伊朗中部肺炎克雷伯菌分离株中 NDM-1 和 OXA-48 碳青霉烯酶基因的高频。

High frequency of NDM-1 and OXA-48 carbapenemase genes among Klebsiella pneumoniae isolates in central Iran.

机构信息

Department of Microbiology & Immunology, Khomein University of Medical Sciences, Khomein, Iran.

Molecular and Medicine Research Center, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran.

出版信息

BMC Microbiol. 2023 Apr 11;23(1):98. doi: 10.1186/s12866-023-02840-x.

DOI:10.1186/s12866-023-02840-x

PMID:37038144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10088178/

Abstract

BACKGROUND

The emergence and distribution of multidrug-resistant (MDR) and carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a global health threat. Therefore, this study aimed to investigate the frequency and antibiotic resistance patterns of MDR, extensively drug-resistant (XDR), and CRKP, as well as the antibiotic resistance genes of Klebsiella pneumoniae (K. pneumoniae) isolates from patients' infectious samples from central Iran.

METHODS

This study examined 546 clinical samples of patients to identify K. pneumoniae. The isolates were investigated for their antibiotic resistance profile, extended-spectrum β-lactamase (ESBL), AMPC β-lactamase, carbapenemase resistance, sulfonamide, tetracycline, plasmid-mediated quinolone resistance (PMQR) along with their resistance genes, integrase, and quaternary ammonium compounds (qac) by polymerase chain reaction (PCR).

RESULTS

Out of 546 clinical samples, 121 (22.1%) cases of K. pneumoniae were identified using culture and PCR methods. The highest antibiotic resistance rates were found for ampicillin (119/121; 98.3%), cotrimoxazole (78/121; 64.4%), and cefixime, cefotaxime, ceftriaxone, and ceftazidime as a group (77/121; 63.6%). Tigecycline, colistin, and fosfomycin were the most effective antimicrobial agents with 98.4%, 96.7%, and 95.9% susceptibility, respectively. The amount of CRKP was 51 (42.1%). All CRKP isolates were MDR. The most abundant genes were bla (77/77; 100%), bla (76/77; 98.7%), bla (76/77; 98.7%), bla (73/77; 94.8%) for ESBL; bla 28 (48.3%) and bla 26 (44.8%) for AMPC β-lactamase; and bla 46 (90.1%) and bla 36 (70.5%) for carbapenemase. Among the PMQR determinants, qnrB (25/52; 48%), qnrS (19/52; 36.5%), and qnrA (11/52; 21.1%) were positive from the isolates. TetA and tetB were recognized in 25 (44.6%) and 17 (30.3%) isolates, respectively. Class 1 and 2 integrons were recognized in 97 (80.1%) and 53 (43.8%) isolates, respectively.

CONCLUSIONS

Due to the high prevalence of MDR and CRKP in central Iran, tracking and immediate intervention are necessary for control and inhibition of K. pneumoniae resistant isolates. Tigecycline, colistin, and fosfomycin are the best treatment options for treatment of patients with CRKP in this geographical area.

摘要

背景

多药耐药（MDR）和碳青霉烯耐药肺炎克雷伯菌（CRKP）的出现和分布已成为全球健康威胁。因此，本研究旨在调查来自伊朗中部患者感染样本的 MDR、广泛耐药（XDR）和 CRKP 以及肺炎克雷伯菌（K. pneumoniae）分离株的抗生素耐药模式和抗生素耐药基因。

方法

本研究共检测了 546 例患者的临床样本，以鉴定肺炎克雷伯菌。通过聚合酶链反应（PCR）检测分离株的抗生素耐药谱、超广谱β-内酰胺酶（ESBL）、AMP C β-内酰胺酶、碳青霉烯酶耐药、磺胺类药物、四环素、质粒介导的喹诺酮耐药（PMQR）及其耐药基因、整合酶和季铵化合物（qac）。

结果

在 546 例临床样本中，通过培养和 PCR 方法鉴定出 121 例（22.1%）肺炎克雷伯菌。发现氨苄西林（119/121；98.3%）、复方磺胺甲噁唑（78/121；64.4%）和头孢噻肟、头孢曲松、头孢他啶和头孢唑肟联合用药（77/121；63.6%）的抗生素耐药率最高。替加环素、黏菌素和磷霉素对肺炎克雷伯菌最有效，敏感性分别为 98.4%、96.7%和 95.9%。CRKP 的数量为 51 株（42.1%）。所有 CRKP 分离株均为 MDR。最常见的基因是 bla（77/77；100%）、bla（76/77；98.7%）、bla（76/77；98.7%）、bla（73/77；94.8%），用于 ESBL；bla 28（48.3%）和 bla 26（44.8%）用于 AMPC β-内酰胺酶；bla 46（90.1%）和 bla 36（70.5%）用于碳青霉烯酶。在 PMQR 决定因素中，qnrB（25/52；48%）、qnrS（19/52；36.5%）和 qnrA（11/52；21.1%）从分离株中呈阳性。在 25 株（44.6%）和 17 株（30.3%）分离株中分别发现了 tetA 和 tetB。在 97 株（80.1%）和 53 株（43.8%）分离株中分别检测到了类 1 和类 2 整合子。