儿童中产超广谱β-内酰胺酶（ESBL）高风险克隆的耐药基因组学和分子流行病学

Resistance genomics and molecular epidemiology of high-risk clones of ESBL-producing in young children.

机构信息

Department of Haematology and Oncology, Shenzhen Children's Hospital, Shenzhen, China.

Paediatric Research Institute, Shenzhen Children's Hospital, Shenzhen, China.

出版信息

Front Cell Infect Microbiol. 2023 May 24;13:1168096. doi: 10.3389/fcimb.2023.1168096. eCollection 2023.

DOI:10.3389/fcimb.2023.1168096

PMID:37293207

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10244630/

Abstract

INTRODUCTION

The emergence of multidrug-resistant poses a global threat, but the distribution and resistance profiling are unclear, especially in young children. Infections due to are common, associated with high mortality, and increasingly β-lactam drug resistant.

METHODS

We studied the molecular epidemiology and antibiotic resistance mechanisms in 294 clinicalisolates of from a pediatric hospital in China. Non-duplicate isolates were recovered from clinical cases and were identified using an API-20 kit followed by antimicrobial susceptibility testing using the VITEK®2 compact system (BioMerieux, France) and also by broth dilution method. In addition, a double-disc synergy test for the ESBL/E-test for MBL was performed. The presence of beta-lactamases, plasmid types, and sequence types was determined by PCR and sequencing.

RESULTS

Fifty-six percent ( = 164) of the isolates were resistant to piperacillin-tazobactam, followed by cefepime (40%; = 117), ceftazidime (39%; = 115), imipenem (36%; = 106), meropenem (33%; = 97), and ciprofloxacin (32%; = 94). Forty-two percent (n = 126) of the isolates were positive for ESBL according to the double-disc synergy test. The blaCTX-M-15 cephalosporinase was observed in 32% (n = 40/126), while 26% (n = 33/126) werepositive for blaNDM-1 carbapenemase. Aminoglycoside resistance gene was observed in 16% (n = 20/126), and glycylcyclines resistance gene tet(A) was observed in 12% (n = 15/126) of the isolates. A total of 23 sequence types were detected, including ST1963 (12%; n = 16), followed by ST381 (11%; = 14), ST234 (10%; = 13), ST145 (58%; = 10), ST304 (57%; = 9), ST663 (5%; n = 7), and a novel strain. In ESBL-producing , 12 different Incompatibility groups (Inc) were observed, the most common being IncFI, IncFIS, and IncA/C. The MOBP was the most common plasmid type, followed by MOBH, MOBF, and MOBQ.

DISCUSSION

Our data suggest that the spread of antibiotic resistance is likely due toclonal spread and dissemination of different clinical strains of harbouring different plasmids. This is a growing threat in hospitals particularly in young children which needs robust prevention strategies.

摘要

简介

多药耐药的出现对全球构成了威胁，但分布和耐药情况尚不清楚，尤其是在幼儿中。引起的感染很常见，死亡率高，并且越来越对β-内酰胺类药物耐药。

方法

我们研究了中国一家儿童医院 294 例临床分离的的分子流行病学和抗生素耐药机制。从临床病例中回收非重复分离株，并使用 API-20 试剂盒进行鉴定，然后使用 VITEK®2 紧凑型系统（法国生物梅里埃）进行抗菌药物敏感性测试，以及肉汤稀释法。此外，还进行了 ESBL/双碟协同试验和 MBL 的 E-试验。通过 PCR 和测序确定β-内酰胺酶、质粒类型和序列类型。

结果

56%（= 164）的分离株对哌拉西林-他唑巴坦耐药，其次是头孢噻肟（40%；= 117）、头孢他啶（39%；= 115）、头孢吡肟（33%；= 97）、美罗培南（33%；= 97）和环丙沙星（32%；= 94）。根据双碟协同试验，42%（n = 126）的分离株呈 ESBL 阳性。观察到 blaCTX-M-15 头孢菌素酶 32%（n = 40/126），blaNDM-1 碳青霉烯酶 26%（n = 33/126）阳性。氨基糖苷类耐药基因 16%（n = 20/126），甘氨酰环素耐药基因 tet(A) 12%（n = 15/126）阳性。共检测到 23 种序列类型，包括 ST1963（12%；n = 16），其次是 ST381（11%；= 14）、ST234（10%；= 13）、ST145（58%；= 10）、ST304（57%；= 9）、ST663（5%；n = 7）和一种新菌株。在产 ESBL 的中，观察到 12 种不同的不相容群（Inc），最常见的是 IncFI、IncFIS 和 IncA/C。MOBP 是最常见的质粒类型，其次是 MOBH、MOBF 和 MOBQ。