Aqel Amin Abdelfattah, Findlay Jacqueline, Al-Maayteh Mohammad, Al-Kaabneh Awatef, Hopkins Katie L, Alzoubi Hamed, Masalha Ibrahim, Turton Jane, Woodford Neil, Ellington Matthew J
1 Microbiology and Immunology Department, Faculty of Medicine, Mu'tah University , Al-Karak, Jordan .
2 Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service , Public Health England, London, United Kingdom .
Microb Drug Resist. 2018 Oct;24(8):1121-1127. doi: 10.1089/mdr.2017.0238. Epub 2018 Mar 8.
We sought to detect and determine the genetic diversity of carbapenemase-producing Enterobacteriaceae (CPE) isolated from clinical specimens in Amman, Jordan. From five hospitals, a total of 2,759 isolates had antimicrobial susceptibilities determined via Vitek II, of which 28 (1%) were carbapenem resistant. Species identifications were determined via matrix-assisted laser desorption ionization time-of-flight mass spectrometry and carbapenemase gene detection via real-time PCR indicated that 23 (82.1%) isolates were Klebsiella pneumoniae (OXA-48-like, n = 7; NDM, n = 14; OXA-48-like and NDM, n = 2), four (14.2%) were Enterobacter cloacae complex (NDM, n = 3 and VIM, n = 1), and one (3.5%) was Escherichia coli (NDM). Sequencing of carbapenemase gene amplicons from a subset of isolates identified bla, bla, and bla alleles. Strain typing detected seven different K. pneumoniae variable number tandem repeat types, consistent with mostly sporadic occurrences along with limited clonal spread. E. cloacae complex isolates were diverse by pulsed-field gel electrophoresis, with a maximum relatedness of 70%. Plasmid restriction fragment length polymorphism (pRFLP) revealed four distinct profiles associated with NDM-encoding plasmids that were positive for replicons of the FII(K)/FIB or FIB incompatibility (Inc) groups via PCR-based replicon typing. OXA-48-encoding IncL/M plasmids differed by two pRFLP bands. The results show diverse CPE produce OXA-48 and NDM-1 enzymes in Jordan and that the carbapenemase genes are distributed on diverse plasmids in Jordanian hospitals, with some limited evidence for related clusters occurring, emphasizing the need for strict infection control measures.
我们试图检测并确定从约旦安曼的临床标本中分离出的产碳青霉烯酶肠杆菌科细菌（CPE）的遗传多样性。从五家医院共收集了2759株分离菌，通过Vitek II测定其药敏性，其中28株（1%）对碳青霉烯类耐药。通过基质辅助激光解吸电离飞行时间质谱法进行菌种鉴定，并通过实时PCR检测碳青霉烯酶基因，结果表明23株（82.1%）分离菌为肺炎克雷伯菌（OXA - 48样，n = 7；NDM，n = 14；OXA - 48样和NDM，n = 2），4株（14.2%）为阴沟肠杆菌复合体（NDM，n = 3；VIM，n = 1），1株（3.5%）为大肠埃希菌（NDM）。对部分分离菌的碳青霉烯酶基因扩增子进行测序，鉴定出bla、bla和bla等位基因。菌株分型检测到7种不同的肺炎克雷伯菌可变数目串联重复序列类型，这与大多为散发病例以及有限的克隆传播一致。阴沟肠杆菌复合体分离菌通过脉冲场凝胶电泳显示出多样性，最大相似度为70%。质粒限制性片段长度多态性（pRFLP）分析显示与NDM编码质粒相关的四种不同图谱，通过基于PCR的复制子分型，这些质粒对FII(K)/FIB或FIB不相容性（Inc）组的复制子呈阳性。编码OXA - 48的IncL/M质粒在两个pRFLP条带上存在差异。结果表明，约旦的多种CPE产生OXA - 48和NDM - 1酶，并且碳青霉烯酶基因分布于约旦医院的多种质粒上，有一些有限的证据表明存在相关菌群，这强调了采取严格感染控制措施的必要性。
