儿童肠球菌属的携带状态：儿科重症监护病房入院前后的克隆多样性和耐药表型变化。

The intestinal carrier status of Enterococcus spp. in children: clonal diversity and alterations in resistance phenotypes before and after admission to a pediatric intensive care unit.

机构信息

Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Department of Microbiology, Faculty of Biological Sciences, Alzahra University, Tehran, Iran.

出版信息

BMC Pediatr. 2023 Aug 30;23(1):434. doi: 10.1186/s12887-023-04238-0.

DOI:10.1186/s12887-023-04238-0

PMID:37648974

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10466818/

Abstract

BACKGROUND

This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods.

METHODS

Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates.

RESULTS

The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient.

CONCLUSIONS

The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children.

摘要

背景

本研究旨在调查儿科重症监护病房（PICU）中肠球菌属的肠道携带情况，并揭示住院期间对定植菌耐药表型和克隆多样性的影响。

方法

在入院和出院时，从儿科重症监护病房的住院患者中采集两份粪便样本。进行培养，并对肠球菌属进行药敏试验和 vanA-D 基因亚型携带检测。随机扩增多态性 DNA（RAPD）-PCR 用于系统发育研究，以检查对定植菌的同源性。

结果

结果显示，入院时、出院时和两个时间点的定植率分别为 31%、28.7%和 40.1%。入院时和出院时粪便肠球菌分离株对万古霉素的耐药率（VR，32.6%和 41.9%）、高水平庆大霉素耐药率（HLGR，25.6%和 27.9%）和多药耐药表型（MDR，48.8%和 65.1%）均较高。屎肠球菌对万古霉素、氨苄西林和利福平的耐药率较高，而屎肠球菌对环丙沙星的耐药率较高。住院时间延长与耐万古霉素、氨苄西林和环丙沙星的耐药株定植有关。而住院期间不同患者的定植菌同源性较低，每个患者的定植菌之间检测到相同（9%）和相似（21%）的 RAPD-PCR 模式。