2014-2017 年泰国农民、猪和住院患者中产碳青霉烯酶肠杆菌科细菌的特征和基因组流行病学。
Characteristics and genomic epidemiology of colistin-resistant Enterobacterales from farmers, swine, and hospitalized patients in Thailand, 2014-2017.
机构信息
Faculty of Medicine Siriraj Hospital, Mahidol University, Salaya, Thailand.
NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK.
出版信息
BMC Infect Dis. 2023 Aug 28;23(1):556. doi: 10.1186/s12879-023-08539-8.
BACKGROUND
Colistin is one of the last resort therapeutic options for treating carbapenemase-producing Enterobacterales, which are resistant to a broad range of beta-lactam antibiotics. However, the increased use of colistin in clinical and livestock farming settings in Thailand and China, has led to the inevitable emergence of colistin resistance. To better understand the rise of colistin-resistant strains in each of these settings, we characterized colistin-resistant Enterobacterales isolated from farmers, swine, and hospitalized patients in Thailand.
METHODS
Enterobacterales were isolated from 149 stool samples or rectal swabs collected from farmers, pigs, and hospitalized patients in Thailand between November 2014-December 2017. Confirmed colistin-resistant isolates were sequenced. Genomic analyses included species identification, multilocus sequence typing, and detection of antimicrobial resistance determinants and plasmids.
RESULTS
The overall colistin-resistant Enterobacterales colonization rate was 26.2% (n = 39/149). The plasmid-mediated colistin-resistance gene (mcr) was detected in all 25 Escherichia coli isolates and 9 of 14 (64.3%) Klebsiella spp. isolates. Five novel mcr allelic variants were also identified: mcr-2.3, mcr-3.21, mcr-3.22, mcr-3.23, and mcr-3.24, that were only detected in E. coli and Klebsiella spp. isolates from farmed pigs.
CONCLUSION
Our data confirmed the presence of colistin-resistance genes in combination with extended spectrum beta-lactamase genes in bacterial isolates from farmers, swine, and patients in Thailand. Differences between the colistin-resistance mechanisms of Escherichia coli and Klebsiella pneumoniae in hospitalized patients were observed, as expected. Additionally, we identified mobile colistin-resistance mcr-1.1 genes from swine and patient isolates belonging to plasmids of the same incompatibility group. This supported the possibility that horizontal transmission of bacterial strains or plasmid-mediated colistin-resistance genes occurs between humans and swine.
背景
多黏菌素是治疗碳青霉烯酶产生肠杆菌科的最后一种治疗选择，这些细菌对广泛的β-内酰胺类抗生素具有耐药性。然而，多黏菌素在泰国和中国的临床和畜牧业中的使用增加，导致多黏菌素耐药性的不可避免出现。为了更好地了解这两种环境中多黏菌素耐药菌株的出现情况，我们对泰国农民、猪和住院患者分离的多黏菌素耐药肠杆菌进行了特征描述。
方法
2014 年 11 月至 2017 年 12 月，从泰国的农民、猪和住院患者中采集了 149 份粪便样本或直肠拭子，从中分离出肠杆菌科。对确认的多黏菌素耐药分离株进行测序。基因组分析包括物种鉴定、多位点序列分型以及检测抗生素耐药决定因素和质粒。
结果
多黏菌素耐药肠杆菌的总体定植率为 26.2%（n=39/149）。所有 25 株大肠埃希菌分离株和 14 株（64.3%）克雷伯菌属分离株均检测到质粒介导的多黏菌素耐药基因（mcr）。还鉴定了 5 种新型 mcr 等位基因变异体：mcr-2.3、mcr-3.21、mcr-3.22、mcr-3.23 和 mcr-3.24，仅在来自养猪场的猪源大肠埃希菌和克雷伯菌属分离株中检测到。
结论
我们的数据证实了来自泰国农民、猪和患者的细菌分离株中存在多黏菌素耐药基因与扩展谱β-内酰胺酶基因的组合。住院患者中大肠埃希菌和肺炎克雷伯菌的多黏菌素耐药机制存在差异，这是意料之中的。此外，我们还从猪和患者分离株中鉴定出属于同一不相容群质粒的移动多黏菌素耐药 mcr-1.1 基因。这支持了细菌菌株或质粒介导的多黏菌素耐药基因在人类和猪之间发生水平传播的可能性。
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