Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain.
Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain.
Int J Antimicrob Agents. 2020 Dec;56(6):106196. doi: 10.1016/j.ijantimicag.2020.106196. Epub 2020 Oct 9.
Pseudomonas aeruginosa global clones associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes, denominated high-risk clones, are a growing threat in hospitals worldwide. Here we provide a 2020 update on nosocomial MDR/XDR high-risk P. aeruginosa clones. According to their prevalence, global spread and association with MDR/XDR profiles and regarding extended-spectrum β-lactamases (ESBLs) and carbapenemases, the worldwide top 10 P. aeruginosa high-risk clones includes ST235, ST111, ST233, ST244, ST357, ST308, ST175, ST277, ST654 and ST298. ST235 is certainly the most relevant high-risk clone, showing a worldwide dissemination associated with over 60 different β-lactamase variants, including multiple carbapenemases from classes A and B. Moreover, ST235 shows a highly virulent phenotype associated with a high mortality rate, likely due to the production of the ExoU cytotoxin. ST111 and ST233 are also worldwide disseminated MDR/XDR clones, particularly linked to VIM-2 metallo-β-lactamase (MBL), whereas ST244 is a very prevalent clone not always associated with MDR/XDR profiles. ST357, ST308 and ST298 are also exoU+ and are therefore potentially associated with higher virulence. In contrast, ST175, prevalent in some European countries, shows a MDR/XDR phenotype frequently caused by specific chromosomal mutations and is associated with lower virulence. Finally, ST277 is highly prevalent in Brazil and is specifically associated with the SPM MBL. A deeper understanding of the underlying factors driving the success of high-risk clones, including the reported increased capacity for acquiring exogenous determinants, increased spontaneous mutation rates or greater ability to develop biofilms, is required to develop global strategies to combat them.
铜绿假单胞菌全球克隆与多药耐药（MDR）和广泛耐药（XDR）表型相关，被称为高风险克隆，是全球医院日益严重的威胁。在这里，我们提供了 2020 年关于医院获得性 MDR/XDR 高风险铜绿假单胞菌克隆的最新信息。根据其流行率、全球传播以及与 MDR/XDR 特征的关联，以及关于扩展谱β-内酰胺酶（ESBLs）和碳青霉烯酶，全球前 10 位铜绿假单胞菌高风险克隆包括 ST235、ST111、ST233、ST244、ST357、ST308、ST175、ST277、ST654 和 ST298。ST235 无疑是最重要的高风险克隆，具有与 60 多种不同β-内酰胺酶变体相关的全球传播，包括 A 类和 B 类的多种碳青霉烯酶。此外，ST235 表现出高度的毒力表型，与高死亡率相关，可能是由于产生了 ExoU 细胞毒素。ST111 和 ST233 也是全球传播的 MDR/XDR 克隆，特别是与 VIM-2 金属β-内酰胺酶（MBL）相关，而 ST244 是一个非常普遍的克隆，并不总是与 MDR/XDR 谱相关。ST357、ST308 和 ST298 也是 ExoU+，因此可能与更高的毒力相关。相比之下，在一些欧洲国家流行的 ST175 表现出 MDR/XDR 表型，通常是由特定的染色体突变引起的，与较低的毒力相关。最后，ST277 在巴西高度流行，与 SPM MBL 特异性相关。需要更深入地了解驱动高风险克隆成功的潜在因素，包括报告的获得外源性决定因素的能力增加、自发突变率增加或形成生物膜的能力增加，以制定对抗它们的全球策略。
