11家中国教学医院血流感染相关碳青霉烯耐药临床分离株中16S rRNA甲基转移酶基因的高流行率
High Prevalence of 16S rRNA Methyltransferase Genes in Carbapenem-Resistant Clinical Isolates Associated with Bloodstream Infections in 11 Chinese Teaching Hospitals.
作者信息
Shen Xiaofei, Liu Li, Yu Jingyi, Ai Wenxiu, Cao Xingwei, Zhan Qing, Guo Yinjuan, Wang Liangxing, Yu Fangyou
机构信息
Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China.
Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, People's Republic of China.
出版信息
Infect Drug Resist. 2020 Jul 9;13:2189-2197. doi: 10.2147/IDR.S254479. eCollection 2020.
OBJECTIVE
The 16S rRNA methylase-mediated high-level resistance to aminoglycosides has become a great concern. The purpose of the study was to investigate the occurrence of 16S rRNA methyltransferase (RMTase) genes in carbapenem-resistant (CRKP) clinical isolates associated with bloodstream infections (BSIs) in China.
METHODS
From July 2015 to December 2018, a total of 137 unique CRKP clinical isolates associated with BSIs were collected from 11 Chinese teaching hospitals. PCR and DNA sequencing were used to identify 16S RMTase genes. Whole-genome sequencing (WGS) was performed on all CRKP clinical isolates. Relevant information was extracted from WGS data (antibiotic resistance determinants, K-type and wzi allelic types). All 16S RMTase-producing CRKP clinical isolates were characterized by antimicrobial susceptibility testing, multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE).
RESULTS
In this study, 137 CRKPs were found to harbor at least one carbapenemase gene. Among 137 CRKPs, 78 (56.9%, 78/137) were positive for 16S RMTase genes (5 for armA, 70 for rmtB, 3 for both armA and rmtB) and highly resistant to gentamicin and amikacin (MICs ≥256 mg/L). Seventy-five isolates harboring 16S RMTase genes also produced ESBLs. In this study, 5 sequence types (STs) and 6 capsule serotypes were found among 78 isolates positive for 16S RMTases genes, while 14 STs and 6 capsule serotypes were found among 59 isolates negative for 16S RMTases genes. Compared with the isolates negative for 16S RMTases genes, the STs and capsular serotypes of 16S RMTases-positive strains are more concentrated. Among 78 16S RMTases-positive strains, the most prevalent clone type is ST11-PFGE-B-KL64-wzi64 (62.8%, 49/78), which mainly carries the rmtB and bla genes and is distributed in 7 provinces in China.
CONCLUSION
A high prevalence of 16S RMTase genes was found among CRKP clinical isolates associated with BSIs from Chinese teaching hospitals, which was attributed to the dissemination of the ST11-PFGE-B-KL64-wzi64 clone.
目的
16S rRNA甲基化酶介导的对氨基糖苷类的高水平耐药已引起广泛关注。本研究旨在调查中国血流感染（BSIs）相关的耐碳青霉烯肺炎克雷伯菌（CRKP）临床分离株中16S rRNA甲基转移酶（RMTase）基因的发生情况。
方法
2015年7月至2018年12月，从11家中国教学医院收集了137株与BSIs相关的独特CRKP临床分离株。采用PCR和DNA测序鉴定16S RMTase基因。对所有CRKP临床分离株进行全基因组测序（WGS）。从WGS数据中提取相关信息（抗生素耐药决定因素、K型和wzi等位基因类型）。对所有产16S RMTase的CRKP临床分离株进行药敏试验、多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）鉴定。
结果
本研究中，137株CRKP至少携带一种碳青霉烯酶基因。在137株CRKP中，78株（56.9%，78/137）16S RMTase基因阳性（armA 5株，rmtB 70株，armA和rmtB均阳性3株），对庆大霉素和阿米卡星高度耐药（MICs≥256 mg/L）。75株携带16S RMTase基因的分离株也产超广谱β-内酰胺酶（ESBLs）。本研究中，16S RMTase基因阳性的78株分离株中发现5种序列型（STs）和6种荚膜血清型，而16S RMTase基因阴性的59株分离株中发现14种STs和6种荚膜血清型。与16S RMTase基因阴性的分离株相比，16S RMTase阳性菌株的STs和荚膜血清型更为集中。在78株16S RMTase阳性菌株中，最常见的克隆型是ST11-PFGE-B-KL64-wzi64（62.8%，49/78），主要携带rmtB和bla基因，分布于中国7个省份。
结论
在中国教学医院与BSIs相关的CRKP临床分离株中发现16S RMTase基因的高流行率，这归因于ST11-PFGE-B-KL64-wzi64克隆的传播。
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