Faccone Diego, Gomez Sonia A, de Mendieta Juan Manuel, Sanz María Belén, Echegorry Mariano, Albornoz Ezequiel, Lucero Celeste, Ceriana Paola, Menocal Alejandra, Martino Florencia, De Belder Denise, Corso Alejandra, Pasterán Fernando
Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistance (NRLAR), National Institute of Infectious Diseases (INEI), ANLIS "Dr. Carlos G. Malbrán", Ave. Velez Sarsfield, 563, Buenos Aires City 1281, Argentina.
Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Godoy Cruz, Buenos Aires City 2290 (C1425FQB), Argentina.
Pathogens. 2023 Mar 18;12(3):479. doi: 10.3390/pathogens12030479.
The global spread of carbapenemase-producing Enterobacterales has become an epidemiological risk for healthcare systems by limiting available antimicrobial treatments. The COVID-19 pandemic worsened this scenario, prompting the emergence of extremely resistant microorganisms.
Between March 2020 and September 2021, the NRL confirmed 82 clinical Enterobacterales isolates harboring a combination of and MBL genes. Molecular typing was analyzed by PFGE and MLST. Modified double-disk synergy (MDDS) tests were used for phenotypic studies.
Isolates were submitted from 28 hospitals located in seven provinces and Buenos Aires City, including 77 , 2 , 2 and 1 . Almost half of isolates (n = 38; 49.4%), detected in 15 hospitals, belong to the CC307 clone. CC11 was the second clone, including 29 (37.7%) isolates (22, ST11 and 7, ST258) from five cities and 12 hospitals. Three isolates belonging to CC45 were also detected. The carbapenemase combinations observed were as follows: 55% plus ; 32.5% plus 5% plus 5% plus ; and 2.5% strain with plus plus . Aztreonam/avibactam and aztreonam/relebactam were the most active combinations (100% and 91% susceptible, respectively), followed by fosfomycin (89%) and tigecycline (84%).
The MDDS tests using ceftazidime-avibactam/EDTA and aztreonam/boronic acid disks improved phenotypic classification as dual producers. The successful high-risk clones of , such as hyper-epidemic CC307 and CC11 clones, drove the dissemination of double carbapenemase-producing isolates during the COVID-19 pandemic.
产碳青霉烯酶肠杆菌科细菌在全球范围内传播，由于可用抗菌治疗方法有限，已成为医疗系统面临的流行病学风险。新冠疫情使这种情况恶化，促使出现了具有极强耐药性的微生物。
在2020年3月至2021年9月期间，国家参考实验室确认了82株临床分离的肠杆菌科细菌，这些细菌携带了 基因和金属β-内酰胺酶（MBL）基因的组合。通过脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）进行分子分型分析。采用改良双碟协同试验（MDDS）进行表型研究。
分离株来自七个省份和布宜诺斯艾利斯市的28家医院，包括77株 、2株 、2株 和1株 。在15家医院检测到的几乎一半的 分离株（n = 38；49.4%）属于CC307克隆。CC11是第二个克隆，包括来自五个城市和12家医院的29株（37.7%）分离株（22株ST11和7株ST258）。还检测到三株属于CC45的分离株。观察到的碳青霉烯酶组合如下：55% 加 ；32.5% 加 ；5% 加 ；5% 加 ；以及2.5%的菌株同时携带 加 加 。氨曲南/阿维巴坦和氨曲南/雷利巴坦是活性最强的组合（分别为100%和91%敏感），其次是磷霉素（89%）和替加环素（84%）。
使用头孢他啶-阿维巴坦/乙二胺四乙酸（EDTA）和氨曲南/硼酸盘的MDDS试验改善了作为双重生产者的表型分类。 在新冠疫情期间， 成功的高风险克隆，如高流行的CC307和CC11克隆，推动了产双碳青霉烯酶分离株的传播。
