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无金属β-内酰胺酶产生的药物初治血流感染肠杆菌科菌株中头孢他啶/阿维巴坦耐药的机制:与头孢他啶阻抗相关。

Mechanisms of ceftazidime/avibactam resistance in drug-naïve bacteraemic Enterobacterales strains without metallo-beta-lactamase production: Associated with ceftazidime impedance.

机构信息

Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China; Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

Int J Antimicrob Agents. 2023 Aug;62(2):106877. doi: 10.1016/j.ijantimicag.2023.106877. Epub 2023 Jun 2.


DOI:10.1016/j.ijantimicag.2023.106877
PMID:37271474
Abstract

In order to investigate ceftazidime/avibactam (CZA) resistance characteristics and mechanisms of bacteraemic Enterobacterales strains that had not been treated previously with CZA, 9708 strains were collected from 43 hospitals in 18 provinces across China from January 2019 to June 2020. The minimum inhibitory concentration (MIC) values of CZA in 165 (1.70%) strains were ≥8/4 mg/L. Ten (6.06%) CZA-resistant strains without metallo-β-lactamase production were obtained from the individuals without prior exposure to CZA, including six Escherichia coli isolates, three Klebsiella pneumoniae isolates and one Enterobacter cloacae isolate. Whole-genome sequencing revealed that ECB88611, ECB142593 and ECB144539 had encoded disrupted OmpF loss of function. OmpF of ECB126041 had a 2_9 MKRNILAV deletion; OmpK35 of three K. pneumoniae isolates harboured amino acid fragment deletions from positions 1 to 38; and ELB117287 had encoded disrupted OmpF. The G132D amino acid substitution of OmpC of ECB88611, ECB142593 and ECB144539, and the 134_135GD insertion of OmpK36 of three K. pneumoniae isolates were predicted to alter ceftazidime permeability. 333_334 YRIK or YRIN insertions occurred in PBP3 of six E. coli isolates. The relative expression of bla in KPB125108 was 4.527 ± 0.2166 times higher than the control strain, and the relative expression of acrF in six E. coli isolates was 2-3 times higher than the control strain. The addition of phenylalanine-arginine-β-naphthylamine at 100 mg/L decreased the MIC values of CZA against nine strains significantly. In conclusion, the antimicrobial resistance mechanisms in 10 isolates included increased expression of bla, non-functional OMPs, upregulation of efflux pump activity, and variants of PBP3. Most of these mechanisms affected the antimicrobial activity of CZA by impeding ceftazidime.

摘要

为了研究未使用过头孢他啶/阿维巴坦(CZA)的血流感染肠杆菌科菌株的 CZA 耐药特征和机制,从 2019 年 1 月至 2020 年 6 月,从中国 18 个省的 43 家医院采集了 9708 株菌株。165 株(1.70%)菌株的头孢他啶最小抑菌浓度(MIC)值≥8/4mg/L。从未使用过 CZA 的个体中获得了 10 株(6.06%)无金属β-内酰胺酶产生的 CZA 耐药株,包括 6 株大肠埃希菌分离株、3 株肺炎克雷伯菌分离株和 1 株阴沟肠杆菌分离株。全基因组测序显示,ECB88611、ECB142593 和 ECB144539 编码的 OmpF 功能丧失。ECB126041 的 OmpF 缺失 2_9 MKRNILAV 片段;三株肺炎克雷伯菌分离株的 OmpK35 从位置 1 到 38 存在氨基酸片段缺失;ELB117287 编码的 OmpF 功能丧失。ECB88611、ECB142593 和 ECB144539 的 OmpC 的 G132D 氨基酸取代以及三株肺炎克雷伯菌分离株的 OmpK36 的 134_135GD 插入被预测会改变头孢他啶的通透性。六株大肠埃希菌分离株的 PBP3 中出现 333_334 YRIK 或 YRIN 插入。在 KPB125108 中,bla 的相对表达水平比对照菌株高 4.527±0.2166 倍,六株大肠埃希菌分离株的 acrF 相对表达水平比对照菌株高 2-3 倍。在 100mg/L 苯丙氨酸-精氨酸-β-萘胺的存在下,CZA 对 9 株菌的 MIC 值显著降低。结论:10 株分离株的抗菌药物耐药机制包括 bla 表达增加、非功能型 OMPs、外排泵活性上调和 PBP3 变异。这些机制大多通过阻碍头孢他啶的作用来影响 CZA 的抗菌活性。

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Mechanisms of ceftazidime/avibactam resistance in drug-naïve bacteraemic Enterobacterales strains without metallo-beta-lactamase production: Associated with ceftazidime impedance.

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[2]
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[2]
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