Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait.
PLoS One. 2020 Nov 17;15(11):e0241971. doi: 10.1371/journal.pone.0241971. eCollection 2020.
Fecal colonization by carbapenem-resistant Enterobacteriaceae (CRE) can be the main reservoir for transmission of these resistant organisms especially in the Intensive Care Units (ICUs).
This study was conducted to evaluate the rate of rectal carriage and molecular characterization of CRE in patients hospitalized in the ICUs of 2 major hospitals (Adan and Mubarak Al Kabeer Hospitals) in Kuwait.
Rectal swabs were collected from all patients at admission, 48 h after admission and once weekly from April 2017- March 2018. Initial CRE screening was carried out on MacConkey agar on which meropenem disc 10μg was placed. Identification of isolates was by API 20E. Susceptibility testing was performed using the E-test method. Polymerase chain reaction (PCR) was used to detect the carbapenemase-encoding genes. Clonal relationship was investigated by pulsed-field electrophoresis (PFGE). Genes of blaOXA-181 and blaNDM-5-carrying plasmids were detected in some strains.
A total of 590 patients were recruited into the study. Of these, 58 were positive for CRE, giving a prevalence of 9.8%; 25/320 (7.8%) in Adan and 33/270 (12.2%) in Mubarak Al Kabeer Hospitals. All isolates were resistant to multiple antibiotics. Resistance rates to colistin and tigecycline were 17% and 83%, respectively. Single genes of blaOXA-181 were detected in isolates from 38 (65.5%) out of 58 patients and in 5 patients colonized by blaOXA-48-positive CRE. A combination of 2 genes was detected in 12 isolates; 5 blaKPC-2 and blaOXA-181, 4 blaVIM-1 and blaOXA-181, and 3 blaNDM-5 and blaOXA-181. PFGE showed an overall level of similarity of 38%. Southern hybridization studies localized the blaOXA-181 and blaNDM-5 genes to a large plasmid of 200kb in 3 K. pneumoniae isolates and a small plasmid of 80kb in 2 E. coli isolates, respectively.
The prevalence of CRE colonization in the 2 hospital ICUs was relatively high and the emergence of blaOXA-181-mediated CRE is a cause for concern as there is the possibility of rapid horizontal spread among hospital patients in Kuwait. Active surveillance of CRE in the ICUs is highly recommended to stem its spread.
产碳青霉烯类耐药肠杆菌科细菌（CRE）的粪便定植可能是这些耐药菌传播的主要来源，尤其是在重症监护病房（ICUs）。
本研究旨在评估科威特 2 家主要医院（Adan 和 Mubarak Al Kabeer 医院） ICU 住院患者直肠携带 CRE 的比率和分子特征。
2017 年 4 月至 2018 年 3 月期间，对所有入院患者、入院后 48 小时和每周一次采集直肠拭子。在含有美罗培南 10μg 药敏纸片的 MacConkey 琼脂上对 CRE 进行初始筛选。通过 API 20E 进行分离株鉴定。采用 E 试验法进行药敏试验。聚合酶链反应（PCR）用于检测碳青霉烯酶编码基因。脉冲场电泳（PFGE）用于研究克隆关系。部分菌株检测 blaOXA-181 和 blaNDM-5 携带质粒的基因。
共纳入 590 例患者。其中，CRE 阳性 58 例，检出率为 9.8%；Adan 医院 320 例中有 25 例（7.8%），Mubarak Al Kabeer 医院 270 例中有 33 例（12.2%）。所有分离株均对多种抗生素耐药。对黏菌素和替加环素的耐药率分别为 17%和 83%。38 例（65.5%）和 5 例 blaOXA-48 阳性 CRE 定植患者的 blaOXA-181 单基因被检出。12 株检出 2 种基因组合；5 株 blaKPC-2 和 blaOXA-181，4 株 blaVIM-1 和 blaOXA-181，3 株 blaNDM-5 和 blaOXA-181。PFGE 显示总体相似度为 38%。Southern 杂交研究将 blaOXA-181 和 blaNDM-5 基因定位于 3 株肺炎克雷伯菌的 200kb 大质粒和 2 株大肠埃希菌的 80kb 小质粒上。
2 家医院 ICU 中 CRE 定植的流行率相对较高，blaOXA-181 介导的 CRE 的出现令人担忧，因为在科威特医院患者之间可能会迅速发生水平传播。强烈建议在 ICU 中对 CRE 进行主动监测，以阻止其传播。
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