医院获得性感染儿科革兰氏阴性杆菌分离株中扩展谱β-内酰胺酶的流行情况和 blaTEM、blaSHV 和 blaCTX-M 基因型的分子检测，一项机构研究。
Prevalence of extended-spectrum beta-lactamase and molecular detection of blaTEM, blaSHV, and blaCTX-M genotypes among gram-negative Bacilli isolates from hospital acquired infections in pediatrics, one institutional study.
机构信息
Medical Microbiology and Immunology, Mansoura Faculty of Medicine, Mansoura, Egypt.
Clinical Pathology Department, Mansoura Faculty of Medicine, Mansoura, Egypt.
出版信息
Ital J Pediatr. 2024 Feb 24;50(1):31. doi: 10.1186/s13052-024-01599-9.
BACKGROUND
Gram-negative bacilli represents an important pathogen in hospital-acquired infections (HAIs) worldwide. The emergence of antibiotic resistance in these pathogens warrants attention for the proper management of infections. Extended-spectrum beta-lactamase (ESBL) resistance represents a major therapeutic problem in infections due to Gram-negative bacilli. The present study aimed to study the extended-spectrum beta-lactamase genes blaTEM, blaSHV, and blaCTX-M by multiplex polymerase reaction in isolated Gram-negative bacilli from HAIs in pediatric patients.
METHODS
The study included one hundred-five isolates of Gram-negative bacilli from pediatric patients with different types of HAIs. The isolates were subjected to full microbiological identification, antibiotics susceptibility by disc diffusion method, the phenotypic study of ESBL, and the genetic study of ESBL genes by multiplex PCR.
RESULTS
Fifty isolates of Gram-Negative bacilli showed ESBL activity by a phenotypic study by double disc diffusion method (50/105). All ESBL producers' isolates were positive by PCR for ESBL genes. The most frequent gene was blaTEM (64%), followed by blaSHV (30%) and CTX-M (22%). Mixed genes were found in 4 isolates (8%) for blaTEM and blaSHV, blaTEM and CTX-M. There was a significant association between PCR for ESBL genes and phenotypic ESBL detection (P = 0.001). There was significant detection of ESBL genes in E. coli (28%), followed by Enterobacter spp. (26%), Klebsiella spp. (24%), Serratia (14%), Pseudomonas spp. (6%) and Proteus (2%), P = 0.01. There Seventy percent of isolates positive for ESBL production had an insignificant association between MDR and PCR for ESBL genes (P = 0.23).
CONCLUSION
The present study highlights the prevalence of ESBL activity among clinical isolates of Gram-negative bacilli isolated from hospital-acquired infections in pediatric patients. The most common gene responsible for this activity was blaTEM gee followed by blaSHV and blaCTX-M. There was a high prevalence of multiple antibiotic resistance among isolates with ESBL activity. The finding of the present study denotes the importance of screening extended beta-lactamase among Gram-negative bacilli associated with HAIs in pediatric patients.
背景
革兰氏阴性杆菌是全球医院获得性感染（HAI）的重要病原体。这些病原体对抗生素的耐药性的出现需要引起重视，以妥善管理感染。产超广谱β-内酰胺酶（ESBL）的耐药性是由革兰氏阴性杆菌引起的感染的主要治疗问题。本研究旨在通过多重聚合酶链反应（PCR）研究儿科患者 HAI 中分离的革兰氏阴性杆菌的 blaTEM、blaSHV 和 blaCTX-M 型扩展谱β-内酰胺酶基因。
方法
本研究纳入了 105 例来自儿科 HAI 患者的革兰氏阴性杆菌分离株。对分离株进行了全面的微生物学鉴定、药敏试验（纸片扩散法）、ESBL 的表型研究以及 ESBL 基因的多重 PCR 遗传研究。
结果
50 株革兰氏阴性杆菌通过双纸片扩散法表型研究显示 ESBL 活性（50/105）。所有 ESBL 产生菌的分离株均通过 PCR 对 ESBL 基因呈阳性。最常见的基因是 blaTEM（64%），其次是 blaSHV（30%）和 CTX-M（22%）。4 株（8%）分离株检测到 blaTEM 和 blaSHV、blaTEM 和 CTX-M 的混合基因。PCR 检测 ESBL 基因与表型 ESBL 检测之间存在显著相关性（P=0.001）。在 E. coli（28%）、肠杆菌属（26%）、克雷伯菌属（24%）、沙雷氏菌属（14%）、铜绿假单胞菌属（6%）和变形杆菌属（2%）中均检测到 ESBL 基因，P=0.01。70%的产 ESBL 分离株与 ESBL 基因的 MDR 之间无显著相关性（P=0.23）。
结论
本研究强调了儿科患者医院获得性感染中临床分离的革兰氏阴性杆菌中 ESBL 活性的流行情况。导致这种活性的最常见基因是 blaTEM 基因，其次是 blaSHV 和 blaCTX-M 基因。产 ESBL 活性的分离株中存在较高的多重抗生素耐药性。本研究的结果表明，对与儿科患者 HAI 相关的革兰氏阴性杆菌进行扩展β-内酰胺酶筛查非常重要。
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