迈向流行：2015-2016 年波兰产 NDM-1 的肺炎克雷伯菌 ST11 谱系大规模扩张。

Towards endemicity: large-scale expansion of the NDM-1-producing Klebsiella pneumoniae ST11 lineage in Poland, 2015-16.

机构信息

Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland.

Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland.

出版信息

J Antimicrob Chemother. 2019 Nov 1;74(11):3199-3204. doi: 10.1093/jac/dkz315.

DOI:10.1093/jac/dkz315

PMID:31406993

Abstract

OBJECTIVES

In 2015 and 2016 Poland recorded rapid proliferation of New Delhi MBL (NDM)-producing Enterobacterales, with at least 470 and 1780 cases, respectively. We addressed the roles of the Klebsiella pneumoniae ST11 NDM-1 outbreak genotype, already spreading in 2012-14, and of newly imported organisms in this increase.

METHODS

The study included 2136 NDM-positive isolates identified between April 2015 and December 2016, following transfer of patients with K. pneumoniae ST147 NDM-1 from Tunisia to Warsaw in March 2015. The isolates were screened by PCR mapping for variants of blaNDM-carrying Tn125-like elements. Selected isolates were typed by PFGE and MLST. NDM-encoding plasmids were analysed by nuclease S1/hybridization, transfer assays, PCR-based replicon typing and PCR mapping.

RESULTS

The organisms were mainly K. pneumoniae containing the Tn125A variant of the ST11 epidemic lineage (n = 2094; ∼98%). Their representatives were of the outbreak pulsotype and ST11, and produced NDM-1, encoded by specific IncFII (pKPX-1/pB-3002cz)-like plasmids. The isolates were recovered in 145 healthcare centres in 13/16 administrative regions, predominantly the Warsaw area. The 'Tunisian' genotype K. pneumoniae ST147 NDM-1 Tn125F comprised 18 isolates (0.8%) from eight institutions. The remaining 24 isolates, mostly K. pneumoniae and Escherichia coli of diverse STs, produced NDM-1 or NDM-5 specified by various Tn125 derivatives and plasmids.

CONCLUSIONS

The K. pneumoniae ST11 NDM-1 outbreak has dramatically expanded in Poland since 2012, which may bring about a countrywide endemic situation in the near future. In addition, the so-far limited K. pneumoniae ST147 NDM-1 outbreak plus multiple NDM imports from different countries were observed in 2015-16.

摘要

目的

2015 年和 2016 年，波兰记录到新德里金属β-内酰胺酶（NDM）产生肠杆菌科的快速增殖，分别有至少 470 例和 1780 例。我们研究了 2012-14 年已传播的肺炎克雷伯菌 ST11 NDM-1 爆发基因型，以及新输入的生物体在这种增加中的作用。

方法

本研究包括 2015 年 4 月至 2016 年 12 月期间，在 2015 年 3 月从突尼斯转院到华沙的肺炎克雷伯菌 ST147 NDM-1 患者的情况下，鉴定出的 2136 例 NDM-阳性分离株。通过 PCR 图谱筛选携带 blaNDM 的 Tn125 样元件的变体。选择分离株进行 PFGE 和 MLST 分型。通过核酸酶 S1/杂交、转移试验、基于 PCR 的复制子分型和 PCR 图谱分析 NDM 编码质粒。

结果

这些生物体主要是含有 ST11 流行谱系的 Tn125A 变体的肺炎克雷伯菌（n = 2094；约 98%）。它们的代表为爆发脉冲型和 ST11，产生 NDM-1，由特定的 IncFII（pKPX-1/pB-3002cz）样质粒编码。这些分离株在 13/16 个行政区的 145 个医疗中心中回收，主要是华沙地区。2015-16 年，来自 8 个机构的 18 株（0.8%）产 NDM-1 的肺炎克雷伯菌 ST147 NDM-1 Tn125F 为“突尼斯”基因型。其余 24 株分离株主要为产 NDM-1 或 NDM-5 的不同 ST 的肺炎克雷伯菌和大肠埃希菌，由各种 Tn125 衍生物和质粒指定。