Markovska Rumyana, Stankova Petya, Stoeva Temenuga, Keuleyan Emma, Mihova Kalina, Boyanova Lyudmila
Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, 1431 Sofia, Bulgaria.
Department of Microbiology and Virology, University Multiprofile Hospital for Active Treatment (UMHAT) "Saint Marina", Medical University of Varna, 9002 Varna, Bulgaria.
Antibiotics (Basel). 2024 Jan 15;13(1):81. doi: 10.3390/antibiotics13010081.
To solve the problem with pan-drug resistant and extensively drug-resistant Gram-negative microbes, newly approved drugs such as ceftazidime/avibactam, cefiderocol, plazomicin, meropenem/vaborbactam, and eravacycline have been introduced in practice. The aim of the present study was to collect carbapenemase-producing clinical isolates, to characterize their carbapenemase genes and clonal relatedness, and to detect their susceptibility to commonly used antimicrobials and the above-mentioned newly approved antibiotics. Sixty-four carbapenemase producers were collected in a period of one year from four Bulgarian hospitals, mainly including (89% of the isolates) and also single , and isolates. The main genotype was (in 61%), followed by (23%), (7.8%) and (7.8%). Many isolates showed the presence of ESBL ( in 76.6%) and AmpC ( in 37.5% or in 7.8% of isolates). The most common MLST type was ST11 (57.8%), followed by ST340 (12.5%), ST258 (6.3%) and ST101 (6.3%). The isolates were highly resistant to standard-group antibiotics, except they were susceptible to tigecycline (83.1%), colistin (79.7%), fosfomycin (32.8%), and aminoglycosides (20.3-35.9%). Among the newly approved compounds, plazomicin (90.6%) and eravacycline (76.3%) showed the best activity. Susceptibility to ceftazidime/avibactam and meropenem/vaborbactam was 34.4% and 27.6%, respectively. For cefiderocol, a large discrepancy was observed between the percentages of susceptible isolates according to EUCAST susceptibility breakpoints (37.5%) and those of CLSI (71.8%), detected by the disk diffusion method. This study is the first report to show patterns of susceptibility to five newly approved antibiotics among molecularly characterized isolates in Bulgaria. The data may contribute to both the improvement of treatment of individual patients and the choice of infection control strategy and antibiotic policy.
为解决泛耐药和广泛耐药革兰氏阴性菌的问题，已在临床实践中引入了新批准的药物，如头孢他啶/阿维巴坦、头孢地尔、普拉佐米星、美罗培南/法硼巴坦和依拉环素。本研究的目的是收集产碳青霉烯酶的临床分离株，鉴定其碳青霉烯酶基因和克隆相关性，并检测它们对常用抗菌药物及上述新批准抗生素的敏感性。在一年时间里，从保加利亚的四家医院收集了64株产碳青霉烯酶的菌株，主要包括（89%的分离株）以及单株、和分离株。主要基因型为（61%），其次是（23%）、（7.8%）和（7.8%）。许多分离株显示存在超广谱β-内酰胺酶（76.6%）和AmpC（37.5%的分离株或7.8%的分离株）。最常见的多位点序列分型（MLST）类型是ST11（57.8%），其次是ST340（12.5%）、ST258（6.3%）和ST101（6.3%）。这些分离株对标准组抗生素高度耐药，但对替加环素（83.1%）、黏菌素（79.7%）、磷霉素（32.8%）和氨基糖苷类（20.3 - 35.9%）敏感。在新批准的化合物中，普拉佐米星（90.6%）和依拉环素（76.3%）显示出最佳活性。对头孢他啶/阿维巴坦和美罗培南/法硼巴坦的敏感性分别为34.4%和27.6%。对于头孢地尔，通过纸片扩散法检测，根据欧盟CAST药敏折点（37.5%）和CLSI（71.8%）检测的敏感分离株百分比之间存在很大差异。本研究是保加利亚首次报道分子特征明确的分离株对五种新批准抗生素的药敏模式。这些数据可能有助于改善个体患者的治疗以及感染控制策略和抗生素政策的选择。
