Al-Hassan Leena L, Al-Madboly Lamiaa A
Department of Global Health and Infection, Brighton and Sussex Medical School, Medical Research Building, University of Sussex, BN1 9PS, Brighton, UK.
Department of Pharmaceutical Microbiology, Tanta University, Elgaish Street, Elgharbya governorate, Tanta, Egypt.
Infect Prev Pract. 2020 Feb 13;2(2):100040. doi: 10.1016/j.infpip.2020.100040. eCollection 2020 Jun.
are problematic hospital pathogens, and the increased incidence of multi drug resistance has significantly limited treatment options. The global epidemiology is not fully characterised due to large data gaps from low- and middle-income countries. This study characterised the molecular epidemiology of an outbreak in Egypt.
Fifty-four isolates were recovered from a 4-month-outbreak at Tanta University Hospitals (TUH). Associated clinical and demographic data, and the antibiograms were analysed, and Carbapenem resistant isolates were screened for acquired carbapenemase genes by PCR and sequencing. Epidemiological typing was performed by single-locus sequencing of and Multi Locus Sequence Typing (MLST), and sequence types (STs) were analysed based on maximum-likelihood phylogeny (PhyML) to identify relatedness.
Immune suppression and ICU admission were the most common co-morbidity and risk factor. Carbapenem resistance accounted for 81%, and correlated with the presence of OXA-23, NDM-1 and -2, and VIM-1 and -2 carbapenemases. Nine different genes were identified which corresponded to 22 different Sequence Types (STs), including 10 novel. International clone (IC2) was the predominant clone. PhyML analysis revealed the presence of 2 distinct clones with multiple sub-lineages.
Given the short duration of the study, there was a rare heterogeneous population in the hospital. Carbapenem resistance is mediated by acquired carbapenemases in diverse lineages indicating the possibility of horizontal gene transfer. The diversity indicates the influx of multiple lineages of IC2 into TUH from unknown sources. Molecular epidemiological studies are essential for infection prevention and control measures.
是有问题的医院病原体，多重耐药性发病率的增加显著限制了治疗选择。由于低收入和中等收入国家存在大量数据缺口，全球流行病学特征尚未完全明确。本研究对埃及一次暴发的分子流行病学特征进行了描述。
从坦塔大学医院（TUH）持续4个月的暴发中分离出54株菌株。分析相关的临床和人口统计学数据以及抗菌谱，通过PCR和测序对耐碳青霉烯类菌株进行获得性碳青霉烯酶基因筛查。通过对 进行单基因座测序和多位点序列分型（MLST）进行流行病学分型，并基于最大似然系统发育（PhyML）分析序列类型（STs）以确定相关性。
免疫抑制和入住重症监护病房是最常见的合并症和危险因素。耐碳青霉烯类占81%，与OXA - 23、NDM - 1和 - 2以及VIM - 1和 - 2碳青霉烯酶的存在相关。鉴定出9种不同的 基因，对应22种不同的序列类型（STs），其中包括10种新类型。国际克隆（IC2）是主要克隆。PhyML分析显示存在2个具有多个亚谱系的不同克隆。
鉴于研究持续时间较短，医院中存在罕见的异质菌群。耐碳青霉烯类由不同谱系中获得的碳青霉烯酶介导，表明存在水平基因转移的可能性。这种多样性表明多种IC2谱系从未知来源流入TUH。分子流行病学研究对于感染预防和控制措施至关重要。
