Rocha Verônica França Diniz, Barbosa Matheus Sales, Leal Helena Ferreira, Silva Giulyana Evelyn Oliveira, Sales Nabila Monalisa Mendes Dantas, Monteiro Adriano de Souza Santos, Azevedo Jailton, Malheiros Allan Roberto Xavier, Ataide Ledilce Almeida, Moreira Beatriz Meurer, Reis Mitermayer Galvão, Bahia Fabianna Márcia Maranhão, Reis Joice Neves
Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil.
Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil.
Front Microbiol. 2022 Mar 9;13:831770. doi: 10.3389/fmicb.2022.831770. eCollection 2022.
Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant (ColR-CRKP), represent a major problem for health systems worldwide and have high lethality. This study investigated the genetic relationship, antimicrobial susceptibility profile, and resistance mechanisms to ColR-CRKP isolates from patients infected/colonized in a tertiary hospital in Salvador, Bahia/Brazil. From September 2016 to January 2018, 46 patients (56 ColR-CRKP positive cultures) were enrolled in the investigation but clinical and demographic data were obtained from 31 patients. Most of them were men (67.7%) and elderly (median age of 62 years old), and the median Charlson score was 3. The main comorbidities were systemic arterial hypertension (38.7%), diabetes (32.2%), and cerebrovascular disease (25.8%). The average hospitalization stay until ColR-CRKP identification in days were 35.12. A total of 90.6% used mechanical ventilation and 93.7% used a central venous catheter. Of the 31 patients who had the data evaluated, 12 had ColR-CRKP infection, and seven died (58.4%). Previous use of polymyxins was identified in 32.2% of the cases, and carbapenems were identified in 70.9%. The minimum inhibitory concentration (MIC) for colistin was > 16 μg/mL, with more than half of the isolates (55%) having a MIC of 256 μg/mL. The gene was detected in 94.7% of the isolates, in 16.0%, and in 1.7%. The , and genes were not detected. The test was negative in all 56 isolates. Alteration of the gene was detected in 87.5% ( = 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS, 22.4% (11/49) did not have the gene detected, 20.4% (10/49) presented the IS, 6.1% (3/49) had a premature stop codon (Q30*), and 2.1% (1/49) presented a thymine deletion at position 104 - 104delT (F35fs). The PFGE profile showed a monoclonal profile in 84.7% of the isolates in different hospital sectors, with ST11 (CC-258) being the most frequent sequence type. This study presents a prolonged outbreak of ColR-CRKP in which 83.9% of the isolates belonged to the same cluster, and 67.6% of the patients evaluated had not used polymyxin, suggesting the possibility of cross-transmission of ColR-CRKP isolates.
耐多药革兰氏阴性菌，如对碳青霉烯类和黏菌素耐药的肺炎克雷伯菌（ColR-CRKP），是全球卫生系统面临的一个主要问题，且致死率很高。本研究调查了巴西巴伊亚州萨尔瓦多一家三级医院中感染/定植患者的ColR-CRKP分离株的遗传关系、抗菌药物敏感性概况及耐药机制。2016年9月至2018年1月，46例患者（56份ColR-CRKP阳性培养物）纳入调查，但临床和人口统计学数据来自31例患者。其中大多数为男性（67.7%）且为老年人（中位年龄62岁），查尔森评分中位数为3分。主要合并症为系统性动脉高血压（38.7%）、糖尿病（32.2%）和脑血管疾病（25.8%）。在识别出ColR-CRKP之前的平均住院天数为35.12天。共有90.6%的患者使用了机械通气，93.7%的患者使用了中心静脉导管。在31例评估了数据的患者中，12例发生了ColR-CRKP感染，7例死亡（58.4%）。32.2%的病例曾使用过多黏菌素，70.9%的病例曾使用过碳青霉烯类。黏菌素的最低抑菌浓度（MIC）>16μg/mL，超过一半的分离株（55%）MIC为256μg/mL。94.7%的分离株检测到 基因，16.0%检测到 基因，1.7%检测到 基因。未检测到 、 和 基因。所有56份分离株的 试验均为阴性。87.5%（ = 49/56）的分离株检测到 基因改变，其中49.0%（24/49）可能由于插入序列导致大小改变，22.4%（11/49）未检测到 基因，20.4%（10/49）存在插入序列，6.1%（3/49）有提前终止密码子（Q30*），2.1%（1/49）在第104位有胸腺嘧啶缺失（104delT，F35fs）。脉冲场凝胶电泳（PFGE）图谱显示，不同医院科室84.7%的分离株为单克隆图谱，ST11（CC-258）是最常见的序列类型。本研究呈现了一次持续时间较长的ColR-CRKP暴发，其中83.9%的分离株属于同一聚类，且67.6%接受评估的患者未使用过多黏菌素，提示存在ColR-CRKP分离株交叉传播的可能性。
