Clin Lab. 2023 Mar 1;69(3). doi: 10.7754/Clin.Lab.2022.220503.
Multidrug-resistant (MDR) Klebsiella is a globally important nosocomial pathogen. In the present study, 101 multidrug-resistant Klebsiella strains isolated from various clinical specimens obtained from two different Medical Faculties' hospitals were involved. We aimed to find out the prevalence of carbapenemase, mobile colistin resistance genes, and integrons in MDR Klebsiella strains.
The antibiotic susceptibilities of strains were determined by Kirby Bauer disc-diffusion method and resistance to colistin was confirmed by detection of minimum inhibitory concentrations. The prevalence of carba-penemase genes (blaOXA-48, blaNDM, blaIMP, blaVIM, blaKPC), mobile colistin-resistance genes (mcr-1 and mcr-2), and integrons (class I, II and III) were examined in Klebsiella strains by polymerase chain reaction.
All strains were resistant to β-lactam antibiotics, carbapenems, and quinolones. On the other hand, only nine (8.9%) strains were resistant to colistin. The most common carbapenemase genes were blaNDM (64.3%) and blaOXA-48 (53.5%). Besides, 28 (27.7%) strains were found to harbor both blaNDM and blaOXA-48. These 28 strains be-longed to the IncA/C (18.7%), IncL/M (7.7%), and IncFIIs (1.1%) plasmid replicon types. No strain was positive for blaIMP, mcr-1, and mcr-2. Class I and Class II integrons were shown to be harbored in 83.2% and 63.3% of strains, respectively. In total, 63 (63.6%) of strains harbored both classes I and II integrons. Class III integron was not detected. There was a statistically significant relationship between the presence of integrons and antibiotic resistance for cefotaxime (p = 0.024), ciprofloxacin (p < 0.001) trimethoprim/sulfamethoxazole (p < 0.001) and levofloxacin (p = 0.002). To our knowledge, this study represents the first report of a human isolate for the co-presence of blaNDM, blaOXA-48 and both Class I and Class II integrons, from Turkey.
Our findings also highlight the dissemination of integrons and carbapenemases and the importance of surveillance on emerging antibiotic resistance.
耐多药（MDR）肺炎克雷伯菌是一种具有全球重要意义的医院获得性病原体。在本研究中，我们从两所不同医学院附属医院获得的各种临床标本中分离出了 101 株多药耐药肺炎克雷伯菌。我们旨在确定 MDR 肺炎克雷伯菌菌株中产碳青霉烯酶、移动性粘菌素耐药基因和整合子的流行情况。
通过 Kirby Bauer 纸片扩散法测定菌株的抗生素敏感性，通过检测最小抑菌浓度确定对粘菌素的耐药性。通过聚合酶链反应检测肺炎克雷伯菌菌株中碳青霉烯酶基因（blaOXA-48、blaNDM、blaIMP、blaVIM、blaKPC）、移动性粘菌素耐药基因（mcr-1 和 mcr-2）和整合子（I 类、II 类和 III 类）的流行情况。
所有菌株均对β-内酰胺类抗生素、碳青霉烯类和喹诺酮类药物耐药。另一方面，只有 9 株（8.9%）对粘菌素耐药。最常见的碳青霉烯酶基因是 blaNDM（64.3%）和 blaOXA-48（53.5%）。此外，28 株（27.7%）菌株同时携带 blaNDM 和 blaOXA-48。这些 28 株菌株属于 IncA/C（18.7%）、IncL/M（7.7%）和 IncFIIs（1.1%）质粒复制子类型。没有菌株对 blaIMP、mcr-1 和 mcr-2 呈阳性。I 类和 II 类整合子分别显示在 83.2%和 63.3%的菌株中存在。总共 63 株（63.6%）菌株同时携带 I 类和 II 类整合子。未检测到 III 类整合子。整合子的存在与头孢噻肟（p = 0.024）、环丙沙星（p < 0.001）、甲氧苄啶/磺胺甲恶唑（p < 0.001）和左氧氟沙星（p = 0.002）的抗生素耐药性之间存在统计学显著关系。据我们所知，这是首次从土耳其报告人类分离株同时携带 blaNDM、blaOXA-48 和 I 类和 II 类整合子。
我们的研究结果还强调了整合子和碳青霉烯酶的传播以及对新出现的抗生素耐药性进行监测的重要性。
