Flerlage Tim, Brazelton de Cardenas Jessica N, Garner Cherilyn D, Hasan Nur A, Karathia Hiren, Qudeimat Amr, Maron Gabriela, Hayden Randall
Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
Open Forum Infect Dis. 2020 Jan 12;7(2):ofaa018. doi: 10.1093/ofid/ofaa018. eCollection 2020 Feb.
Genes conferring carbapenem resistance have disseminated worldwide among Gram-negative bacteria. Here we present longitudinal changes in clinically obtained isolates from 1 immunocompromised pediatric patient. This report demonstrates potential for antibiotic resistance genes and plasmids to emerge over time in clinical isolates from patients receiving intensive anticancer chemotherapy and broad-spectrum antibiotics.
Thirty-three isolates obtained over 7 months from 1 patient were included. Clinical data were abstracted from the medical record. For each isolate, studies included phenotypic antibacterial resistance patterns, sequence typing, bacterial isolate sequencing, plasmid identification, and antibiotic resistance gene identification.
Sites of isolation included blood, wound culture, and culture for surveillance purposes from the perianal area. Isolates were of 5 sequence types (STs). All were resistant to multiple classes of antibiotics; 23 (69.6%) were phenotypically resistant to all carbapenems. The blaNDM-5 gene was identified in 22 (67%) isolates, all of ST-167 and ST-940, and appeared to coincide with the presence of the IncFII and IncX3 plasmid.
We present unique microbiologic data from 33 multidrug-resistant isolates obtained over the course of 7 months from an individual patient in the United States. Two sequence types causing invasive infection in the same patient and harboring the blaNDM-5 gene, encoded on the IncX3 plasmid and the IncFII plasmid, were identified. This study highlights the emergence of multidrug-resistant bacteria on antibiotic therapy and the necessity of adequate neutrophil number and function in the clearance of bacteremia.
赋予碳青霉烯类耐药性的基因已在全球范围内的革兰氏阴性菌中传播。在此，我们展示了一名免疫功能低下儿科患者临床分离株的纵向变化。本报告证明了在接受强化抗癌化疗和广谱抗生素治疗的患者临床分离株中，抗生素耐药基因和质粒随时间出现的可能性。
纳入了在7个月内从1名患者获得的33株分离株。临床数据从病历中提取。对于每株分离株，研究包括表型抗菌耐药模式、序列分型、细菌分离株测序、质粒鉴定和抗生素耐药基因鉴定。
分离部位包括血液、伤口培养物以及肛周区域的监测培养物。分离株有5种序列类型（STs）。所有分离株均对多类抗生素耐药；23株（69.6%）对所有碳青霉烯类药物表现出表型耐药。在22株（67%）分离株中鉴定出blaNDM - 5基因，均为ST - 167和ST - 940型，且似乎与IncFII和IncX3质粒的存在一致。
我们展示了从美国一名患者在7个月内获得的33株多重耐药分离株的独特微生物学数据。鉴定出两种序列类型在同一患者中引起侵袭性感染，并携带在IncX3质粒和IncFII质粒上编码的blaNDM - 5基因。本研究强调了抗生素治疗中多重耐药菌的出现以及足够数量和功能的中性粒细胞在清除菌血症中的必要性。
