Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
Pediatr Neonatol. 2021 Mar;62(2):129-137. doi: 10.1016/j.pedneo.2020.10.002. Epub 2020 Oct 14.
Gastrointestinal carriage of multidrug resistant (MDR) Gram-negative bacilli, especially Klebsiella pneumoniae and Escherichia coli, was highly associated with severe nosocomial infections. The main objectives of this study were to determine the clonal relatedness of intestinal carriage and transmission risk factors of MDR E. coli and K. pneumoniae amongst preterm infants admitted to the neonatal intensive care unit (NICU).
A prospective cohort study of preterm infants with gestational age < 37 weeks was conducted in the NICU of the University of Malaya Medical Centre (UMMC). Infants' stool specimens were collected on day 1 (meconium), week 1, week 2, week 8 and week 10 during their admission (from 1st June to 31st August 2017) until discharge. The presence and antibiotic resistance pattern of MDR E. coli and K. pneumoniae were determined. Strain clonality and relatedness were explored via pulsed-field gel electrophoresis (PFGE) fingerprints. The risk factors for MDR strains acquisition were evaluated using the Cox proportional-hazards model and Firth logistic regression.
A total of 139 stool specimens were obtained from 50 subjects. Twenty-six (52%) infants were colonized with MDR K. pneumoniae and/or E. coli. High clonal dissemination between two clusters of ESBL-producing K. pneumoniae strains was seen from PFGE profile. We detected a persistent, dominant, aminoglycosides-resistant strains cluster (cluster B), which harbored bla, bla, bla, bla, ompK35 and ompK36 genes. Infants born to women who were anemic in pregnancy [OR = 0.01 (CI = 0.00-0.39), P-value = 0.042] and infants exposed to penicillin/β-lactams group antibiotics during the first week of life [OR = 0.02 (CI = 0.02-0.32), P-value = 0.013] were found to have a lower risk of MDR K. pneumoniae and E. coli colonization.
The prevalence of dominant aminoglycosides-resistant strains cluster in the NICU is alarming. Awareness of and vigilance for the dominant cluster found will enable the reduction of cross-transmission amongst high-risk infants.
携带多重耐药(MDR)革兰氏阴性杆菌(尤其是肺炎克雷伯菌和大肠杆菌)的胃肠道与严重医院获得性感染密切相关。本研究的主要目的是确定肠道携带的克隆相关性以及早产儿在入住新生儿重症监护病房(NICU)期间传播 MDR 大肠杆菌和肺炎克雷伯菌的危险因素。
在马来亚大学医学中心(UMMC)的 NICU 中进行了一项前瞻性队列研究,研究对象为胎龄<37 周的早产儿。在婴儿住院期间(2017 年 6 月 1 日至 8 月 31 日),从第 1 天(胎粪)开始,每周 1 天、第 2 天、第 8 天和第 10 天收集婴儿的粪便标本,直到出院。确定 MDR 大肠杆菌和肺炎克雷伯菌的存在和抗生素耐药模式。通过脉冲场凝胶电泳(PFGE)指纹图谱探索菌株的克隆性和相关性。使用 Cox 比例风险模型和 Firth 逻辑回归评估 MDR 菌株获得的危险因素。
从 50 名患儿中获得了 139 份粪便标本。26 名(52%)患儿定植了产超广谱β-内酰胺酶(ESBL)的肺炎克雷伯菌和/或大肠杆菌。从 PFGE 图谱中发现了两群 ESBL 产肺炎克雷伯菌菌株之间的高克隆传播。我们检测到了一个持续存在的、优势的、氨基糖苷类耐药菌株群(群 B),该菌株群携带 blaCTX-M-15、blaTEM-1、blaSHV-12、blaOXA-1、ompK35 和 ompK36 基因。妊娠期间贫血的产妇所生的婴儿(OR=0.01(95%CI=0.00-0.39),P 值=0.042)和在生命的第一周接触青霉素/β-内酰胺类抗生素的婴儿(OR=0.02(95%CI=0.02-0.32),P 值=0.013)发生 MDR 肺炎克雷伯菌和大肠杆菌定植的风险较低。
NICU 中优势氨基糖苷类耐药菌株群的流行令人担忧。对发现的优势群的认识和警惕将有助于减少高危婴儿之间的交叉传播。