性的时间趋势。
结果
肠杆菌科对阿莫西林/克拉维酸、3GCs、甲氧苄啶/磺胺甲恶唑、氟喹诺酮类、庆大霉素和四环素的耐药性呈显著的时间性增加（P<0.001）。也检测到 MDR 的增加（P<0.0001）。3GC 耐药主要由大肠埃希菌中 blaCTX-M-15 和 blaCMY-2 的存在以及奇异变形杆菌中 blaCMY-2 的存在引起。检测到两个主要的 3GC 耐药大肠埃希菌克隆谱系：O25b:H4-B2-ST131 和 ST648。9.2%（n=11/119）的葡萄球菌属中检测到 mecA 基因，包括耐甲氧西林金黄色葡萄球菌克隆复合体（CC）5（n=2）和耐甲氧西林表皮葡萄球菌 CC5（n=4）。还检测到耐甲氧西林中间葡萄球菌的 MDR 时间性增加（P=0.0069）。一些氨苄西林耐药和/或 HLGR 肠球菌属被发现属于医院适应 CC，即粪肠球菌 ST6-CC6（n=1）和屎肠球菌 CC17（n=8）。
结论
犬猫 UTI 分离菌的抗菌药物耐药性和 MDR 细菌的时间性增加给兽医治疗带来了重要的治疗限制。此外，高风险 MDR 克隆谱系的检测引起了人们对公共卫生的关注，因为患有 UTI 的伴侣动物可能有助于此类细菌的传播。
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