巴基斯坦临床分离株的抗生素耐药性和毒力特征（基因和表型）分析：碳青霉烯类和黏菌素耐药显著水平的鉴定
Analysis of Antibiotic Resistance and Virulence Traits (Genetic and Phenotypic) in Clinical Isolates from Pakistan: Identification of Significant Levels of Carbapenem and Colistin Resistance.
作者信息
Imtiaz Wajiha, Syed Zainab, Rafaque Zara, Andrews Simon Colin, Dasti Javid Iqbal
机构信息
Department of Microbiology, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
School of Biological Sciences, Whiteknights, University of Reading, Reading RG6 6AJ, UK.
出版信息
Infect Drug Resist. 2021 Jan 25;14:227-236. doi: 10.2147/IDR.S293290. eCollection 2021.
BACKGROUND
The emergence of carbapenem-resistant and hypervirulent hypermucoviscous strains poses a significant public health challenge. We determined the MDR profiles, antibiotic resistance factors, virulence gene complement, and hypermucoviscous features of 200 clinical isolates from two major tertiary care hospitals in Islamabad and Rawalpindi, Pakistan.
METHODS
Susceptibility profiling and phenotypic analysis were performed according to the CLSI guidelines. Genetic determinants of antibiotic resistance and virulence were detected by PCR. Biofilm formation analysis was performed by microtiter plate assay.
RESULTS
The isolates displayed a high degree of antibiotic resistance: 36% MDR-CRKP; 38% carbapenem resistance; 55% gentamicin resistance; 53% ciprofloxacin resistance; and 59% aztreonam resistance. In particular, the level of resistance against fosfomycin (22%) and colistin (15%) is consistent with previous reports of increased resistance levels. Combined resistance to carbapenem and colistin was 7%. Genetic factors associated with colistin resistance ( and genes) were detected in 12 and 9% of the isolates, respectively. Significant differences in resistance to gentamicin and levofloxacin were observed between the 200 isolates. Many of the isolates harbored genes specifying extended-spectrum and/or carbapenem-resistant β-lactamases: (46%), (39%), and (24%). The prevalence of the hypermucoviscous phenotype was 22% and 13% of the MDR isolates carried the gene (regulator for mucoid phenotype). Key virulence factor genes detected include those encoding: porins ( and ; at 56 and 55% prevalence, respectively); adhesins ( and ; at 19, 18, and 22% prevalence, respectively); and the polysaccharide regulator, , at 16% prevalence.
CONCLUSION
This report highlights carbapenem-resistant (CRKP) prevalence, emerging resistance to fosfomycin, and the presence of and in colistin-resistant isolates. Further, the detection of signifies the prevalence of the hypermucoviscous trait in CRKP clinical isolates from Pakistan.
背景
耐碳青霉烯类和高毒力高黏液性菌株的出现对公共卫生构成了重大挑战。我们确定了来自巴基斯坦伊斯兰堡和拉瓦尔品第两家主要三级医疗医院的200株临床分离株的多重耐药谱、抗生素耐药因素、毒力基因组成和高黏液性特征。
方法
根据临床和实验室标准协会（CLSI）指南进行药敏分析和表型分析。通过聚合酶链反应（PCR）检测抗生素耐药性和毒力的遗传决定因素。通过微量滴定板法进行生物膜形成分析。
结果
分离株表现出高度的抗生素耐药性：36%为多重耐药耐碳青霉烯肺炎克雷伯菌（MDR-CRKP）；38%对碳青霉烯类耐药；55%对庆大霉素耐药；53%对环丙沙星耐药；59%对氨曲南耐药。特别是，对磷霉素（22%）和黏菌素（15%）的耐药水平与先前报道的耐药水平增加一致。对碳青霉烯类和黏菌素的联合耐药率为7%。分别在12%和9%的分离株中检测到与黏菌素耐药相关的遗传因素（ 和 基因）。在200株分离株中观察到对庆大霉素和左氧氟沙星的耐药性存在显著差异。许多分离株携带指定超广谱和/或耐碳青霉烯β-内酰胺酶的基因： （46%）、 （39%）和 （24%）。高黏液性表型的患病率为22%，13%的多重耐药分离株携带 基因（黏液样表型调节因子）。检测到的关键毒力因子基因包括编码以下物质的基因：孔蛋白（ 和 ；患病率分别为56%和55%）；黏附素（ 和 ；患病率分别为19%、18%和22%）；以及多糖调节因子 ，患病率为16%。
结论
本报告强调了耐碳青霉烯肺炎克雷伯菌（CRKP）的患病率、对磷霉素新出现的耐药性以及耐黏菌素分离株中 和 的存在。此外， 的检测表明巴基斯坦CRKP临床分离株中高黏液性特征的患病率。
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