International Health Management Associates, Inc., Schaumburg, IL, USA.
Pfizer, Inc., Cambridge, MA, USA.
J Antimicrob Chemother. 2020 May 1;75(5):1165-1173. doi: 10.1093/jac/dkz571.
To determine the spread of ESBLs and carbapenemases in Enterobacterales and Pseudomonas aeruginosa in Europe.
45 335 Gram-negative bacilli were collected in 18 European countries as part of the International Network for Optimal Resistance Monitoring (INFORM) global surveillance programme from 2013 to 2017. Antimicrobial susceptibility was determined using broth microdilution, and 9546 isolates were screened for β-lactamase genes by PCR and sequencing.
ESBLs were identified in 35.5% of Klebsiella pneumoniae and 18.5% of Escherichia coli. ESBL carriage was lowest among isolates in Northern/Western Europe and highest in Eastern Europe. CTX-M-15 was the dominant ESBL in all countries except Greece, where SHV-type ESBLs were more common. Carbapenemases (KPC, OXA-48-like, GES, NDM and VIM) were found in 3.4% of Enterobacterales and were most common among K. pneumoniae (10.5% of those collected). Carbapenemase carriage was lowest in Northern/Western and highest in Southern Europe. KPC-positive Enterobacterales were most abundant but the percentages of OXA-48-like-, NDM- and VIM-positive isolates increased over time and were correlated with an increase in meropenem non-susceptibility. Carbapenemases (VIM, IMP, NDM and GES) were also identified in 5.1% of P. aeruginosa and were commonly found in Eastern Europe. Carbapenemase carriage and meropenem non-susceptibility among P. aeruginosa fluctuated over the 5 years studied and were not well correlated.
ESBL and carbapenemase carriage varied by species and European subregion. Meropenem non-susceptibility in European isolates of Enterobacterales can be attributed to carbapenemase carriage and is increasingly caused by MBLs and OXA-48-like carbapenemases. Carbapenemases or other β-lactamases are not a common cause of meropenem non-susceptibility in P. aeruginosa in Europe.
确定欧洲肠杆菌科和铜绿假单胞菌中产 ESBL 和碳青霉烯酶的传播情况。
2013 年至 2017 年，在欧洲 18 个国家收集了 45335 株革兰氏阴性杆菌，作为国际最佳耐药监测网络（INFORM）全球监测计划的一部分。使用肉汤微量稀释法测定抗菌药物敏感性，对 9546 株分离物进行 PCR 和测序以筛选β-内酰胺酶基因。
在肺炎克雷伯菌和大肠埃希菌中分别发现 35.5%和 18.5%的产 ESBL。在东欧，产 ESBL 率在北欧/西欧分离株中最低，在东欧最高。CTX-M-15 是所有国家除希腊以外的主要 ESBL，在希腊，SHV 型 ESBL 更为常见。在肠杆菌科中发现了 3.4%的碳青霉烯酶（KPC、OXA-48 样、GES、NDM 和 VIM），在肺炎克雷伯菌中最为常见（占收集菌株的 10.5%）。在北欧/西欧，碳青霉烯酶携带率最低，在南欧最高。KPC 阳性肠杆菌科最为丰富，但随着时间的推移，OXA-48 样、NDM 和 VIM 阳性分离株的比例增加，并与美罗培南不敏感增加相关。在 5.1%的铜绿假单胞菌中也发现了碳青霉烯酶（VIM、IMP、NDM 和 GES），在东欧更为常见。在研究的 5 年内，铜绿假单胞菌的碳青霉烯酶携带率和不敏感美罗培南率波动较大，相关性不大。
ESBL 和碳青霉烯酶的携带率因物种和欧洲亚区而异。欧洲肠杆菌科分离株对美罗培南的不敏感可归因于碳青霉烯酶的携带，并且越来越多地由 MBL 和 OXA-48 样碳青霉烯酶引起。在欧洲，碳青霉烯酶或其他β-内酰胺酶并不是铜绿假单胞菌对美罗培南不敏感的常见原因。
