Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, 65000, Thailand.
Department of Family Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, 65000, Thailand.
J Microbiol Immunol Infect. 2023 Jun;56(3):612-623. doi: 10.1016/j.jmii.2023.01.018. Epub 2023 Feb 8.
Presently, community-associated carbapenemase-producing Enterobacterales (CPE) remains largely unknown and require public attention. This study aimed to investigate the presence of CPE from outpatients in Thailand.
Non-duplicate stool (n = 886) and urine (n = 289) samples were collected from outpatients with diarrhea and urinary tract infection, respectively. Demographic data and characteristics of patients were collected. Isolation of CPE was performed by plating enrichment culture on agar supplemented with meropenem. Carbapenemase genes were screened by PCR and sequencing. CPE isolates were phenotypically and genotypically characterized.
Fifteen samples (1.3%, 14 stool and 1 urine) yielded bla-positive carbapenemase-producing Klebsiella pneumoniae (CPKP). Additional resistance to colistin and tigecycline was observed in 53.3% and 46.7% of isolates, respectively. Age >60 years was identified as a risk factor for patients with CPKP (P < 0.001, adjusted odds ratio = 11.500, 95% confidence interval = 3.223-41.034). Pulsed field gel electrophoresis revealed genetic diversity of CPKP isolates; however, clonal spread has been observed. ST70 (n = 4) was common, followed by ST147 (n = 3). bla from all isolates were transferable and mainly resided on IncA/C plasmid (80%). All bla plasmids remained stable in bacterial host for at least 10 days in antibiotic-free environments, regardless of replicon types.
This study demonstrates that the prevalence of CPE among outpatients in Thailand remains low and the spread of bla-positive CPKP may be driven by IncA/C plasmid. Our results emphasize the need for a large-scale surveillance study to limit further spread of CPE in community.
目前，社区获得性碳青霉烯酶肠杆菌科（CPE）在很大程度上尚未被发现，需要引起公众关注。本研究旨在调查泰国门诊患者中 CPE 的存在情况。
收集了 886 份腹泻门诊患者的粪便和 289 份尿路感染门诊患者的尿液非重复样本。收集了患者的人口统计学数据和特征。通过在含有美罗培南的琼脂上进行选择性增菌培养来分离 CPE。通过 PCR 和测序筛选碳青霉烯酶基因。对 CPE 分离株进行表型和基因型特征分析。
从 15 份样本（1.3%，14 份粪便和 1 份尿液）中分离出bla阳性产碳青霉烯酶肺炎克雷伯菌（CPKP）。在分离株中，分别有 53.3%和 46.7%对多粘菌素和替加环素耐药。年龄>60 岁被确定为 CPKP 患者的危险因素（P<0.001，调整后的优势比=11.500，95%置信区间=3.223-41.034）。脉冲场凝胶电泳显示 CPKP 分离株存在遗传多样性，但存在克隆传播。ST70（n=4）常见，其次是 ST147（n=3）。所有 bla 均为可转移的，主要位于 IncA/C 质粒上（80%）。无论复制子类型如何，在抗生素环境中，所有 bla 质粒在细菌宿主中至少稳定 10 天。
本研究表明，泰国门诊患者中 CPE 的流行率仍然较低，bla阳性 CPKP 的传播可能由 IncA/C 质粒驱动。我们的结果强调需要进行大规模监测研究，以限制社区中 CPE 的进一步传播。
