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阿根廷产 KPC 肺炎克雷伯菌的流行情况变化:高黏液性 ST25 和高风险克隆 ST307 的出现。

Changing epidemiology of KPC-producing Klebsiella pneumoniae in Argentina: Emergence of hypermucoviscous ST25 and high-risk clone ST307.

机构信息

Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Laboratorio de Resistencia Bacteriana, Junin 956, Ciudad Autónoma de Buenos Aires, Argentina; CONICET (Consejo Nacional de Investigaciones Científicas y Técnicas), Godoy Cruz 2290, Ciudad Autónoma de Buenos Aires, Argentina.

Universidad de Buenos Aires, Instituto de Investigaciones Médicas Alfredo Lanari, Combatientes de Malvinas 3150, Ciudad Autónoma de Buenos Aires, Argentina.

出版信息

J Glob Antimicrob Resist. 2019 Sep;18:238-242. doi: 10.1016/j.jgar.2019.06.005. Epub 2019 Jun 13.

Abstract

OBJECTIVES

To assess the epidemiological features of 76 Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) isolates recovered from three hospitals in Buenos Aires, Argentina, during 2015-2017.

METHODS

Antimicrobial susceptibilities were determined according to CLSI Clinical and Laboratoy Standards guidelines. Molecular typing of KPC-Kp was performed by pulsed-field gel electrophoresis (PFGE)-Xbal and multilocus sequence typing. Plasmid encoded genes involved in carbapenem, fosfomycin and colistin resistance were detected by polymerase chain reaction (PCR) and sequencing. Also, mgrB inactivation was investigated in those colistin-resistant isolates. Genetic platforms involved in horizontal spread of bla were investigated by PCR mapping.

RESULTS

Besides β-lactams, high resistance rates were observed for gentamycin, quinolones and trimethoprim-sulfamethoxazole. KPC-Kp sequence type (ST)258 corresponded to 26% of the isolates, while 42% corresponded to ST25. The other isolates were distributed in a diversity of lineages such as ST11 (10.5%), ST392 (10.5%), ST307, ST13, ST101, ST15 and ST551. bla was detected in 75 of 76 isolates, and one ST307 isolate harboured bla. Tn4401 was identified as the genetic platform for bla in epidemic lineages such as ST258 and ST307. However, in ST25 and ST392, which are usually not related to bla, a bla-bearing non-Tn4401 element was identified. Alterations in mgrB were detected in seven of 11 colistin-resistant isolates.

CONCLUSIONS

Despite previous reports in Argentina, ST258 is no longer the absolute clone among KPC-Kp isolates. In the present study, dissemination of more virulent lineages such as the hypermucoviscous ST25 was detected. The emergence of the high-risk clone ST307 and occurrence of bla was noticed for the first time in this region.

摘要

目的

评估 2015 年至 2017 年期间,阿根廷布宜诺斯艾利斯的三家医院分离的 76 株产碳青霉烯酶肺炎克雷伯菌(KPC-Kp)的流行病学特征。

方法

根据 CLSI 临床和实验室标准指南测定抗菌药物敏感性。采用脉冲场凝胶电泳(PFGE)-Xbal 和多位点序列分型对 KPC-Kp 进行分子分型。通过聚合酶链反应(PCR)和测序检测与碳青霉烯、磷霉素和粘菌素耐药相关的质粒编码基因。同时,研究了那些耐粘菌素的分离株中 mgrB 的失活情况。通过 PCR 图谱研究了 bla 水平传播的遗传平台。

结果

除了β-内酰胺类药物外,对庆大霉素、喹诺酮类和复方磺胺甲恶唑的耐药率也很高。KPC-Kp 序列型(ST)258 占分离株的 26%,而 42%的分离株属于 ST25。其他分离株分布在不同的谱系中,如 ST11(10.5%)、ST392(10.5%)、ST307、ST13、ST101、ST15 和 ST551。在 76 株分离株中检测到 bla,一株 ST307 分离株携带 bla。Tn4401 被鉴定为流行谱系如 ST258 和 ST307 中 bla 的遗传平台。然而,在通常与 bla 无关的 ST25 和 ST392 中,鉴定出携带 bla 的非 Tn4401 元件。在 11 株耐粘菌素的分离株中检测到 mgrB 的改变。

结论

尽管阿根廷之前有报道,但 ST258 不再是 KPC-Kp 分离株中的绝对克隆。在本研究中,检测到更具毒力的谱系,如高粘液性 ST25 的传播。高危克隆 ST307 的出现和 bla 的发生在该地区尚属首次。

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