Gajdács Márió
Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary.
Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary.
Antibiotics (Basel). 2020 Apr 1;9(4):153. doi: 10.3390/antibiotics9040153.
This paper briefly reports the occurrence and epidemiology of carbapenem-resistant but cephalosporin-susceptible (Car-R/Ceph-S) isolates from urinary tract infections (UTIs) in a tertiary-care hospital in the Southern Region of Hungary, and the phenotypic characterization of the possible resistance mechanisms in these isolates. Isolates and data were collected regarding UTIs corresponding to the period between 2008 and 2017. Susceptibility testing was performed using the Kirby-Bauer disk diffusion method; minimum inhibitory concentrations (MICs) of the isolates were determined using E-tests. The phenotypic detection of ampicillin C-type (AmpC) β-lactamases, efflux pump overexpression and carbapenemase production was also performed. represented = 575 (2.72% ± 0.64%) from outpatient, and = 1045 (5.43% ± 0.81%) from inpatient urinary samples, respectively. Based on the disk diffusion test, = 359 (22.16%) were carbapenem-resistant; in addition to carbapenems, = (64.34%) were also resistant to ciprofloxacin; = (60.17%) to gentamicin/tobramycin; = (58.51%) to levofloxacin; and = (27.57%) to amikacin. From among the carbapenem-resistant isolates, = 56 (15.59%) isolates were multidrug-resistant, while = 16 (4.46%) were extensively drug-resistant. From among the Car-R/Ceph-S isolates ( = 57), overexpression of AmpC was observed in = 7 cases (12.28%); carbapenemase production in = 4 (7.02%); while overexpression of efflux pumps was present in = 31 (54.39%) isolates. To spare last-resort agents, e.g., colistin, the use of broad-spectrum cephalosporins or safe, alternative agents should be considered in these infections.
本文简要报告了匈牙利南部地区一家三级护理医院尿路感染（UTIs）中耐碳青霉烯但对头孢菌素敏感（Car-R/Ceph-S）分离株的发生情况和流行病学，以及这些分离株中可能的耐药机制的表型特征。收集了2008年至2017年期间与UTIs相关的分离株和数据。采用 Kirby-Bauer 纸片扩散法进行药敏试验；使用 E-test 测定分离株的最低抑菌浓度（MICs）。还进行了氨苄西林 C 型（AmpC）β-内酰胺酶、外排泵过度表达和碳青霉烯酶产生的表型检测。分别代表门诊患者尿液样本中的575株（2.72%±0.64%）和住院患者尿液样本中的1045株（5.43%±0.81%）。根据纸片扩散试验，359株（22.16%）对碳青霉烯耐药；除碳青霉烯类外，（64.34%）对环丙沙星也耐药；（60.17%）对庆大霉素/妥布霉素耐药；（58.51%）对左氧氟沙星耐药；（27.57%）对阿米卡星耐药。在耐碳青霉烯分离株中，56株（15.59%）为多重耐药，16株（4.46%）为广泛耐药。在Car-R/Ceph-S分离株（n = 57）中，7例（12.28%）观察到AmpC过度表达；4例（7.02%）产生碳青霉烯酶；而31株（54.39%）分离株存在外排泵过度表达。为了避免使用如黏菌素等最后手段药物，在这些感染中应考虑使用广谱头孢菌素或安全的替代药物。
