Chang Chung-Yu, Huang Po-Hao, Lu Po-Liang
School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Department of Microbiology and Immunology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Antibiotics (Basel). 2022 Aug 26;11(9):1153. doi: 10.3390/antibiotics11091153.
complex (ECC) is ubiquitous in the environment and is an important pathogen causing nosocomial infections. Because routine methods used in clinical laboratories cannot identify species within ECC, the clinical significance of each species within ECC is less known. We applied gene sequencing to identify the species/clusters of ECC and detected β-lactamase genes and class 1 integrons with PCR for 184 clinical ECC isolates in Taiwan from 2013 to 2014 to investigate the clinical impact of species within ECC. The four most common clusters were subsp. (cluster VIII) (29.9%), subsp. (cluster VI) (20.1%), subsp. (cluster XI) (12%), and (cluster II) (10.3%). , which consisted of four clusters (clusters III, VI, VII, and VIII), is the predominant species and accounted for 57.1% of the isolates. The ceftazidime resistance rate was 27.2%, and the ceftriaxone resistance rate was 29.3%. Resistance to third generation cephalosporin was associated with a higher 30-day mortality rate. In total, 5 (2.7%), 24 (13.0%), and 1 (0.5%) isolates carried ESBL, AmpC, and carbapenemase genes, respectively. Class 1 integrons were present in 24.5% of the isolates, and most of the cassettes pertain to antibiotic resistance. Resistance to third generation cephalosporins, multidrug resistance, and class 1 integrons were significantly more in (clusters III, VI, VII, and VIII) than in the other species. The 30-day mortality rate and 100-day mortality did not differ significantly between patients with and those with infections with the other species. In conclusion, the distribution of third generation cephalosporin resistance, multidrug resistance, and class 1 integrons were uneven among species. The resistance to third generation cephalosporins possessed significant impact on patient outcome.
阴沟肠杆菌复合体（ECC）在环境中普遍存在，是引起医院感染的重要病原体。由于临床实验室使用的常规方法无法鉴定ECC中的菌种，ECC中各菌种的临床意义鲜为人知。我们应用基因测序来鉴定ECC的菌种/菌簇，并对2013年至2014年台湾地区的184株临床ECC分离株进行PCR检测β-内酰胺酶基因和1类整合子，以研究ECC中菌种的临床影响。四个最常见的菌簇是阴沟肠杆菌阴沟亚种（菌簇VIII）（29.9%）、阴沟肠杆菌产气亚种（菌簇VI）（20.1%）、阴沟肠杆菌居泉亚种（菌簇XI）（12%）和阴沟肠杆菌（菌簇II）（10.3%）。阴沟肠杆菌由四个菌簇（菌簇III、VI、VII和VIII）组成，是主要菌种，占分离株的57.1%。头孢他啶耐药率为27.2%，头孢曲松耐药率为29.3%。对第三代头孢菌素的耐药与30天较高的死亡率相关。总共分别有5株（2.7%）、24株（13.0%）和1株（0.5%）分离株携带超广谱β-内酰胺酶（ESBL）、AmpC和碳青霉烯酶基因。1类整合子存在于24.5%的分离株中，且大多数盒式结构与抗生素耐药性有关。阴沟肠杆菌（菌簇III、VI、VII和VIII）对第三代头孢菌素的耐药、多重耐药和1类整合子显著多于其他菌种。阴沟肠杆菌感染患者与其他菌种感染患者的30天死亡率和100天死亡率无显著差异。总之，第三代头孢菌素耐药、多重耐药和1类整合子在阴沟肠杆菌菌种间分布不均。对第三代头孢菌素的耐药对患者预后有显著影响。
