IHMA, Schaumburg, Illinois, USA.
Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Antimicrob Agents Chemother. 2021 Jun 17;65(7):e0200020. doi: 10.1128/AAC.02000-20.
To estimate the incidence of carbapenem-resistant (CRE), a global collection of 81,781 surveillance isolates of collected from patients in 39 countries in five geographic regions from 2012 to 2017 was studied. Overall, 3.3% of isolates were meropenem-nonsusceptible (MIC ≥2 μg/ml), ranging from 1.4% (North America) to 5.3% (Latin America) of isolates by region. Klebsiella pneumoniae accounted for the largest number of meropenem-nonsusceptible isolates (76.7%). The majority of meropenem-nonsusceptible carried KPC-type carbapenemases (47.4%), metallo-β-lactamases (MBLs; 20.6%) or OXA-48-like β-lactamases (19.0%). Forty-three carbapenemase sequence variants (8 KPC-type, 4 GES-type, 7 OXA-48-like, 5 NDM-type, 7 IMP-type, and 12 VIM-type) were detected, with KPC-2, KPC-3, OXA-48, NDM-1, IMP-4, and VIM-1 identified as the most common variants of each carbapenemase type. The resistance mechanisms responsible for meropenem-nonsusceptibility varied by region. A total of 67.3% of all carbapenemase-positive isolates identified carried at least one additional plasmid-mediated or intrinsic chromosomally encoded extended-spectrum β-lactamase, AmpC β-lactamase, or carbapenemase. The overall percentage of meropenem-nonsusceptible increased from 2.7% in 2012 to 2014 to 3.8% in 2015 to 2017. This increase could be attributed to the increasing proportion of carbapenemase-positive isolates that was observed, most notably among isolates carrying NDM-type MBLs in Asia/South Pacific, Europe, and Latin America; OXA-48-like carbapenemases in Europe, Middle East/Africa, and Asia/South Pacific; VIM-type MBLs in Europe; and KPC-type carbapenemases in Latin America. Ongoing CRE surveillance combined with a global antimicrobial stewardship strategy, sensitive clinical laboratory detection methods, and adherence to infection control practices will be needed to interrupt the spread of CRE.
为了估计碳青霉烯类耐药（CRE）的发生率，研究了 2012 年至 2017 年间从五个地理区域的 39 个国家的患者中收集的 81781 份全球监测分离株。总体而言，3.3%的分离株对美罗培南不敏感（MIC≥2μg/ml），按地区划分，从北美 1.4%到拉丁美洲 5.3%不等。肺炎克雷伯菌造成的美罗培南不敏感分离株数量最多（76.7%）。大多数对美罗培南不敏感的 携带 KPC 型碳青霉烯酶（47.4%）、金属-β-内酰胺酶（MBL；20.6%）或 OXA-48 样β-内酰胺酶（19.0%）。检测到 43 种碳青霉烯酶序列变异体（8 种 KPC 型、4 种 GES 型、7 种 OXA-48 样、5 种 NDM 型、7 种 IMP 型和 12 种 VIM 型），其中 KPC-2、KPC-3、OXA-48、NDM-1、IMP-4 和 VIM-1 被确定为每种碳青霉烯酶类型最常见的变体。导致美罗培南不敏感的耐药机制因地区而异。所有碳青霉烯酶阳性分离株中，共有 67.3%至少携带一种额外的质粒介导或固有染色体编码的超广谱β-内酰胺酶、AmpCβ-内酰胺酶或碳青霉烯酶。2012 年至 2014 年，美罗培南不敏感 的总体比例从 2.7%上升至 2015 年至 2017 年的 3.8%。这一增长可能归因于碳青霉烯酶阳性分离株比例的增加，在亚洲/大洋洲、欧洲和拉丁美洲携带 NDM 型 MBL 的分离株中；在欧洲、中东/非洲和亚洲/大洋洲携带 OXA-48 样碳青霉烯酶的分离株；在欧洲携带 VIM 型 MBL 的分离株；以及在拉丁美洲携带 KPC 型碳青霉烯酶的分离株。需要持续进行 CRE 监测，结合全球抗菌药物管理策略、敏感的临床实验室检测方法和遵循感染控制措施，以阻止 CRE 的传播。
