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中国温州一家教学医院中出现产多重耐药性OXA-232的ST15菌株疫情。

Outbreak of Multidrug-Resistant OXA-232-Producing ST15 in a Teaching Hospital in Wenzhou, China.

作者信息

Jia Huaiyu, Zhang Ying, Ye Jianzhong, Xu Wenya, Xu Ye, Zeng Weiliang, Liao Wenli, Chen Tao, Cao Jianming, Wu Qing, Zhou Tieli

机构信息

Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.

Department of Medical Laboratory Science, School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.

出版信息

Infect Drug Resist. 2021 Oct 24;14:4395-4407. doi: 10.2147/IDR.S329563. eCollection 2021.

DOI:10.2147/IDR.S329563
PMID:34729016
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8554319/
Abstract

BACKGROUND

OXA-232-producing carbapenem-resistant (CRKP) has the potential to become the "third epidemic" of carbapenem-resistant strain after KPC-2 and NDM in China. We investigated the first outbreak of CRKP in the First Affiliated Hospital of Wenzhou Medical University.

METHODS

We collected 610 clinical isolates of CRKP from the First Affiliated Hospital of Wenzhou Medical University between January 2019 and September 2020 and screened them by Polymerase Chain Reaction (PCR). The multilocus sequence typing and pulsed-field gel electrophoresis were used to determine the genetic relatedness of the strains. The antimicrobial susceptibility test was performed to determine the drug resistance of the clinical isolates. The molecular mechanism underlying carbapenem resistance was elucidated by performing PCR and conjugation experiments. The virulence potential of the strains was determined by the string test, detection of virulence-associated genes and capsular serotypes, and larval infection model.

RESULTS

Between September 2019 and May 2020, 26 OXA-232-producing CRKP were obtained from 12 patients in our hospital. Ten patients were hospitalized in the intensive care units (ICU) and the overall mortality of the inpatients involved in the outbreak was 50% (6/12). Epidemiological investigations reported that all the OXA-232-producing CRKP strains belonged to the sequence type ST15 and can be clonally transmitted among the inpatients in the ICU. All the strains had low virulence and were resistant to commonly used clinical antibiotics except for ceftazidime/avibactam, colistin, and tigecycline. The OXA-232-producing CRKP was sensitive to triclosan and chlorhexidine, and its eradication from our hospital can be achieved by the use of disinfectants in the ICU.

CONCLUSION

In our study, OXA-232-producing CRKP isolates appeared to be clonally transmitted and the sequence type ST15 was responsible for the outbreak. Therefore, effective measurements for the infection control of CRKP are urgently needed to prevent its epidemic in the nearby region in the future.

摘要

背景

产OXA-232的耐碳青霉烯类肺炎克雷伯菌(CRKP)有可能成为继KPC-2和NDM之后中国耐碳青霉烯类菌株的“第三次流行”。我们对温州医科大学附属第一医院首次爆发的CRKP进行了调查。

方法

我们收集了2019年1月至2020年9月期间温州医科大学附属第一医院的610株CRKP临床分离株,并通过聚合酶链反应(PCR)进行筛选。采用多位点序列分型和脉冲场凝胶电泳来确定菌株的遗传相关性。进行抗菌药敏试验以确定临床分离株的耐药性。通过PCR和接合实验阐明耐碳青霉烯类的分子机制。通过串珠试验、毒力相关基因检测、荚膜血清型检测和幼虫感染模型来确定菌株的毒力潜力。

结果

2019年9月至2020年5月期间,我们医院从12名患者中分离出26株产OXA-232的CRKP。10名患者入住重症监护病房(ICU),此次爆发所涉及住院患者的总体死亡率为50%(6/12)。流行病学调查显示,所有产OXA-232的CRKP菌株均属于序列型ST15,可在ICU住院患者中克隆传播。所有菌株毒力较低,除头孢他啶/阿维巴坦、黏菌素和替加环素外,对常用临床抗生素均耐药。产OXA-232 的CRKP对三氯生和氯己定敏感,在ICU使用消毒剂可将其从我院清除。

结论

在我们的研究中,产OXA-232的CRKP分离株似乎是克隆传播的,序列型ST15是此次爆发的原因。因此,迫切需要采取有效的CRKP感染控制措施,以防止其未来在附近地区流行。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/9adbe1712277/IDR-14-4395-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/d8115d5851aa/IDR-14-4395-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/c5af2060d1a6/IDR-14-4395-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/a4a38ce926cc/IDR-14-4395-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/9adbe1712277/IDR-14-4395-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/d8115d5851aa/IDR-14-4395-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/c5af2060d1a6/IDR-14-4395-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/a4a38ce926cc/IDR-14-4395-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb63/8554319/9adbe1712277/IDR-14-4395-g0004.jpg

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