约旦三家主要医院分离的碳青霉烯类耐药鲍曼不动杆菌的分子流行病学研究。
Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from three major hospitals in Jordan.
机构信息
Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan.
Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE.
出版信息
Int J Clin Pract. 2021 Dec;75(12):e14998. doi: 10.1111/ijcp.14998. Epub 2021 Nov 5.
BACKGROUND
In the last decade, incidences of carbapenem-resistant Acinetobacter baumannii have been increasingly reported worldwide. Consequently, A. baumannii was included in the World Health Organization's new list of critical pathogens, for which new drugs are desperately needed. The objective of this research was to study the molecular epidemiology and antimicrobial susceptibility of clinical carbapenem-resistant A. baumannii isolated from Jordanian hospitals.
METHODS
A total of 78 A. baumannii and 8 Acinetobacter spp. isolates were collected from three major hospitals in Jordan during 2018. Disc diffusion and microdilution methods were used to test their susceptibility against 19 antimicrobial agents. Multilocus sequence typing (MLST) was performed using the Pasteur scheme, followed by eBURST analysis for all isolates. PCR was used to detect β-lactam resistance genes, bla , bla , and bla .
RESULTS
Of the 86 tested isolates, 78 (90.6%) exhibited resistance to carbapenems, whereas no resistance was recorded to tigecycline or polymyxins. Based on the resistance profiles, 10.4% and 84.8% of isolates were classified into multidrug resistant (MDR) or extensively drug resistant (XDR), respectively. The most prevalent carbapenems resistance genes amongst isolates were bla (89.5%), followed by bla (88.3%) and bla (10.4%). MLST revealed the presence of 19 sequence types (STs), belonging to eight different international complexes. The most commonly detected clonal complex (CC) was CC2, representing 64% of all typed isolates.
CONCLUSIONS
This is the first study to report the clonal diversity of A. baumannii isolates in Jordan. A high incidence of carbapenem resistance was detected in the isolates investigated. In addition, our findings provided evidence for the widespread of bla harbouring carbapenem-resistant A. baumannii and belonging to CC2. The number of XDR isolates identified in this study is alarming. Thus, periodic surveillance and molecular epidemiological studies of resistance factors are important to improve treatment outcomes and prevent the spread of A. baumannii infections.
背景
在过去十年中，碳青霉烯类耐药鲍曼不动杆菌的发生率在全球范围内不断增加。因此，鲍曼不动杆菌被世界卫生组织列入新的关键病原体名单，急需新的药物。本研究的目的是研究从约旦医院分离的临床碳青霉烯类耐药鲍曼不动杆菌的分子流行病学和抗菌药物敏感性。
方法
本研究共收集了 2018 年约旦三家主要医院的 78 株鲍曼不动杆菌和 8 株不动杆菌属分离株。采用纸片扩散法和微量稀释法检测其对 19 种抗菌药物的敏感性。采用巴斯德方案进行多位点序列分型（MLST），对所有分离株进行 eBURST 分析。采用 PCR 检测β-内酰胺类耐药基因 bla OXA-23 、 bla OXA-51 、 bla OXA-24/40 。
结果
在 86 株受试菌株中，78 株（90.6%）对碳青霉烯类药物耐药，而对替加环素或多黏菌素类药物无耐药性。根据耐药谱，10.4%和 84.8%的分离株分别归类为多药耐药（MDR）或广泛耐药（XDR）。分离株中最常见的碳青霉烯类耐药基因是 bla OXA-23 （89.5%），其次是 bla OXA-51 （88.3%）和 bla OXA-24/40 （10.4%）。MLST 显示存在 19 种序列类型（STs），属于 8 个不同的国际复合体。最常见的克隆复合体（CC）是 CC2，占所有定型分离株的 64%。
结论
这是首次报道约旦鲍曼不动杆菌分离株的克隆多样性。在所研究的分离株中，碳青霉烯类耐药的发生率很高。此外，本研究结果为广泛携带 bla 的碳青霉烯类耐药鲍曼不动杆菌和属于 CC2 的菌株提供了证据。本研究中鉴定的 XDR 分离株数量令人震惊。因此，定期进行耐药因素的监测和分子流行病学研究，对于改善治疗效果和防止鲍曼不动杆菌感染的传播非常重要。
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