Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Red Española de Investigación en Patología Infecciosa (REIPI), Madrid, Spain.
J Antimicrob Chemother. 2018 Nov 1;73(11):3039-3043. doi: 10.1093/jac/dky284.
To describe the incidence and microbiological features of carbapenemase-producing Enterobacteriaceae (CPE) from colonized patients in a Spanish university hospital during a cluster-randomized study [the Resistance of Gram-Negative Organisms: Studying Intervention Strategies (R-GNOSIS) project] on isolation strategies for faecal ESBL carriers.
From March 2014 to March 2016, 15 556 rectal swabs from 8209 patients admitted in two surgical wards and two medical wards were collected and seeded on ESBL and CPE chromogenic agars. Carbapenemase characterization (PCR and sequencing) was performed, and antibiotic susceptibility (MIC), clonality (PFGE and MLST) and diversity (Simpson diversity index estimation) were determined.
One hundred and ninety-eight CPE isolates, mainly Klebsiella pneumoniae (53.5%) and Escherichia coli (19.2%), were identified in 162 patients (2%). Prevalence of CPE carriage remained unchanged over time. Overall, amikacin (9.6%), tigecycline (9.6%) and colistin (0.5%) showed low non-susceptibility. The most frequent carbapenemase was OXA-48 (64.1%), followed by VIM-1 (26.8%), NDM-1 (5.3%) and KPC-3 (3.5%), and these were co-produced with ESBLs in 43.9%. OXA-48 plus CTX-M-15 was the most frequent association. Two major K. pneumoniae clones were identified (OXA-48-CTX-M-15-ST11 and VIM-1-SHV-12-ST54) with considerable genetic diversity among the remaining isolates, including OXA-48-E. coli. Species diversity tended to decrease from 0.75 in the first 6 months of the study to 0.43 in the final months. The emergence of new clones (i.e. OXA-48-Kluyvera spp. and NDM-1-K. pneumoniae ST437 and ST101) and displacement of other particular clones were also demonstrated.
We describe a polyclonal and changeable CPE population over time. Coexistence of worldwide disseminated clones, such as ST11-OXA-48- K. pneumoniae, with unrelated and emerging OXA-48-E. coli clones, depicts a disturbing CPE epidemiology in our institution.
描述在一项关于粪便产 ESBL 携带者隔离策略的随机对照研究[革兰氏阴性菌耐药：研究干预策略（R-GNOSIS）项目]中，西班牙某大学医院定植患者中产碳青霉烯酶肠杆菌科（CPE）的发生率和微生物学特征。
2014 年 3 月至 2016 年 3 月，从两个外科病房和两个内科病房收治的 8209 名患者中采集了 15556 份直肠拭子，并接种在 ESBL 和 CPE 显色琼脂上。对碳青霉烯酶进行了特征分析（PCR 和测序），并测定了抗生素敏感性（MIC）、克隆性（PFGE 和 MLST）和多样性（辛普森多样性指数估计）。
在 162 名患者（2%）中鉴定出 198 株 CPE 分离株，主要为肺炎克雷伯菌（53.5%）和大肠埃希菌（19.2%）。CPE 定植率随时间变化无明显变化。总的来说，阿米卡星（9.6%）、替加环素（9.6%）和黏菌素（0.5%）的非敏感性较低。最常见的碳青霉烯酶为 OXA-48（64.1%），其次为 VIM-1（26.8%）、NDM-1（5.3%）和 KPC-3（3.5%），其中 43.9%与 ESBL 共同产生。OXA-48 加 CTX-M-15 是最常见的组合。鉴定出两个主要的肺炎克雷伯菌克隆（OXA-48-CTX-M-15-ST11 和 VIM-1-SHV-12-ST54），其余分离株的遗传多样性相当大，包括 OXA-48-E 大肠埃希菌。物种多样性从研究开始的前 6 个月的 0.75 下降到最后几个月的 0.43。还证明了新克隆（即 OXA-48-克鲁维酵母和 NDM-1-肺炎克雷伯菌 ST437 和 ST101）的出现和其他特定克隆的取代。
我们描述了一个随时间推移而呈现多克隆和变化的 CPE 群体。世界范围内传播的克隆，如 ST11-OXA-48-肺炎克雷伯菌，与不相关和新兴的 OXA-48-E 大肠埃希菌克隆共存，描绘了我们机构中令人不安的 CPE 流行病学。
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