莫桑比克马普托中央医院产 ESBL 和质粒介导 AmpC 型高产头孢菌素酶的多重耐药大肠埃希菌临床分离株的高流行率。
High prevalence of multidrug resistant ESBL- and plasmid mediated AmpC-producing clinical isolates of Escherichia coli at Maputo Central Hospital, Mozambique.
机构信息
Microbiology Laboratory, Maputo Central Hospital, Maputo, Mozambique.
High Institute of Health Sciences (ISCISA), Maputo, Mozambique.
出版信息
BMC Infect Dis. 2021 Jan 6;21(1):16. doi: 10.1186/s12879-020-05696-y.
BACKGROUND
Epidemiological data of cephalosporin-resistant Enterobacterales in Sub-Saharan Africa is still restricted, and in particular in Mozambique. The aim of this study was to detect and characterize extended-spectrum β-lactamase (ESBL) - and plasmid-mediated AmpC (pAmpC)-producing clinical strains of Escherichia coli at Maputo Central Hospital (MCH), a 1000-bed reference hospital in Maputo, Mozambique.
METHODS
A total of 230 clinical isolates of E. coli from urine (n = 199) and blood cultures (n = 31) were collected at MCH during August-November 2015. Antimicrobial susceptibility testing was performed by the disc diffusion method and interpreted according to EUCAST guidelines. Isolates with reduced susceptibility to 3rd generation cephalosporins were examined further; phenotypically for an ESBL-/AmpC-phenotype by combined disc methods and genetically for ESBL- and pAmpC-encoding genes by PCR and partial amplicon sequencing as well as genetic relatedness by ERIC-PCR.
RESULTS
A total of 75 isolates with reduced susceptibility to cefotaxime and/or ceftazidime (n = 75) from urine (n = 58/199; 29%) and blood (n = 17/31; 55%) were detected. All 75 isolates were phenotypically ESBL-positive and 25/75 (33%) of those also expressed an AmpC-phenotype. ESBL-PCR and amplicon sequencing revealed a majority of bla (n = 58/75; 77%) dominated by bla. All AmpC-phenotype positive isolates (n = 25/75; 33%) scored positive for one or more pAmpC-genes dominated by bla. Multidrug resistance (resistance ≥ three antibiotic classes) was observed in all the 75 ESBL-positive isolates dominated by resistance to trimethoprim-sulfamethoxazole, ciprofloxacin and gentamicin. ERIC-PCR revealed genetic diversity among strains with minor clusters indicating intra-hospital spread.
CONCLUSION
We have observed a high prevalence of MDR pAmpC- and/or ESBL-producing clinical E. coli isolates with FOX/MOX and CTX-Ms as the major β-lactamase types, respectively. ERIC-PCR analyses revealed genetic diversity and some clusters indicating within-hospital spread. The overall findings strongly support the urgent need for accurate and rapid diagnostic services to guide antibiotic treatment and improved infection control measures.
背景
撒哈拉以南非洲地区头孢菌素耐药肠杆菌科的流行病学数据仍然有限，特别是在莫桑比克。本研究的目的是在莫桑比克马普托中央医院（MCH）检测并鉴定产超广谱β-内酰胺酶（ESBL）和质粒介导的AmpC（pAmpC）的大肠埃希菌临床分离株，MCH 是一家拥有 1000 张床位的参考医院。
方法
2015 年 8 月至 11 月，从马普托中央医院的尿液（n=199）和血液培养物（n=31）中收集了 230 株大肠埃希菌临床分离株。采用纸片扩散法进行抗菌药物敏感性试验，根据 EUCAST 指南进行解释。对 3 代头孢菌素敏感性降低的分离株进一步进行表型检测，通过联合药敏纸片法检测 ESBL-/AmpC-表型，通过 PCR 和部分扩增子测序检测 ESBL 和 pAmpC 编码基因，并通过 ERIC-PCR 检测遗传相关性。
结果
从尿液（n=58/199；29%）和血液（n=17/31；55%）中检测到 75 株对头孢噻肟和/或头孢他啶（cefotaxime and/or ceftazidime）敏感性降低的分离株（n=75）。所有 75 株分离株的表型均为 ESBL 阳性，其中 25 株（33%）也表达 AmpC 表型。ESBL-PCR 和扩增子测序显示，bla（n=58/75；77%）为主导的 bla. 所有 AmpC 表型阳性分离株（n=25/75；33%）均携带一种或多种 pAmpC 基因，以 bla. 为主导。所有 75 株 ESBL 阳性分离株均表现出多重耐药（≥3 种抗生素耐药），以对甲氧苄啶-磺胺甲恶唑、环丙沙星和庆大霉素的耐药性为主。ERIC-PCR 显示，菌株间遗传多样性较小，存在院内传播的小簇。
结论
我们观察到产 MDR pAmpC-和/或 ESBL 的临床大肠埃希菌分离株的高流行率，FOX/MOX 和 CTX-Ms 分别为主要的β-内酰胺酶类型。ERIC-PCR 分析显示遗传多样性和一些簇表明存在院内传播。总的来说，这些发现强烈支持迫切需要准确和快速的诊断服务，以指导抗生素治疗和改善感染控制措施。
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