Black Cody A, So Wonhee, Dallas Steven S, Gawrys Gerard, Benavides Raymond, Aguilar Samantha, Chen Chang-Jui, Shurko James F, Lee Grace C
The University of Texas at Austin, College of Pharmacy, Austin, TX, United States.
School of Medicine, The University of Texas Health San Antonio, San Antonio, TX, United States.
Front Microbiol. 2021 Feb 10;11:623574. doi: 10.3389/fmicb.2020.623574. eCollection 2020.
Carbapenem-resistant Enterobacterales (CRE) pose a significant global public health threat. Resistance among CRE is particularly complex, owing to numerous possible resistance mechanisms and broad definitions. We aimed to characterize the clinical and molecular profiles of CRE in the South Texas region.
We compared the clinical, genotypic, and phenotypic profiles of carbapenemase producing Enterobacterales (CPE) with those of non-carbapenemase producers (NCPE) isolated from South Texas, United States between 2011 and 2019. Molecular characteristics and resistance mechanisms were analyzed using whole-genome sequences.
The majority (59%) of the CRE isolates were NCPE while 41% of isolates harbored carbapenemases, predmonantly -type. The most common CPE was while majority of and were NCPE Among , the clonal group 307 has emerged as a predmoninant group and was associated with as many CRE infections as the previous common clonal group 258. Patients with NCPE compared to CPE infections were associated with higher antimicrobial exposure prior to culture collection (days of therapy, 795 vs. 242; < 0.001) and emergency department visits within past 90 days (22% vs. 4%; = 0.011). The all cause 30-day mortality was 21%.
This study highlights the diversity of resistance mechanisms underlying CRE in South Texas, with 59% not harboring a carbapenemase. Individuals with NCPE infections were more likely to have had prior antimicrobial therapy and emergency department visits compared to those with CPE. Identification and distinction of these mechanisms by rapid identification of species and carbapenemase would allow for optimal treatment and infection control efforts.
耐碳青霉烯类肠杆菌科细菌（CRE）对全球公共卫生构成重大威胁。由于存在众多可能的耐药机制和宽泛的定义，CRE的耐药情况尤为复杂。我们旨在描述南德克萨斯地区CRE的临床和分子特征。
我们比较了2011年至2019年从美国南德克萨斯分离出的产碳青霉烯酶肠杆菌科细菌（CPE）与非产碳青霉烯酶细菌（NCPE）的临床、基因型和表型特征。使用全基因组序列分析分子特征和耐药机制。
大多数（59%）CRE分离株为NCPE，而41%的分离株携带碳青霉烯酶，主要是 型。最常见的CPE是 ，而大多数 和 是NCPE。在 中，克隆群307已成为主要群体，与之前常见的克隆群258引起的CRE感染数量相同。与CPE感染患者相比，NCPE感染患者在培养标本采集前的抗菌药物暴露量更高（治疗天数，795天对242天； < 0.001），且在过去90天内急诊就诊次数更多（22%对4%； = 0.011）。全因30天死亡率为21%。
本研究突出了南德克萨斯地区CRE耐药机制的多样性，59%的菌株不携带碳青霉烯酶。与CPE感染患者相比，NCPE感染患者更有可能接受过先前的抗菌治疗并去过急诊。通过快速鉴定菌种和碳青霉烯酶来识别和区分这些机制，将有助于进行最佳治疗和感染控制工作。
