Rakotondrasoa Andriniaina, Passet Virginie, Herindrainy Perlinot, Garin Benoit, Kermorvant-Duchemin Elsa, Delarocque-Astagneau Elisabeth, Guillemot Didier, Huynh Bich-Tram, Brisse Sylvain, Collard Jean-Marc
Experimental Bacteriology Unit, Institut Pasteur Madagascar, Antananarivo, Madagascar.
Institut Pasteur, Biodiversity & Epidemiology of Bacterial Pathogens, Paris, France.
J Antimicrob Chemother. 2020 Jul 1;75(7):1736-1746. doi: 10.1093/jac/dkaa107.
To define characteristics of Klebsiella pneumoniae isolated from carriage and infections in mothers and their neonates belonging to a paediatric cohort in Madagascar.
A total of 2000 mothers and their 2001 neonates were included. For each mother, vaginal and stool samples were collected at the birth. Additionally, upon suspicion of infection, samples were collected from suspected infected body sites in 121 neonates. Genomic sequences of all isolated K. pneumoniae were used for phylogenetic analyses and to investigate the genomic content of antimicrobial resistance genes, virulence genes and plasmid replicon types.
Five percent (n = 101) of mothers were K. pneumoniae positive. Of 251 collected K. pneumoniae isolates, 102 (40.6%) were from mothers and 149 (59.3%) were from neonates. A total of 49 (19.5%; all from infants except 1) isolates were from infected body sites. MLST identified 108 different STs distributed over the six K. pneumoniae phylogroups Kp1 to Kp6. We found 65 (25.8%) ESBL producers and a total of 101 (40.2%) MDR isolates. The most common ESBL gene was blaCTX-M-15 (in 99.3% of isolates expressing ESBL). One isolate co-harboured blaCTX-M-15 and blaNDM-1 genes. Three isolates from infected body sites belonged to hypervirulent-associated ST23 (n = 1) and ST25 (n = 2). We observed two cases of mother-to-child transmission and sustained K. pneumoniae carriage was identified in 10 neonates, with identical isolates observed longitudinally over the course of 18 to 115 days.
This study revealed substantial genetic diversity and a high rate of antimicrobial resistance among K. pneumoniae isolated from both carriage and infections in Madagascar.
确定从马达加斯加一个儿科队列中的母亲及其新生儿的携带菌和感染菌中分离出的肺炎克雷伯菌的特征。
共纳入2000名母亲及其2001名新生儿。对于每位母亲，在分娩时采集阴道和粪便样本。此外，在怀疑感染时，从121名新生儿的疑似感染身体部位采集样本。所有分离出的肺炎克雷伯菌的基因组序列用于系统发育分析，并研究抗菌药物耐药基因、毒力基因和质粒复制子类型的基因组内容。
5%（n = 101）的母亲肺炎克雷伯菌呈阳性。在收集的251株肺炎克雷伯菌分离株中，102株（40.6%）来自母亲，149株（59.3%）来自新生儿。共有49株（19.5%；除1株外均来自婴儿）分离株来自感染身体部位。多位点序列分型鉴定出108种不同的序列型，分布在肺炎克雷伯菌的6个菌系Kp1至Kp6中。我们发现65株（25.8%）产超广谱β-内酰胺酶菌株，共有101株（40.2%）多重耐药分离株。最常见的超广谱β-内酰胺酶基因是blaCTX-M-15（在99.3%表达超广谱β-内酰胺酶的分离株中）。1株分离株同时携带blaCTX-M-15和blaNDM-1基因。3株来自感染身体部位的分离株属于与高毒力相关的ST23（n = 1）和ST25（n = 2）。我们观察到2例母婴传播病例，在10名新生儿中鉴定出持续的肺炎克雷伯菌携带情况，在18至115天的病程中纵向观察到相同的分离株。
本研究揭示了从马达加斯加的携带菌和感染菌中分离出的肺炎克雷伯菌具有丰富的遗传多样性和较高的抗菌药物耐药率。
