Clinical Microbiology and Parasitology Department, Hospital Universitario La Paz, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Front Cell Infect Microbiol. 2023 May 2;13:1180714. doi: 10.3389/fcimb.2023.1180714. eCollection 2023.
Intestinal colonization by Multi-Drug Resistant Organisms (MDROs) can pose a threat on the health of critically ill patients. The extent of colonization by these organisms is related to previous antibiotic treatments and their ability to cause infections among adult patients. The aim of this study is to determine the relationship between the intestinal Relative Loads (RLs) of selected antibiotic resistance genes, antibiotic consumption and extra-intestinal spread among critically ill pediatric patients.
RLs of , , and were determined in 382 rectal swabs obtained from 90 pediatric critically ill patients using qPCRs. The RLs were compared to the patients' demographics, antibiotic consumption, and detection of MDROs from extra-intestinal sites. 16SrDNA metagenomic sequencing was performed for 40 samples and clonality analyses were done for representative isolates.
76 (74.45%) patients from which 340 (89.01%) rectal swabs were collected had at least one swab that was positive for one of the tested genes. Routine cultures did not identify carbapenemases in 32 (45.1%) and 78 (58.2%) swabs that were positive by PCR for and blaVIM, respectively. RLs of above 6.5% were associated with extra-intestinal spread of blaOXA-48-harboring MDROs. Consumption of carbapenems, non-carbapenem β-lactams, and glycopeptides were statistically associated with testing negative for and while the consumption of trimethoprim/sulfamethoxazole and aminoglycosides was associated with testing negative for blaOXA-48 (P<0.05). In conclusion, targeted qPCRs can be used to determine the extent of intestinal dominance by antibiotic resistant opportunistic pathogens and their potential to cause extra-intestinal infections among a critically ill pediatric population.
肠道定植多重耐药菌（MDROs）可能对危重症患者的健康构成威胁。这些生物体的定植程度与之前的抗生素治疗以及它们在成年患者中引起感染的能力有关。本研究旨在确定选定抗生素耐药基因的肠道相对负荷（RL）、抗生素消耗与危重症儿科患者肠外传播之间的关系。
使用 qPCR 法测定 90 例危重症儿科患者的 382 份直肠拭子中 、 、 和 的 RL。将 RL 与患者的人口统计学、抗生素消耗以及从肠外部位检测到的 MDROs 进行比较。对 40 个样本进行 16SrDNA 宏基因组测序，并对代表性分离株进行克隆性分析。
从收集的 340 份（89.01%）直肠拭子中，有 76 例（74.45%）患者至少有一份拭子对其中一种测试基因呈阳性。常规培养未在 32 份（45.1%）和 78 份（58.2%）通过 PCR 检测blaVIM 和 blaOXA-48 阳性的拭子中鉴定出碳青霉烯酶。RL 超过 6.5%与blaOXA-48 携带 MDROs 的肠外传播有关。碳青霉烯类、非碳青霉烯类β-内酰胺类和糖肽类抗生素的消耗与 和 检测阴性呈统计学相关，而磺胺甲恶唑/甲氧苄啶和氨基糖苷类抗生素的消耗与 blaOXA-48 检测阴性相关（P<0.05）。总之，靶向 qPCR 可用于确定危重症儿科人群中抗生素耐药机会性病原体的肠道优势程度及其引起肠外感染的潜力。
