来自加沙地带巴勒斯坦儿科医院的碳青霉烯类抗生素编码多重耐药革兰氏阴性菌的首次报告。

First report of carbapenems encoding multidrug-resistant gram-negative bacteria from a pediatric hospital in Gaza Strip, Palestine.

机构信息

Department of Medical Laboratory Sciences, Faculty of Medical Sciences, Al-Aqsa University, Gaza, Palestine.

Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al Azhar University, Gaza, Palestine.

出版信息

BMC Microbiol. 2024 Oct 9;24(1):393. doi: 10.1186/s12866-024-03550-8.

DOI:10.1186/s12866-024-03550-8

PMID:39379824

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11462914/

Abstract

BACKGROUND

The worldwide prevalence of multi-drug resistance (MDR) in Gram-negative bacteria (GNB), particularly related to extended-spectrum beta-lactamases (ESBLs) and carbapenemases, poses significant global public health and clinical challenges.

OBJECTIVES

To characterize ESBL-producing Gram-negative bacilli, within a pediatric hospital in Gaza using whole genome sequencing (WGS).

METHODS

A total of 158 clinical isolates of Gram-negative bacilli were collected from Al-Nasser Pediatric Hospital. These isolates were tested for ESBL production using the double disk synergy test. The antibiotic susceptibility profile was determined using the Kirby Bauer method following the Clinical and Laboratory Standard Institute guidelines. Selected 15 phenotypically MDR isolates were whole-genome sequenced and characterized for their genome-based species identity and antibiotic resistance gene profile.

RESULTS

Of the 158 isolates, 93 (58.9%) were positive for ESBL production. The frequency of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Proteus mirabilis, and Serratia marcescens was 50%, 22.7%, 22.7%, 1.8%, 1.2%, and 1.2% respectively. The prevalence of ESBL among urine, pus, blood, and sputum was 64%, 44%, 23%, and 63.6%, respectively. Chloramphenicol, Imipenem, and Meropenem were the most effective antibiotics against ESBL producers. In sequenced isolates, an average of six anti-microbial resistance (AMR) genes were noted per isolate, where one of them carried up to 13 antibiotic resistance genes. Carbapenem resistance genes such as bla(6.6%), bla (6.6%), and bla (6.6%) were detected. All the sequenced E. coli isolates (n = 8) showed multiple resistance genes, mainly against β-lactamase (25.0%), aminoglycosides (37.5%), sulfonamides (37.5%), and genes conferring resistance to tetracyclines (25.0).

CONCLUSION

Our results showed a high prevalence of ESBL-producing GNB isolated from a pediatric hospital in the Gaza Strip. Various antibiotic resistance genes were identified, including those encoding ESBL and carbapenems. The results highlight the significant challenge posed by MDR in GNB and emphasize the need for effective antibiotic strategies. Given the high endemicity observed in various studies from Palestine, it is important to conduct clinical and molecular epidemiology research to identify risk factors, transmission patterns, and clinical outcomes associated with GNB strains that carry ESBL and carbapenem resistance genes.

摘要

背景

全球革兰氏阴性菌（GNB）中多药耐药（MDR）的流行，特别是与扩展谱β-内酰胺酶（ESBLs）和碳青霉烯酶有关，对全球公共卫生和临床构成了重大挑战。

目的

使用全基因组测序（WGS）对加沙地带一家儿科医院的产 ESBL 革兰氏阴性杆菌进行特征描述。

方法

从纳赛尔儿科医院收集了 158 株革兰氏阴性杆菌临床分离株。采用双碟协同试验检测这些分离株产 ESBL 的情况。根据临床和实验室标准协会指南，采用 Kirby Bauer 法测定抗生素药敏谱。选择 15 株表型上 MDR 的分离株进行全基因组测序，并对其基于基因组的种属身份和抗生素耐药基因谱进行特征描述。

结果

在 158 株分离株中，93 株（58.9%）产 ESBL。大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、奇异变形杆菌和粘质沙雷氏菌的检出率分别为 50%、22.7%、22.7%、1.8%、1.2%和 1.2%。尿液、脓液、血液和痰液中 ESBL 的检出率分别为 64%、44%、23%和 63.6%。氯霉素、亚胺培南和美罗培南是对产 ESBL 菌最有效的抗生素。在测序分离株中，每个分离株平均携带 6 个抗微生物药物耐药（AMR）基因，其中一个携带多达 13 个抗生素耐药基因。检测到碳青霉烯类耐药基因 bla(6.6%)、bla(6.6%)和 bla(6.6%)。所有测序的大肠埃希菌分离株（n=8）均显示出多种耐药基因，主要针对β-内酰胺酶（25.0%）、氨基糖苷类（37.5%）、磺胺类（37.5%）和四环素耐药基因（25.0%）。

结论

我们的结果显示，从加沙地带的一家儿科医院分离出的产 ESBL 革兰氏阴性菌的流行率很高。鉴定出了各种抗生素耐药基因，包括编码 ESBL 和碳青霉烯类的基因。结果突出表明了革兰氏阴性菌中 MDR 带来的重大挑战，并强调了需要采取有效的抗生素策略。鉴于巴勒斯坦的各种研究中观察到的高地方性，进行临床和分子流行病学研究以确定与携带 ESBL 和碳青霉烯类耐药基因的 GNB 菌株相关的危险因素、传播模式和临床结果非常重要。