Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
Department of Microbiology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
BMC Infect Dis. 2021 Oct 13;21(1):1061. doi: 10.1186/s12879-021-06758-5.
The worldwide spread of carbapenemase-producing Enterobacteriaceae (CPE) has reduced the clinical utility of carbapenems. Plasmids often play an important role in the spread of genes encoding drug-resistance factors, especially in the horizontal transfer of these genes among species of Enterobacteriaceae. This study describes a patient infected with three species of CPE carrying an identical transferrable IncL/M plasmid.
Clinical isolates of CPE were collected at St. Luke's International Hospital, Tokyo, Japan, from 2015 to 2019. Three species of CPE isolates, Enterobacter cloacae, Klebsiella aerogenes and Serratia marcescens, were isolated from a patient who developed severe gallstone pancreatitis associated with bloodstream infection, with all three isolates producing IMP-1 metallo-β-lactamase. The complete sequences of the plasmids of the three isolates were determined by both MiSeq and MinION. The medical chart of this patient was retrospectively reviewed conducted to obtain relevant clinical information.
The three CPE species carried an IncL/M plasmid, pSL264, which was 81,133 bp in size and harbored bla. The genetic environment surrounding bla consisted of int1-bla-aac(6')-IIc-qacL-qacEdelta1-sul1-istB-IS21. Conjugation experiments showed that S. marcescens could transmit the plasmid to E. cloacae and K. aerogenes. In contrast, pSL264 could not transfer from E. cloacae or K. aerogenes to S. marcescens.
The IncL/M plasmid pSL264 harboring bla was able to transfer among different species of Enterobacteriaceae in a patient receiving long-term antimicrobial treatment. The worldwide emergence and spread of IncL/M plasmids harboring carbapenemase-encoding genes among species of Enterobacteriaceae is becoming a serious public health hazard.
碳青霉烯酶产生肠杆菌科（CPE）的全球传播降低了碳青霉烯类药物的临床实用性。质粒在耐药基因编码的传播中经常发挥重要作用，尤其是在肠杆菌科不同种属之间的这些基因的水平转移中。本研究描述了一名感染三种携带可转移 IncL/M 质粒的 CPE 的患者。
2015 年至 2019 年，在日本东京的圣卢克国际医院收集了 CPE 的临床分离株。从一名患有严重胆石性胰腺炎合并血流感染的患者中分离出三种 CPE 分离株，分别为阴沟肠杆菌、产气肠杆菌和粘质沙雷氏菌，所有三种分离株均产生 IMP-1 金属β-内酰胺酶。通过 MiSeq 和 MinION 两种方法确定了三种分离株质粒的完整序列。回顾性查阅该患者的病历，以获取相关临床信息。
三种 CPE 携带 IncL/M 质粒 pSL264，大小为 81133bp，携带 bla。bla 周围的遗传环境由 int1-bla-aac(6')-IIc-qacL-qacEdelta1-sul1-istB-IS21 组成。接合实验表明，粘质沙雷氏菌可以将质粒传递给阴沟肠杆菌和产气肠杆菌。相比之下，pSL264 不能从阴沟肠杆菌或产气肠杆菌转移到粘质沙雷氏菌。
携带 bla 的 IncL/M 质粒 pSL264 能够在接受长期抗菌治疗的患者中在不同种属的肠杆菌科之间转移。在肠杆菌科不同种属中携带碳青霉烯酶编码基因的 IncL/M 质粒的全球出现和传播正在成为一个严重的公共卫生危害。
