Sakurai Aki, Dinh An Q, Hanson Blake M, Shropshire William C, Rizvi Samie A, Rydell Kirsten, Tran Truc T, Wanger Audrey, Arias Cesar A, Miller William R
Department of Infectious Diseases and Microbiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Department of Internal Medicine, Division of Infectious Diseases, Houston Methodist Hospital, 6560 Fannin St, Scurlock Tower, Suite 1540, Houston, TX, USA.
JAC Antimicrob Resist. 2023 Jun 3;5(3):dlad070. doi: 10.1093/jacamr/dlad070. eCollection 2023 Jun.
The increased identification of carbapenem-resistant (CR-PA) is an ongoing concern. However, information on the evolving antimicrobial resistance profile and molecular epidemiology of CR-PA over time is scarce. Thus, we conducted a cross-sectional analysis to investigate the phenotypic and genotypic characteristics of CR-PA recovered over different time periods, focusing on the isolates exhibiting a ceftolozane/tazobactam resistance phenotype.
A total of 169 CR-PA isolated from clinical specimens at a single centre in Houston, TX, USA were studied. Among them, 61 isolates collected between 1999 and 2005 were defined as historical strains, and 108 collected between 2017 and 2018 were defined as contemporary strains. Antimicrobial susceptibilities against selected β-lactams was determined. WGS data were used for the identification of antimicrobial resistance determinants and phylogenetic analysis.
Non-susceptibility to ceftolozane/tazobactam and ceftazidime/avibactam increased from 2% (1/59) to 17% (18/108) and from 7% (4/59) to 17% (18/108) from the historical to the contemporary collection, respectively. Carbapenemase genes, which were not identified in the historical collection, were harboured by 4.6% (5/108) of the contemporary strains, and the prevalence of ESBL genes also increased from 3.3% (2/61) to 16% (17/108). Genes encoding acquired β-lactamases were largely confined to the high-risk clones. Among ceftolozane/tazobactam-resistant isolates, non-susceptibility to ceftazidime/avibactam, imipenem/relebactam and cefiderocol was observed in 94% (15/16), 56% (9/16) and 12.5% (2/16), respectively. Resistance to ceftolozane/tazobactam and imipenem/relebactam was primarily associated with the presence of exogenous β-lactamases.
Acquisition of exogenous carbapenemases and ESBLs may be a worrisome trend in .
耐碳青霉烯类肺炎克雷伯菌（CR - PA）的检出率不断上升，这一直是人们关注的问题。然而，关于CR - PA随时间推移不断演变的抗菌药物耐药谱和分子流行病学的信息却很匮乏。因此，我们进行了一项横断面分析，以研究不同时间段分离出的CR - PA的表型和基因型特征，重点关注表现出头孢洛扎/他唑巴坦耐药表型的分离株。
对从美国得克萨斯州休斯顿一个中心的临床标本中分离出的169株CR - PA进行了研究。其中，1999年至2005年收集的61株分离株被定义为历史菌株，2017年至2018年收集的108株被定义为当代菌株。测定了对选定β - 内酰胺类药物的抗菌敏感性。全基因组测序（WGS）数据用于鉴定抗菌药物耐药决定因素和系统发育分析。
从历史菌株到当代菌株，对头孢洛扎/他唑巴坦和头孢他啶/阿维巴坦的不敏感性分别从2%（1/59）增至17%（18/108）和从7%（4/59）增至17%（18/108）。当代菌株中有4.6%（5/108）携带了历史菌株中未发现的碳青霉烯酶基因，超广谱β - 内酰胺酶（ESBL）基因的流行率也从3.3%（2/61）增至16%（17/108）。编码获得性β - 内酰胺酶的基因主要局限于高危克隆。在对头孢洛扎/他唑巴坦耐药的分离株中，对头孢他啶/阿维巴坦、亚胺培南/瑞来巴坦和头孢地尔的不敏感性分别为94%（15/16）、56%（9/16）和12.5%（2/16）。对头孢洛扎/他唑巴坦和亚胺培南/瑞来巴坦的耐药主要与外源性β - 内酰胺酶的存在有关。
获得外源性碳青霉烯酶和ESBLs可能是一个令人担忧的趋势。
