Echegorry Mariano, Marchetti Paulina, Sanchez Cristian, Olivieri Laura, Faccone Diego, Martino Florencia, Sarkis Badola Tomas, Ceriana Paola, Rapoport Melina, Lucero Celeste, Albornoz Ezequiel, Corso Alejandra, Pasteran Fernando
Servicio Antimicrobianos, National Reference Laboratory in Antimicrobial Resistant, National Institute of Infectious Diseases (INEI), Administración Nacional de Laboratorios e Institutos de Salud (ANLIS) "Dr. Carlos G Malbrán", Ave. Velez Sarsfield 563, Buenos Aires City 1281, Argentina.
Antibiotics (Basel). 2024 Nov 27;13(12):1139. doi: 10.3390/antibiotics13121139.
The COVID-19 pandemic has exacerbated the global antimicrobial resistance (AMR) crisis. Consequently, it is more urgent than ever to prioritize AMR containment and support countries in improving the detection, characterization, and rapid response to emerging AMR threats. We conducted a prospective, multicenter study to assess the prevalence of carbapenemase-producing Enterobacterales in infectious processes in Argentina during the post-COVID-19 pandemic period and explore therapeutic alternatives for their treatment (RECAPT-AR study).
A total of 182 hospitals participated by submitting Enterobacterales clinical isolates to the National Reference Laboratory (NRL) during the first three weeks of November 2021. Inclusion criteria were defined as an ertapenem MIC ≥ 0.5 mg/L, a zone diameter ≤ 22 mm. Carbapenemase genes and those coding for major extended-spectrum β-lactamases were molecularly characterized using multiplex PCR at the NRL. Antibiotic susceptibility testing followed international standards (CLSI and EUCAST).
The NRL analyzed 821 Enterobacterales isolates. Metallo-β-lactamase (MBL, 42.0%) and KPC (39.8%) accounted for 81.8% of carbapenemases, followed by OXA-163 (7.4%), a variant of OXA-48 with additional activity against extended-spectrum cephalosporins, and enzyme combinations (8.3%). These combinations included NDM plus KPC (3.4%), OXA-163 plus KPC (2.4%), and OXA-163 plus NDM (2.1%). was the main species recovered, representing 76% of the isolates. According to the carbapenemase classes or combinations, tigecycline exhibited a susceptibility range of 33-83%, fosfomycin 59-81%, colistin 27-78%, and amikacin 17-81%. Ceftazidime-avibactam (CZA) and imipenem-relebactam (IMR) showed 92% and 98% susceptibility against serine carbapenemases, respectively. Meanwhile, aztreonam-avibactam (AZA) exhibited 96-98% susceptibility against all carbapenemase classes.
A new epidemiological landscape has emerged, characterized by the equivalent circulation of NDM and KPC. remains the primary species responsible for their dissemination. The co-production of carbapenemase combinations, particularly KPC plus NDM, was confirmed, mainly in . High activity was observed for AZA against MBLs and for CZA and IMR against KPC and OXA-163 carbapenemases.
新冠疫情加剧了全球抗菌药物耐药性（AMR）危机。因此，将控制AMR作为优先事项并支持各国改善对新出现的AMR威胁的检测、特征分析和快速应对，比以往任何时候都更加紧迫。我们开展了一项前瞻性多中心研究，以评估阿根廷在新冠疫情后时期感染性疾病中产碳青霉烯酶肠杆菌科细菌的流行情况，并探索其治疗的替代方案（RECAPT-AR研究）。
共有182家医院参与，于2021年11月的前三周将肠杆菌科临床分离株提交至国家参考实验室（NRL）。纳入标准定义为厄他培南最低抑菌浓度（MIC）≥0.5mg/L，抑菌圈直径≤22mm。在NRL使用多重聚合酶链反应对碳青霉烯酶基因以及编码主要超广谱β-内酰胺酶的基因进行分子特征分析。抗生素敏感性试验遵循国际标准（美国临床和实验室标准协会和欧洲抗菌药物敏感性试验委员会）。
NRL分析了821株肠杆菌科分离株。金属β-内酰胺酶（MBL，42.0%）和肺炎克雷伯菌碳青霉烯酶（KPC，39.8%）占碳青霉烯酶的81.8%，其次是OXA-163（7.4%），它是OXA-48的一种变体，对超广谱头孢菌素具有额外活性，以及酶组合（8.3%）。这些组合包括NDM加KPC（3.4%）、OXA-163加KPC（2.4%）和OXA-163加NDM（2.1%）。大肠埃希菌是主要分离出的菌种，占分离株的76%。根据碳青霉烯酶类别或组合，替加环素的敏感率范围为33 - 83%，磷霉素为59 - 81%，黏菌素为27 - 78%，阿米卡星为17 - 81%。头孢他啶-阿维巴坦（CZA）和亚胺培南-瑞来巴坦（IMR）对丝氨酸碳青霉烯酶的敏感率分别为92%和98%。同时，氨曲南-阿维巴坦（AZA）对所有碳青霉烯酶类别的敏感率为96 - 98%。
出现了一种新的流行病学态势，其特征是NDM和KPC的等量传播。大肠埃希菌仍然是其传播的主要菌种。证实了碳青霉烯酶组合的共同产生，特别是KPC加NDM，主要在大肠埃希菌中。观察到AZA对MBL有高活性，CZA和IMR对KPC和OXA-163碳青霉烯酶有高活性。
