西班牙一家医院反复分离出嗜肺军团菌：两年的抗菌药物耐药性监测。
Legionella pneumophila recurrently isolated in a Spanish hospital: Two years of antimicrobial resistance surveillance.
机构信息
Departament de Microbiologia, CATLAB Centre Analítiques AIE, Viladecavalls, Barcelona, Spain; Department of Medical Biochemistry and Microbiology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Division of Microsystems Technology, Department of Engineering Sciences, Uppsala University, Uppsala, Sweden; Departament de Genètica i Microbiologia, Universitat Autònoma de Barcelona (UAB), Spain.
Servicio de Microbiología. Hospital Universitario Ramón y Cajal e Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
出版信息
Environ Res. 2018 Oct;166:638-646. doi: 10.1016/j.envres.2018.06.045. Epub 2018 Jul 5.
OBJECTIVES
The aim of this study was to monitor the spread, persistence and antibiotic resistance patterns of Legionella spp. strains found in a hospital water distribution system. These environmental studies are intended to help detect the presence of antibiotic resistant strains before they infect patients.
METHODS
Antimicrobial surveillance tests were performed at 27 different sampling points of the water network of a large Spanish hospital over two years. Water samples were screened for Legionella according to ISO 11731:2007. Legionella spp. isolates were identified by serotyping and by mass spectrometry (MALDI-ToF). Epidemiological molecular typing was done by Pulse-Field Gel Electrophoresis (PFGE) and by Sequence-Based Typing (SBT). Antibiotic susceptibility tests were performed using disk diffusion and ETEST®.
RESULTS
Legionella spp. were recurrently isolated for 2 years. All isolates belonged the same group, L. pneumophila serogroups 2-14. Isolates were all attributed by SBT to sequence type (ST) ST328, although PFGE revealed 5 different patterns. No significant change in antibiotic susceptibility could be observed for this study period, irrespectively of the method used.
CONCLUSION
Colonization of water systems by Legionella spp. is still occurring, although all the prevention rules were strictly followed. Antibiotic resistance monitoring may help us to find resistance in bacteria with environmental reservoirs but difficult to isolate from patients. The knowledge of the antibiotic susceptibility in environmental strains may help us to predict changes in clinical strains. This study might also help reconsidering Legionnaires' disease (LD) diagnostic methods. L. pneumophila serogroups 2-14 present all along the time of the investigation in the water distribution system can cause LD. However, they may not be detected by routine urine tests run on patients, thereby missing an ongoing LD infection.
目的
本研究旨在监测医院供水系统中发现的军团菌属菌株的传播、持续存在和抗生素耐药模式。这些环境研究旨在帮助在感染患者之前发现抗生素耐药菌株的存在。
方法
在两年内，对一家西班牙大型医院的水网络的 27 个不同采样点进行了抗菌监测测试。根据 ISO 11731:2007 对水样本进行军团菌筛查。通过血清分型和基质辅助激光解吸电离飞行时间质谱（MALDI-ToF）鉴定军团菌属分离株。通过脉冲场凝胶电泳（PFGE）和基于序列的分型（SBT）进行流行病学分子分型。使用纸片扩散法和 ETEST®进行抗生素敏感性测试。
结果
军团菌属在 2 年内反复分离。所有分离株均属于同一组，即嗜肺军团菌血清群 2-14。通过 SBT，所有分离株均归因于序列型（ST）ST328，尽管 PFGE 显示出 5 种不同的模式。尽管使用的方法不同，但在此研究期间，未观察到抗生素敏感性的显著变化。
结论
尽管严格遵循了所有预防规则，但军团菌属对水系统的定植仍在发生。抗生素耐药性监测可能有助于我们发现具有环境储库但难以从患者中分离的细菌的耐药性。了解环境菌株的抗生素敏感性有助于我们预测临床菌株的变化。这项研究还可能有助于重新考虑军团病（LD）的诊断方法。在供水系统中一直存在的嗜肺军团菌血清群 2-14 可能引起 LD，但可能无法通过对患者进行的常规尿液检测检测到，从而错过正在进行的 LD 感染。
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