Hidalgo Elena, Sotelo Jared, Pérez-Vázquez María, Iniesta Ángela, Cañada-García Javier E, Valiente Olga, Aracil Belén, Arana David M, Oteo-Iglesias Jesús
Servicio de Microbiología, Hospital Universitario de Getafe, 28905 Madrid, Spain.
Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, 28222 Madrid, Spain.
Microorganisms. 2025 May 16;13(5):1149. doi: 10.3390/microorganisms13051149.
The global emergence of carbapenem-resistant (CRAB) represents a significant public health threat. In the summer of 2022, a polyclonal CRAB outbreak occurred in our hospital, marking the first detection of an NDM-1 plus OXA-23 co-producing strain in Spain. The aim of this study was to phenotypically and genotypically characterize the clonal spread of NDM-1 and OXA-23 co-producing isolates and to describe the infection control measures implemented to contain the outbreak. Patients with multidrug-resistant isolates (July 2022-May 2023) were included in the study. Isolates were identified via MALDI-TOF, and antimicrobial susceptibility was tested using a broth microdilution method (DKMGN SensititreTM panels). Whole-genome sequencing was performed on 24 representative isolates. Phylogenetic analysis was performed using Ridom SeqSphere+ (cgMLST), while sequence typing was performed using ARIBA (Pasteur and Oxford schemes). isolates from the affected patients belonged to five different sequence types. The two main STs were ST1Pas/ST231Oxf (NDM-1- and OXA-23-co-producing), which accounted for 58%, and ST136Pas/ST406Oxf (OXA-23-producing), which accounted for 21%. All isolates were resistant to fluoroquinolones, trimethoprim/sulfamethoxazole, aminoglycosides, and carbapenems. In addition, 8% were resistant to colistin and 17% to cefiderocol. Finally, the affected patients were cohorted, and a thorough cleaning of the affected units was carried out. This study documents the clonal spread of an NDM-1- and OXA-23-co-producing strain in Spain, linked to a Libyan patient, highlighting the risk of cross-border spread. Although infection control measures successfully contained the outbreak, surveillance is essential as the incidence of CRAB infections is expected to increase.
耐碳青霉烯类鲍曼不动杆菌（CRAB）在全球范围内出现，对公共卫生构成了重大威胁。2022年夏天，我院发生了多克隆CRAB暴发，这是西班牙首次检测到一株同时产NDM-1和OXA-23的菌株。本研究的目的是从表型和基因型上对同时产NDM-1和OXA-23的分离株的克隆传播进行特征分析，并描述为控制疫情而实施的感染控制措施。研究纳入了有多药耐药分离株的患者（2022年7月至2023年5月）。通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF）鉴定分离株，并使用肉汤微量稀释法（DKMGN SensititreTM平板）检测抗菌药物敏感性。对24株代表性分离株进行全基因组测序。使用Ridom SeqSphere+（cgMLST）进行系统发育分析，同时使用ARIBA（巴斯德和牛津方案）进行序列分型。受影响患者的分离株属于五种不同的序列类型。两个主要的序列型为ST1Pas/ST231Oxf（同时产NDM-1和OXA-23），占58%，以及ST136Pas/ST406Oxf（产OXA-23），占21%。所有分离株对氟喹诺酮类、甲氧苄啶/磺胺甲恶唑、氨基糖苷类和碳青霉烯类均耐药。此外，8%的分离株对黏菌素耐药，17%对头孢地尔耐药。最后，对受影响的患者进行了分组，并对受影响的病房进行了彻底清洁。本研究记录了西班牙一株同时产NDM-1和OXA-23的菌株与一名利比亚患者相关的克隆传播，突出了跨境传播的风险。尽管感染控制措施成功控制了疫情，但由于预计CRAB感染的发病率会增加，监测至关重要。
