Choudhury Debarati, Alanbari Rawan, Saveliev Pauline, Sokurenko Evgeni, Fuzi Miklos, Tchesnokova Veronika
Department of Microbiology, University of Washington School of Medicine, Seattle, WA, United States.
Department of Microbiology, Al-Mustansiriyah University, College of Medicine, Baghdad, Iraq.
Front Microbiol. 2024 Oct 2;15:1446818. doi: 10.3389/fmicb.2024.1446818. eCollection 2024.
Antibiotic prescription practices differ between countries, influencing regional antimicrobial resistance prevalence. However, comparisons of clonal diversity among resistant bacteria in countries with different prescribing practices are rare. The rise of fluoroquinolone-resistant (FQREC), often multidrug-resistant, exacerbates global antibiotic resistance. Unlike in the USA, antibiotics are commonly dispensed in Iraq without prescriptions, leading to widespread overuse and misuse. This study aimed to assess the impact of varying antibiotic use practices on FQREC diversity.
We compared FQREC prevalence, multidrug resistance, and clonality of FQREC among isolated from urine submitted between 2017 and 2018 to three US hospitals and two Iraqi hospitals. All FQREC isolates were analyzed for QRDR mutations and the presence of PMQR genes. A subset of FQREC strains from the ST131-30R/Rx subgroups underwent whole-genome sequencing (WGS) and phylogenetic analysis.
from Iraq showed significantly higher resistance to all tested antibiotics compared to those from the USA, with 76.2% being FQREC versus 31.2% in the USA ( < 0.01). Iraqi FQREC strains were more frequently multidrug resistant. The predominant subgroup in both countries was ST131-30, with the notable absence of ST1193 among Iraqi FQREC. Iraqi-origin ST131-30 strains exhibited higher minimum inhibitory concentrations (MICs) for ciprofloxacin and greater resistance to third-generation cephalosporins (3GC), trimethoprim/sulfamethoxazole (TMP/STX), and imipenem (IMI) than those from the USA. Increased 3GC resistance in Iraqi strains was linked to a higher proportion of -carrying 30Rx subclade isolates. Additionally, Iraqi 30 strains exhibited higher MICs for fluoroquinolones due to more frequent carriage of PMQR determinants compared to US strains. Whole-genome sequencing was performed on 46 Iraqi and 63 US 30 isolates. Phylogenetic analysis revealed two clades-30R and 30Rx-present in both countries, with isolates from both regions distributed throughout, without the emergence of distinct new major subclones. However, Iraqi isolates tended to cluster in separate subclades, indicating endemic circulation of the strain groups.
In regions like Iraq, where antibiotics are overused and misused, resistance among uropathogenic to various antibiotics is significantly higher. Most Iraqi resistant strains belong to well-known international groups, and no new highly successful strains have emerged. The absence of ST1193 in Iraq may reflect regional, socioeconomic, demographic, or cultural factors that hinder the success of certain strain groups in the country.
各国抗生素处方习惯存在差异，影响着区域抗菌药物耐药性的流行情况。然而，在处方习惯不同的国家中，对抗性细菌的克隆多样性进行比较的情况却很少见。耐氟喹诺酮（FQREC）细菌的出现，通常具有多重耐药性，加剧了全球抗生素耐药性问题。与美国不同，在伊拉克抗生素通常无需处方即可配药，导致广泛的过度使用和滥用。本研究旨在评估不同抗生素使用习惯对FQREC多样性的影响。
我们比较了2017年至2018年间提交给三家美国医院和两家伊拉克医院的尿液分离株中FQREC的流行率、多重耐药性和克隆性。对所有FQREC分离株进行喹诺酮耐药决定区（QRDR）突变和质粒介导喹诺酮耐药（PMQR）基因检测。对来自ST131-30R/Rx亚组的一部分FQREC菌株进行全基因组测序（WGS）和系统发育分析。
与美国分离株相比，伊拉克分离株对所有测试抗生素的耐药性显著更高，伊拉克的FQREC占76.2%，而美国为31.2%（P<0.01）。伊拉克FQREC菌株更常具有多重耐药性。两国的主要亚组均为ST131-30，伊拉克FQREC中明显不存在ST1193。伊拉克来源的ST131-30菌株对环丙沙星的最低抑菌浓度（MIC）更高，对第三代头孢菌素（3GC）、甲氧苄啶/磺胺甲恶唑（TMP/STX）和亚胺培南（IMI）的耐药性也高于美国菌株。伊拉克菌株对3GC耐药性增加与携带30Rx亚分支分离株的比例较高有关。此外，与美国菌株相比，伊拉克30菌株由于更频繁携带PMQR决定簇，对氟喹诺酮类药物的MIC更高。对46株伊拉克和63株美国30分离株进行了全基因组测序。系统发育分析显示，两国均存在两个分支——30R和30Rx，两个地区的分离株分布在整个分支中，没有出现明显的新的主要亚克隆。然而，伊拉克分离株倾向于聚集在不同亚分支中，表明菌株组在当地流行。
在伊拉克等抗生素过度使用和滥用的地区，尿路致病性细菌对各种抗生素的耐药性显著更高。大多数伊拉克耐药菌株属于知名的国际菌群，没有出现新的高致病性菌株。伊拉克不存在ST1193可能反映了区域、社会经济、人口或文化因素，这些因素阻碍了某些菌株组在该国的传播。
