Buzgó Lilla, Kiss Zsanett, Göbhardter Dániel, Lesinszki Virág, Ungvári Erika, Rádai Zoltán, Laczkó Levente, Damjanova Ivelina, Kardos Gábor, Tóth Ákos
Department of Bacteriology, Parasitology and Mycology, National Center for Public Health and Pharmacy, 1097 Budapest, Hungary.
One Health Institute, Faculty of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary.
Antibiotics (Basel). 2025 May 8;14(5):475. doi: 10.3390/antibiotics14050475.
BACKGROUND/OBJECTIVES: The global spread of carbapenemase-producing (CPKP) strains represent a severe public health threat due to very limited choice of antibacterial therapy. Cefiderocol, a novel siderophore-cephalosporin, may represent a new therapeutic option but resistance is increasingly being described. Our aim was to investigate in vitro cefiderocol susceptibility among CPKP strains in Hungary and assess correlations between resistance, carbapenemase types, and clonal lineages.
The study was performed on 420 CPKP strains from 34 Hungarian healthcare institutes (HCIs) submitted to the National Reference Laboratory of Antimicrobial Resistance (March 2021 to April 2023). The disk diffusion method (Liofilchem, Via Scozia, Italy) was used for in vitro cefiderocol susceptibility testing (according to EUCAST guidelines). For molecular epidemiologic investigation, we used whole genome sequencing (Illumina MiSeq, 150 bp paired-end) and pulsed-field gel electrophoresis (PFGE). Carbapenemase gene type was determined by multiplex PCR. Statistical analysis was performed in R (v.4.2.0).
Dominant high-risk clones (ST147, ST395, ST258) exhibited regional distribution, with ST147/NDM-1 strains showing the highest cefiderocol resistance (75%). Overall resistance was 65%. Carbapenemase gene types occurred as follows: 35 , 53 , 57 , 153 , and 122 +. Cefiderocol resistance rates by carbapenemase type were 20%, 44%, 70%, and 75% in the case of , , , and +.
The results show a high prevalence of cefiderocol resistance in CPKP in Hungary, with different rates of resistance in different carbapenemase gene-carrying high-risk clones, highlighting the growing challenge in treating these infections.
背景/目的：产碳青霉烯酶（CPKP）菌株在全球范围内的传播对公共卫生构成了严重威胁，因为抗菌治疗的选择非常有限。头孢地尔，一种新型的铁载体头孢菌素，可能代表一种新的治疗选择，但对其耐药性的报道越来越多。我们的目的是调查匈牙利CPKP菌株对头孢地尔的体外敏感性，并评估耐药性、碳青霉烯酶类型和克隆谱系之间的相关性。
该研究对来自匈牙利34家医疗机构（HCI）的420株CPKP菌株进行了检测（2021年3月至2023年4月提交给国家抗菌药物耐药性参考实验室）。采用纸片扩散法（Liofilchem，意大利维亚斯科齐亚）进行头孢地尔体外敏感性试验（根据欧盟CAST指南）。对于分子流行病学调查，我们使用了全基因组测序（Illumina MiSeq，150 bp双端）和脉冲场凝胶电泳（PFGE）。通过多重PCR确定碳青霉烯酶基因类型。在R（v.4.2.0）中进行统计分析。
主要的高危克隆（ST147、ST395、ST258）呈现区域分布，其中ST147/NDM-1菌株对头孢地尔的耐药性最高（75%）。总体耐药率为65%。碳青霉烯酶基因类型如下：35、53、57、153和122 +。在、、、和+的情况下，不同碳青霉烯酶类型的头孢地尔耐药率分别为20%、44%、70%和75%。
结果显示匈牙利CPKP菌株对头孢地尔耐药性的高流行率，不同携带碳青霉烯酶基因的高危克隆的耐药率不同，突出了治疗这些感染日益增加的挑战。
