Rus Maria, Licker Monica, Musuroi Corina, Seclaman Edward, Muntean Delia, Cirlea Natalia, Tamas Alina, Vulpie Silvana, Horhat Florin George, Baditoiu Luminita
Department of Microbiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
"Pius Brinzeu" County Clinical Emergency Hospital, Timisoara, Romania.
Infect Drug Resist. 2020 Dec 31;13:4751-4761. doi: 10.2147/IDR.S280977. eCollection 2020.
Carbapenem-resistant (CRP) is a group of multidrug-resistant (MDR) microorganisms that raise special treatment problems due to their intrinsic resistance to colistin. In this study, our aim is to provide a phenotypic and molecular characterization of the carbapenemases secreted by CRP strains isolated from inpatients from an intensive care unit (ICU) and surgical wards, as well as the identification of the risk factors involved in their acquisition.
An observational, cross-sectional study was performed which included all strains isolated in samples from inpatients on high-risk wards of the largest university hospital in Western Romania, from July 2017 to April 2019. Meropenem-resistant strains (N=65) with MIC ≥16 µg/mL were subjected to a singleplex PCR assay for the detection of NDM, VIM and CTX-M genes. The analysis of risk factors was performed by logistic regression.
Out of 8317 samples that were processed, 400 strains were isolated: 64% belonging to the genus , 26.75% to the genus and 9.25% to the genus . Most CRP strains (N=56) were of MBL type, and 55 had the NDM gene as the prevalent gene substrate. was the main species that provided the circulating MDR strains. Most CRP strains came from patients admitted to ICU, being isolated mainly from bronchial aspirates and blood cultures. Multivariate analysis revealed 3 independent risk factors - mechanical ventilation>96h (HR: 40.51 [13.65-120.25], p <0.001), tracheostomy (HR: 2.65 [1.14-6.17], p = 0.024) and prolonged antibiotic therapy (HR: 1.01 [1.00-1.02], p = 0.03).
There is a significant increase in the incidence of CR strains, the MBL-NDM type being predominant. These strains presented various other resistance mechanisms, being often extremely difficult to treat and led to an excess of lethality of 27.16%.
耐碳青霉烯类（CRP）是一类多重耐药（MDR）微生物，由于其对黏菌素具有固有耐药性，引发了特殊的治疗问题。在本研究中，我们的目的是对从重症监护病房（ICU）和外科病房的住院患者中分离出的CRP菌株所分泌的碳青霉烯酶进行表型和分子特征分析，并确定其获得的危险因素。
进行了一项观察性横断面研究，纳入了2017年7月至2019年4月期间罗马尼亚西部最大的大学医院高危病房住院患者样本中分离出的所有菌株。对美罗培南耐药菌株（N = 65），其MIC≥16μg/mL，进行单重PCR检测NDM、VIM和CTX - M基因。通过逻辑回归分析危险因素。
在处理的8317个样本中，分离出400株菌株：64%属于属，26.75%属于属，9.25%属于属。大多数CRP菌株（N = 56）为MBL型，55株以NDM基因为主要基因底物。是提供循环MDR菌株的主要菌种。大多数CRP菌株来自入住ICU的患者，主要从支气管吸出物和血培养中分离得到。多因素分析显示3个独立危险因素——机械通气>96小时（HR：40.51 [13.65 - 120.25]，p <0.001）、气管切开术（HR：2.65 [1.14 - 6.17]，p = 0.024）和长期抗生素治疗（HR：1.01 [1.00 - 1.02]，p = 0.03）。
CR菌株的发病率显著增加，MBL - NDM型占主导。这些菌株呈现出各种其他耐药机制，通常极难治疗，并导致27.16%的额外致死率。
