Coombs Geoffrey W, Daley Denise A, Shoby Princy, Mowlaboccus Shakeel
Antimicrobial Resistance and Infectious Diseases (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia ;Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia ;Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia ;Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
Commun Dis Intell (2018). 2023 Nov 16;47. doi: 10.33321/cdi.2023.47.68.
From 1 January to 31 December 2022, fifty-five institutions across Australia participated in the Australian Enterococcal Surveillance Outcome Program (AESOP). The aim of AESOP 2022 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the Enterococcus faecium isolates. Of the 1,535 unique episodes of enterococcal bacteraemia investigated, 92.8% were caused by either E. faecalis (52.9%) or E. faecium (39.9%). Ampicillin and vancomycin resistance were not detected in E. faecalis but were detected in 95.4% and 46.9% of E. faecium respectively. One E. faecalis isolate, with a daptomycin minimum inhibitory concentration (MIC) of 8.0 mg/L, harboured the F478L GdpD mutation. One E. faecium with a daptomycin MIC of 24.0 mg/L harboured the A20D Cls mutation; both mutations are known to be associated with daptomycin resistance. Two E. faecium isolates, one with a linezolid MIC ≥ 256 mg/L and the other with a linezolid MIC of 16 mg/L, harboured the 23S rRNA G2576T mutation, a mutation associated with linezolid resistance in enterococci. Overall, 48.8% of E. faecium harboured either the vanA or the vanB gene, of which 28.0% harboured vanA and 72.0% harboured vanB. The percentage of vancomycin-resistant E. faecium bacteraemia isolates in Australia remains substantially higher than that recorded in most European countries. The E. faecium isolates consisted of 62 multi-locus sequence types (STs); 85.5% of isolates were classified into eight major STs each containing ten or more isolates. All major STs belonged to clonal complex (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The major STs (ST17, ST78, ST80, ST117, ST555, ST796, ST1421, and ST1424) were each found across most regions of Australia. The predominant ST was ST17, which was identified in all regions. Overall, 53.7% of isolates belonging to the eight major STs harboured the vanA or vanB gene. AESOP 2022 has shown that enterococcal bacteraemia episodes in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin resistant vanA- or vanB-positive E. faecium which have limited treatment options.
2022年1月1日至12月31日，澳大利亚各地的55家机构参与了澳大利亚肠球菌监测结果项目（AESOP）。2022年AESOP的目的是确定澳大利亚肠球菌血症分离株中耐抗菌药物的比例，并对粪肠球菌分离株的分子流行病学特征进行描述。在调查的1535例独特的肠球菌血症病例中，92.8%由粪肠球菌（52.9%）或屎肠球菌（39.9%）引起。粪肠球菌中未检测到氨苄西林和万古霉素耐药性，但在屎肠球菌中分别检测到95.4%和46.9%的耐药性。一株达托霉素最低抑菌浓度（MIC）为8.0mg/L的粪肠球菌分离株携带F478L GdpD突变。一株达托霉素MIC为24.0mg/L的屎肠球菌携带A20D Cls突变；已知这两种突变均与达托霉素耐药性有关。两株屎肠球菌分离株，一株利奈唑胺MIC≥256mg/L，另一株利奈唑胺MIC为16mg/L，携带23S rRNA G2576T突变，该突变与肠球菌对利奈唑胺的耐药性有关。总体而言，48.8%的屎肠球菌携带vanA或vanB基因，其中28.0%携带vanA，72.0%携带vanB。澳大利亚耐万古霉素屎肠球菌血症分离株的比例仍大大高于大多数欧洲国家记录的比例。屎肠球菌分离株由62种多位点序列类型（STs）组成；85.5%的分离株被分类为8种主要STs，每种STs包含10个或更多分离株。所有主要STs均属于克隆复合体（CC）17，这是一个主要的医院适应性多克隆屎肠球菌簇。主要STs（ST17、ST78、ST80、ST117、ST555、ST796、ST1421和ST1424）在澳大利亚的大多数地区均有发现。主要ST是ST17，在所有地区均有鉴定。总体而言，属于8种主要STs的分离株中有53.7%携带vanA或vanB基因。2022年AESOP表明，澳大利亚的肠球菌血症病例通常由多克隆氨苄西林耐药、高水平庆大霉素耐药、vanA或vanB阳性的屎肠球菌引起，这些菌株的治疗选择有限。
