Marchetti Vittoria Mattioni, Bitar Ibrahim, Mercato Alessandra, Nucleo Elisabetta, Bonomini Annalisa, Pedroni Palmino, Hrabak Jaroslav, Migliavacca Roberta
Department of Clinical Surgical Diagnostic and Pediatric Sciences, Unit of Microbiology and Clinical Microbiology, University of Pavia, Pavia, Italy.
Department of Microbiology, Faculty of Medicine in Pilsen, University Hospital in Pilsen, Charles University, Pilsen, Czechia.
Front Microbiol. 2020 Jan 21;10:3095. doi: 10.3389/fmicb.2019.03095. eCollection 2019.
Aim of this study was to genetically characterize two carbapenemase-producing strains obtained from a pediatric patient affected by diarrhea, expressing OXA-181 and/or NDM-5 type enzymes. The above microorganisms were collected in the same Desenzano hospital (Northern Italy) where the gene was detected for the first time in Italy 3 years ago. One strain (5P), belonged to sequence type ST405/ST477 (according to Pasture/Oxford schemes) and serotype O102:H6. It was characterized by a 130562 bp multi-replicon plasmid IncFII/IncFIA/IncFIB (pVSI_NDM-5) enclosing two main antibiotic resistance islands: (i) ARI-I, 10030 bp in size, carried genes coding for β-lactam- ( , ), fluoroquinolone/aminoglycoside- () and phenicol- resistance (), (ii) ARI-II, 15326 bp in size, carried genes coding for sulfonamide- (), β-lactam- ( , ), phenicol- (), trimethoprim- (), antiseptic- (Δ), and aminoglycoside- (, ) resistance. The other isolate (5M), belonged to sequence type ST2659/ST759 and serotype O50/02:H18, and carried four plasmids: a 153866 bp multi-replicon IncFII/IncFIA/IncFIB (pISV_IncFII_NDM-5), an 89866 bp IncI1 plasmid, a 51480 bp IncX3 plasmid (pISV_IncX3_OXA181), and a 41143 bp IncI plasmid (pISV_IncI_CMY-42). pISV_IncFII_NDM-5 carried two main antibiotic resistance islands: (i) ARI-III, 12220 bp in size, carried genes coding for β-lactam- ( ), fluoroquinolone/aminoglycoside- (), tetracycline- () and phenicol- resistance (, ), and ii) ARI-IV, 26527 bp in size, carried determinants coding for macrolide- (, ), sulfonamide- (), beta-lactam- ( , ), trimethoprim- (, ), antiseptic- (Δ), and aminoglycoside- resistance (). pISV_IncI_CMY-42 harbored the gene coding for beta-lactam resistance, pISV_IncX3_OXA181 harbored genes encoding fluoroquinolone- () and beta-lactams- resistance ( ). In conclusion, the detection of two different NDM-5 strains from a pediatric patient with a history of travel to the Far East countries strongly highlight an increasing trend and risk of importation from such areas.
本研究的目的是对从一名腹泻儿科患者分离出的两株产碳青霉烯酶菌株进行基因特征分析，这两株菌株表达OXA - 181和/或NDM - 5型酶。上述微生物是在意大利北部的德桑扎诺医院收集的，3年前在该医院首次在意大利检测到相关基因。其中一株菌株（5P），属于序列型ST405/ST477（根据帕斯托/牛津方案），血清型为O102:H6。其特征是含有一个130562 bp的多复制子质粒IncFII/IncFIA/IncFIB（pVSI_NDM - 5），该质粒包含两个主要的抗生素抗性岛：（i）ARI - I，大小为10030 bp，携带编码β - 内酰胺（ ， ）、氟喹诺酮/氨基糖苷（ ）和氯霉素抗性（ ）的基因；（ii）ARI - II，大小为15326 bp，携带编码磺胺（ ）、β - 内酰胺（ ， ）、氯霉素（ ）、甲氧苄啶（ ）、防腐剂（Δ）和氨基糖苷（ ， ）抗性的基因。另一株分离株（5M），属于序列型ST2659/ST759，血清型为O50/02:H18，携带四个质粒：一个153866 bp的多复制子IncFII/IncFIA/IncFIB（pISV_IncFII_NDM - 5）、一个89866 bp的IncI1质粒、一个51480 bp的IncX3质粒（pISV_IncX3_OXA181）和一个41143 bp的IncI质粒（pISV_IncI_CMY - 42）。pISV_IncFII_NDM - 5携带两个主要的抗生素抗性岛：（i）ARI - III，大小为12220 bp，携带编码β - 内酰胺（ ）、氟喹诺酮/氨基糖苷（ ）、四环素（ ）和氯霉素抗性（ ， ）的基因；（ii）ARI - IV，大小为26527 bp，携带编码大环内酯（ ， ）、磺胺（ ）、β - 内酰胺（ ， ）、甲氧苄啶（ ， ）、防腐剂（Δ）和氨基糖苷抗性（ ）的决定簇。pISV_IncI_CMY - 42含有编码β - 内酰胺抗性的 基因，pISV_IncX3_OXA181含有编码氟喹诺酮（ ）和β - 内酰胺抗性（ ）的基因。总之，从一名有前往远东国家旅行史的儿科患者中检测到两株不同的NDM - 5菌株，强烈凸显了来自这些地区的输入性病例呈上升趋势及风险。
