Japan-Thailand Research Collaboration Center on Emerging and Re-emerging Infections, Research Institute for Microbial Diseases, Osaka Universitygrid.136593.b, Osaka, Japan.
Department of Bacterial Infections, Research Institute for Microbial Diseases, Osaka Universitygrid.136593.b, Osaka, Japan.
J Clin Microbiol. 2022 Dec 21;60(12):e0108022. doi: 10.1128/jcm.01080-22. Epub 2022 Nov 29.
Despite frequent identification of plasmids carrying carbapenemase genes, the transfer of plasmids carrying carbapenemase genes is not well recognized in clinical settings because of technical limitations. To investigate the detailed mechanisms of the spread of carbapenem-resistant (CRE), we performed multifaceted genomic surveillance of CRE isolates in Thailand and analyzed their plasmidome. We analyzed 371 isolates carrying and 114 isolates carrying obtained from clinical samples of 473 patients in 11 representative hospitals located in six provinces in Thailand between 2012 and 2017. The complete structures of plasmids carrying and chromosomal phylogeny were determined by combining Southern blotting hybridization analysis and our previously performed whole-genome short-read sequencing data. Dissemination of the gene among the isolates in Thailand was mainly owing to the nationwide clonal spread of Escherichia coli ST410 and regional clonal spreads of Escherichia coli ST361 and ST405. Analysis of -carrying isolates revealed nationwide dissemination of two specific plasmids and nationwide clonal dissemination of Klebsiella pneumoniae ST16 accompanied with regional disseminations of three distinctive K. pneumoniae clones (ST231, ST14, and ST147) with different plasmids. Dissemination of CRE carrying in Thailand is mainly based on nationwide clonal expansions of E. coli ST410 carrying and K. pneumoniae ST16 carrying , nationwide dissemination of two distinctive plasmids carrying , and accumulation of clonal expansions in regional areas. Although the overuse of antibiotics can promote CRE dissemination, the limited variety of transmitters highlights the importance of preventing horizontal dissemination among patients.
尽管经常发现携带碳青霉烯酶基因的质粒，但由于技术限制，临床上并未充分认识到携带碳青霉烯酶基因的质粒的转移。为了研究碳青霉烯类耐药菌（CRE）传播的详细机制，我们对泰国的 CRE 分离株进行了多方面的基因组监测，并分析了它们的质粒组。我们分析了从 2012 年至 2017 年在泰国六个省的 11 家代表性医院的 473 名患者的临床样本中获得的 371 株携带 和 114 株携带 的分离株。通过结合 Southern 印迹杂交分析和我们之前进行的全基因组短读测序数据，确定了携带 和染色体系统发育的质粒的完整结构。在泰国， 基因在 分离株中的传播主要是由于大肠杆菌 ST410 的全国性克隆传播以及大肠杆菌 ST361 和 ST405 的区域性克隆传播。携带 的分离株分析表明，两个特定质粒在全国范围内传播，肺炎克雷伯菌 ST16 伴随着不同质粒的三个独特肺炎克雷伯菌克隆（ST231、ST14 和 ST147）的全国性传播。泰国携带 的 CRE 的传播主要基于携带 的大肠杆菌 ST410 的全国性克隆扩张、携带 的肺炎克雷伯菌 ST16 的全国性传播、两个独特的携带 的质粒的传播以及在局部地区的克隆扩张的积累。尽管抗生素的过度使用可以促进 CRE 的传播，但传播媒介的种类有限突出了防止患者之间水平传播的重要性。
