Lin Lin, Xiao Xiaoguang, Wang Xiaonan, Xia Meng, Liu Shuang
Department of Clinical Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian, China.
Microb Drug Resist. 2020 Feb;26(2):94-99. doi: 10.1089/mdr.2018.0398. Epub 2019 Aug 21.
Carbapenem-resistant (CRKP) has become a serious challenge for clinical treatment and public health. We found that both KPC-2-producing (KPC-KP) and NDM-1-producing (NDM-KP) are epidemic in a teaching hospital in Northeast China. The main aim of the present study was to compare antimicrobial susceptibility differences between KPC-KP and NDM-KP and elucidate complex resistant genotypes of the KPC-KP and NDM-KP by PCR and sequencing. Among 82 CRKP isolated between January 2015 and December 2016, 59 isolates were KPC-KP and 23 isolates were NDM-KP. All 59 KPC-KP had no susceptibility to gentamicin, tobramycin, levofloxacin, and ciprofloxacin, had very low susceptibility to amikacin (3.39%) and fosfomycin (8.47%), whereas the susceptibility of NDM-KP to the above antibiotics was 21.74%, 13.04%, 17.39%, 17.39%, 69.57%, and 73.91%, respectively. Although the susceptibility of NDM-KP to tigecycline (95.65%) and polymyxin B (73.91%) was higher than that of KPC-KP (84.75% and 69.49%, respectively), the difference was not statistically significant. The MIC of KPC-KP and NDM-KP to aztreonam-avibactam were 4 and 2 μg/mL, respectively. All 82 CRKP carried 2 or 3 Extended Spectrum Beta-Lactamase (ESBL) genes, and 79/82 CRKP carried the AmpC gene . The aminoglycoside resistance gene was detected in 96.61% of KPC-KP and in 21.74% of NDM-KP. It seems that KPC-KP was more resistant to antibiotics than NDM-KP in this study, so that available therapeutic regimens against KPC-KP are very limited. Aztreonam-avibactam may be a promising and valuable option against both KPC-KP and NDM-KP.
耐碳青霉烯类肺炎克雷伯菌（CRKP）已成为临床治疗和公共卫生领域的一项严峻挑战。我们发现产KPC-2的肺炎克雷伯菌（KPC-KP）和产NDM-1的肺炎克雷伯菌（NDM-KP）在我国东北一家教学医院中均呈流行态势。本研究的主要目的是比较KPC-KP和NDM-KP之间的抗菌药敏差异，并通过聚合酶链反应（PCR）和测序阐明KPC-KP和NDM-KP复杂的耐药基因型。在2015年1月至2016年12月期间分离出的82株CRKP中，59株为KPC-KP，23株为NDM-KP。所有59株KPC-KP对庆大霉素、妥布霉素、左氧氟沙星和环丙沙星均无药敏性，对阿米卡星（3.39%）和磷霉素（8.47%）的药敏性极低，而NDM-KP对上述抗生素的药敏性分别为21.74%、13.04%、17.39%、17.39%、69.57%和73.91%。尽管NDM-KP对替加环素（95.65%）和多粘菌素B（73.91%）的药敏性高于KPC-KP（分别为84.75%和69.49%），但差异无统计学意义。KPC-KP和NDM-KP对阿维巴坦钠-氨曲南的最低抑菌浓度（MIC）分别为4和2μg/mL。所有82株CRKP均携带2或3种超广谱β-内酰胺酶（ESBL）基因，82株中有79株携带AmpC基因。氨基糖苷类耐药基因在96.61%的KPC-KP和21.74%的NDM-KP中被检测到。在本研究中，KPC-KP似乎比NDM-KP对抗生素的耐药性更强，因此针对KPC-KP的可用治疗方案非常有限。阿维巴坦钠-氨曲南可能是针对KPC-KP和NDM-KP的一种有前景且有价值的选择。
