Microbiology laboratory, School of Pharmacy, Saint-Joseph University, Beirut, Lebanon; College of Natural and Health Sciences, Zayed University, Dubai, United Arab Emirates.
Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
Int J Antimicrob Agents. 2018 Jul;52(1):90-95. doi: 10.1016/j.ijantimicag.2018.03.003. Epub 2018 Mar 9.
Few studies have addressed the molecular epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) isolates in the Arabian Peninsula, and such investigations have been missing from Dubai, a major economical, tourism and medical centre of the region. The antibiotic susceptibility, the carbapenemase type produced, and the clonality of 89 CRE strains isolated in five major Dubai hospitals in June 2015 to June 2016 were determined. Thirty-three percent of the collection of 70 Klebsiella pneumoniae, 13 Escherichia coli and 6 other Enterobacteriaceae were extremely drug resistant, 27% were resistant to colistin, and 4.5% (4 K. pneumoniae isolates) were resistant to all antibiotics tested. The colistin resistance rate in K. pneumoniae was 31.4%. None of the isolates carried mobile colistin resistance genes. Seventy-seven isolates produced carbapenemase: 53.3% OXA-48-like, 24.7% NDM and 22.1% both OXA-48-like and NDM, respectively. Pulsed-field gel electrophoresis clustered 50% of K. pneumoniae into a 35-membered group, which showed significant association with double carbapenemase production, with extreme drug resistance, and with being isolated from Emirati patients. Members of the cluster belonged to sequence type ST14. The rate of colistin resistance in K. pneumoniae ST14 was 37.1% vs. 27.1% of K. pneumoniae isolates outside of the cluster. Two of the panresistant K. pneumoniae isolates also belonged to ST14, whereas the other two were ST15 and ST231, respectively. In conclusion, beyond the overall high colistin resistance rate in CRE, the emergence of a highly resistant clone of K. pneumoniae ST14 in all Dubai hospitals investigated is a serious problem requiring immediate attention.
在阿拉伯半岛，很少有研究涉及碳青霉烯类耐药肠杆菌科（CRE）分离株的分子流行病学，而在该地区的主要经济、旅游和医疗中心迪拜，也缺乏此类研究。本研究旨在确定 2015 年 6 月至 2016 年 6 月期间在迪拜五家主要医院分离的 89 株 CRE 菌株的抗生素敏感性、产生的碳青霉烯酶类型和克隆性。在所收集的 70 株肺炎克雷伯菌、13 株大肠埃希菌和 6 株其他肠杆菌科细菌中，33%为极度耐药，27%对黏菌素耐药，4.5%（4 株肺炎克雷伯菌）对所有测试的抗生素均耐药。肺炎克雷伯菌的黏菌素耐药率为 31.4%。分离株均未携带移动性黏菌素耐药基因。77 株产碳青霉烯酶：53.3%为 OXA-48 样，24.7%为 NDM，22.1%为 OXA-48 样和 NDM 均产。脉冲场凝胶电泳将 50%的肺炎克雷伯菌聚类成一个 35 株组成的群，该群与双重碳青霉烯酶产生、极度耐药以及从阿联酋患者中分离有关。该群的成员属于序列型 ST14。群内肺炎克雷伯菌 ST14 的黏菌素耐药率为 37.1%，群外肺炎克雷伯菌的耐药率为 27.1%。两株泛耐药肺炎克雷伯菌也属于 ST14，而另外两株分别属于 ST15 和 ST231。总之，除了 CRE 中总体较高的黏菌素耐药率之外，在所有调查的迪拜医院中，均出现了高度耐药的肺炎克雷伯菌 ST14 克隆，这是一个亟待关注的严重问题。
