Divison of Infection disease, Department of Internal Medicine, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan.
2Graduate Institute of Bioengineering, Tatung University, Taipei, Taiwan.
Antimicrob Resist Infect Control. 2018 Oct 11;7:123. doi: 10.1186/s13756-018-0410-5. eCollection 2018.
Although the prevalence of the carbapenem-resistant (CRAB) has increased in Taiwan, few studies have elucidated the prevalence of different carbapenemase genes in Taiwan. The first objective of this study was to identify the types and prevalence of different carbapenemase genes, and the second objective was to determine the carbapenem antimicrobial susceptibility of carbapenemase producing isolates.
In total, 269 CRAB blood isolates from four medical centres in Taiwan from 1/1/2009 to 31/12/2013 were analysed. Antimicrobial susceptibilities were determined using the Vitek 2 system. Carbapenemase genes were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) was used to identify the different pulsotypes.
All 269 CRAB isolates had the -like gene, while 237 (88.1%) had the -like gene, and 11 (4.09%) had the -like gene. Twenty-one CRAB isolates (7.81%) contained only the -like gene. None of the isolates had the -like gene or the metallo-β-lactamases (MBL)-encoding genes. In 28.69% of isolates with the -like gene and 90.91% of isolates with the -like gene, the minimum inhibitory concentrations (MICs) for imipenem were 64 mg/L or more. In 37.55% of isolates with the -like gene and 100% of isolates with the -like gene, meropenem MICs were 64 mg/L or more. PFGE analyses indicated that six highly similar genomes which harbored the -like gene came from three different medical centres.
Our study determined the prevalence of CRAB, the types and prevalence of carbapenemase genes, carbapenem susceptibility among CRAB isolates, and documented that the -like gene had greater resistance to carbapenem than the -like gene. We also demonstrated inter-hospital transmission of the highly resistant -like gene.
尽管台湾的耐碳青霉烯类肠杆菌科细菌（CRAB）的流行率有所增加，但很少有研究阐明台湾不同碳青霉烯酶基因的流行率。本研究的第一个目的是确定不同碳青霉烯酶基因的类型和流行率，第二个目的是确定产碳青霉烯酶分离株对碳青霉烯类抗生素的药敏性。
从 2009 年 1 月 1 日至 2013 年 12 月 31 日，从台湾的四家医疗中心共分析了 269 株 CRAB 血培养分离株。采用 Vitek 2 系统测定抗菌药物敏感性。通过聚合酶链反应（PCR）和测序鉴定碳青霉烯酶基因。脉冲场凝胶电泳（PFGE）用于鉴定不同的脉冲场凝胶电泳型。
所有 269 株 CRAB 分离株均携带blaNDM-1 基因，而 237 株（88.1%）携带blaCTX-M-15 基因，11 株（4.09%）携带blaIMP-1 基因。21 株 CRAB 分离株（7.81%）仅携带 blaCTX-M-15 基因。没有分离株携带 blaKPC 基因或金属β-内酰胺酶（MBL）编码基因。在携带 blaCTX-M-15 基因的 28.69%的分离株和携带 blaNDM-1 基因的 90.91%的分离株中，亚胺培南的最低抑菌浓度（MIC）为 64mg/L 或更高。在携带 blaCTX-M-15 基因的 37.55%的分离株和携带 blaNDM-1 基因的 100%的分离株中，美罗培南的 MIC 为 64mg/L 或更高。PFGE 分析表明，来自三个不同医疗中心的 6 个高度相似的基因组携带 blaCTX-M-15 基因。
本研究确定了 CRAB 的流行率、碳青霉烯酶基因的类型和流行率、CRAB 分离株对碳青霉烯类抗生素的药敏性，并证明 blaCTX-M-15 基因比 blaNDM-1 基因具有更高的碳青霉烯类耐药性。我们还证明了高度耐药的 blaCTX-M-15 基因在医院间的传播。
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