从伊朗一家大学医院分离出的产碳青霉烯酶菌株的分子流行病学：高风险克隆传播的证据
Molecular Epidemiology of Carbapenemase-Producing Isolated from an Iranian University Hospital: Evidence for Spread of High-Risk Clones.
作者信息
Ohadian Moghadam Solmaz, Afshar Davoud, Nowroozi Mohammad Reza, Behnamfar Amir, Farzin Amirreza
机构信息
Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Microbiology and Virology, Zanjan University of Medical Sciences, Zanjan, Iran.
出版信息
Infect Drug Resist. 2020 Jun 3;13:1583-1592. doi: 10.2147/IDR.S253756. eCollection 2020.
PURPOSE
Given the importance of treatment failure due to multidrug-resistant (MDR) strains, studies on population structure of these organisms are necessary to improve control strategies. Accordingly, the current study aimed to determine the prevalence of carbapenem-resistant (CRPA) at a teaching referral hospital in Iran and to analyz their molecular clonality by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) for epidemiological purposes.
METHODS
In this study, modified Hodge test (MHT) and double-disk synergy test (DDST) were used for carbapenemase production and metallo-β-lactamases (MBLs) screening, respectively. All isolates were tested for antimicrobial resistance. Moreover, MBL genes (IMP, VIM, SPM, NDM) were detected by multiplex PCR assay.
RESULTS
Among 68 clinical isolates, 38 (55.88%) isolates were CRPA. Antibiotic susceptibility testing revealed that most of these isolates were MDR. PFGE analyses showed 5 common types and 27 single types among CRPA isolates. MLST analysis revealed three major clusters (MLST-sequence types (STs): 235, 357, and 861) among them. The 30 non-CRPA isolates corresponded mainly to MLST-STs 253, 360, and 446.
CONCLUSION
Our results showed that internationally distributed MLST-STs with widely genomic diversity have spread in our hospital, and clonal expansion of MDR strains of was described as well.
目的
鉴于多重耐药（MDR）菌株导致治疗失败的重要性，对这些微生物的种群结构进行研究对于改进控制策略是必要的。因此，本研究旨在确定伊朗一家教学转诊医院耐碳青霉烯类肺炎克雷伯菌（CRPA）的流行率，并通过多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）分析其分子克隆性，以用于流行病学目的。
方法
在本研究中，改良 Hodge 试验（MHT）和双纸片协同试验（DDST）分别用于检测碳青霉烯酶的产生和金属β-内酰胺酶（MBL）的筛选。对所有分离株进行抗菌药物敏感性测试。此外，通过多重 PCR 检测 MBL 基因（IMP、VIM、SPM、NDM）。
结果
在 68 株临床分离株中，38 株（55.88%）为 CRPA。药敏试验显示这些分离株大多为多重耐药。PFGE 分析显示 CRPA 分离株中有 5 种常见类型和 27 种单一类型。MLST 分析显示其中有三个主要聚类（MLST 序列类型（STs）：235、357 和 861）。30 株非 CRPA 分离株主要对应于 MLST-STs 253、360 和 446。
结论
我们的结果表明，具有广泛基因组多样性的国际分布的 MLST-STs 在我们医院已经传播，并且还描述了多重耐药菌株的克隆扩增情况。
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