Miltgen Guillaume, Bour Maxime, Allyn Jérôme, Allou Nicolas, Vedani Thibaut, Vuillemenot Jean-Baptiste, Triponney Pauline, Martinet Olivier, Lugagne Nathalie, Benoit-Cattin Thierry, Dortet Laurent, Birer Aurélien, Jaffar-Bandjee Marie-Christine, Belmonte Olivier, Plésiat Patrick, Potron Anaïs
Laboratoire de Bactériologie, Centre Hospitalier Universitaire La Réunion, Saint-Denis, France; UMR Processus Infectieux en Milieu Insulaire Tropical, CNRS 9192, INSERM U1187, IRD 249, Université de la Réunion, Sainte-Clotilde, France.
Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France.
Int J Antimicrob Agents. 2021 Oct;58(4):106402. doi: 10.1016/j.ijantimicag.2021.106402. Epub 2021 Jul 19.
Dual resistance to colistin and carbapenems is a milestone reached by certain extensively-drug resistant (XDR) Gram-negative bacteria. This study describes the first outbreak of XDR colistin- and carbapenem-resistant OXA-23-/NDM-1-producing Acinetobacter baumannii (CCRAB) in the European overseas territory of Reunion Island (France, Indian Ocean). Between April 2019 and June 2020, 13 patients admitted to the University Hospital of Reunion Island were involved in the outbreak, of whom eight were infected and six died. The first case was traced to a medical evacuation from Mayotte Island (Comoros archipelago). An epidemiological link could be established for 11 patients. All of the collected CCRAB isolates showed the same resistance profile and co-produced intrinsic β-lactamases OXA-69 and ADC-191, together with acquired carbapenem-hydrolysing β-lactamases OXA-23 and NDM-1. A mutation likely involved in colistin resistance was detected in the two-component system PmrAB (D82N in PmrA). All of the isolates were found to belong to ST1/ST231 clonal complex and were phylogenetically indistinguishable. Their further characterization by whole-genome sequence analyses (whole-genome multi-locus sequence typing, single nucleotide polymorphisms) provided hints about the transmission pathways. This study pleads for strict application of control and prevention measures in institutions where the risk of imported XDR bacteria is high.
对黏菌素和碳青霉烯类药物的双重耐药性是某些广泛耐药（XDR）革兰氏阴性菌达到的一个里程碑。本研究描述了在留尼汪岛（法国，印度洋）这一欧洲海外领地首次爆发的产OXA - 23 / NDM - 1的耐黏菌素和碳青霉烯类鲍曼不动杆菌（CCRAB）疫情。在2019年4月至2020年6月期间，留尼汪岛大学医院收治的13名患者卷入了此次疫情，其中8人受到感染，6人死亡。首例病例追溯至从马约特岛（科摩罗群岛）的一次医疗后送。11名患者之间可建立起流行病学联系。所有收集到的CCRAB分离株均显示出相同的耐药谱，共同产生固有β - 内酰胺酶OXA - 69和ADC - 191，以及获得性碳青霉烯水解β - 内酰胺酶OXA - 23和NDM - 1。在双组分系统PmrAB中检测到一个可能与黏菌素耐药有关的突变（PmrA中的D82N）。所有分离株均属于ST1 / ST231克隆复合体，在系统发育上无法区分。通过全基因组序列分析（全基因组多位点序列分型、单核苷酸多态性）对它们进行的进一步特征分析为传播途径提供了线索。本研究呼吁在输入XDR细菌风险高的机构严格实施控制和预防措施。
