Cano-Martín Estefanía, Portillo-Calderón Inés, Pérez-Palacios Patricia, Navarro-Marí José María, Fernández-Sierra María Amelia, Gutiérrez-Fernández José
Department of Preventive Medicine and Public Health, Virgen de las Nieves University Hospital & ibs, Granada-Instituto de Investigación Biosanitaria de Granada, Avda. de las Fuerzas Armadas, 2, 18014 Granada, Spain.
Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología Clínica, Hospital Universitario Virgen Macarena & Instituto de Biomedicina de Sevilla (IBIs), Hospital Universitario Virgen Macarena/CSIC/Universidad de Sevilla, 41020 Sevilla, Spain.
Antibiotics (Basel). 2021 Sep 18;10(9):1127. doi: 10.3390/antibiotics10091127.
Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsed-field gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with , 14 with , 9 with , 11 with , 46 with , 70 with , and 52 with . The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner.
在过去几十年中，事实证明，细菌对抗生素的耐药性很难控制。大量的多重耐药细菌包括产碳青霉烯酶细菌（CPB），针对这类细菌，可用的治疗选择和感染控制措施有限。此外，碳青霉烯酶与高风险克隆相关联，这些克隆由每种细菌所属的序列类型（ST）定义。这项横断面回顾性研究的目的是描述2015年至2020年期间在西班牙南部一家三级医院分离出的CPB群体，并确定ST与医院定义的流行病学情况之间的关系。对2015年1月至2020年12月期间收到的所有直肠和咽拭子以及临床样本中的CPB进行微生物学研究，使用MicroScan和质谱对分离株进行特征分析。通过PCR和桑格测序检测碳青霉烯酶，并通过多位点序列分型（MLST）指定STs。使用Xbal、Spel或Apal酶通过脉冲场凝胶电泳确定分离株的遗传相关性。记录每个CPB分离的事件，并将其分类为与暴发有关或无关。研究期间有320起CPB事件：18起为[具体菌株1]，14起为[具体菌株2]，9起为[具体菌株3]，11起为[具体菌株4]，46起为[具体菌株5]，70起为[具体菌株6]，52起为[具体菌株7]。检测到的碳青霉烯酶组为OXA、VIM、KPC和NDM以及各种亚组。对于ST15、ST258、ST307和ST45，[具体菌株1]事件与暴发之间存在同步关系，但其他CPB不存在这种关系。这些年来，CPB感染大幅增加，最显著的是在2020年，与COVID-19大流行同时发生。这项研究强调了基因测序技术在控制这些微生物传播方面的有用性，特别是在医疗保健中心。这些技术能提供更快的结果，降低其成本可能会使其实时应用更可行。将流行病学数据与实时分子测序技术相结合，可以在这些CPB的传播控制和感染患者的管理方面取得重大进展。实时测序对于提高精确度从而控制暴发并更有效地针对感染预防措施至关重要。
