泰国春武里府临床样本中 ESKAPEE 多重耐药病原体的分子特征（2017-2018 年）。
Molecular characterization of multidrug-resistant ESKAPEE pathogens from clinical samples in Chonburi, Thailand (2017-2018).
机构信息
Bacterial and Parasitic Diseases Department, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, 10400, Thailand.
Wound Infections Department, Bacterial Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
出版信息
BMC Infect Dis. 2022 Aug 17;22(1):695. doi: 10.1186/s12879-022-07678-8.
BACKGROUND
ESKAPEE pathogens Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli are multi-drug resistant (MDR) bacteria that present increasing treatment challenges for healthcare institutions and public health worldwide.
METHODS
431 MDR ESKAPEE pathogens were collected from Queen Sirikit Naval Hospital, Chonburi, Thailand between 2017 and 2018. Species identification and antimicrobial resistance (AMR) phenotype were determined following CLSI and EUCAST guidelines on the BD Phoenix System. Molecular identification of antibiotic resistant genes was performed by polymerase chain reaction (PCR), real-time PCR assays, and whole genome sequencing (WGS).
RESULTS
Of the 431 MDR isolates collected, 1.2% were E. faecium, 5.8% were S. aureus, 23.7% were K. pneumoniae, 22.5% were A. baumannii, 4.6% were P. aeruginosa, 0.9% were Enterobacter spp., and 41.3% were E. coli. Of the 401 Gram-negative MDR isolates, 51% were carbapenem resistant, 45% were ESBL producers only, 2% were colistin resistance and ESBLs producers (2%), and 2% were non-ESBLs producers. The most prevalent carbapenemase genes were bla (23%), which was only identified in A. baumannii, followed by bla (17%), and bla (13%). Beta-lactamase genes detected included bla bla, bla, bla, bla, bla, bla and bla. Seven E. coli and K. pneumoniae isolates showed resistance to colistin and carried mcr-1 or mcr-3, with 2 E. coli strains carrying both genes. Among 30 Gram-positive MDR ESKAPEE, all VRE isolates carried the vanA gene (100%) and 84% S. aureus isolates carried the mecA gene.
CONCLUSIONS
This report highlights the prevalence of AMR among clinical ESKAPEE pathogens in eastern Thailand. E. coli was the most common MDR pathogen collected, followed by K. pneumoniae, and A. baumannii. Carbapenem-resistant Enterobacteriaceae (CRE) and extended spectrum beta-lactamases (ESBLs) producers were the most common resistance profiles. The co-occurrence of mcr-1 and mcr-3 in 2 E. coli strains, which did not affect the level of colistin resistance, is also reported. The participation of global stakeholders and surveillance of MDR remain essential for the control and management of MDR ESKAPEE pathogens.
背景
屎肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、肠杆菌属和大肠埃希菌是耐多药（MDR）的病原体，这些病原体对全球医疗机构和公共卫生构成了日益严峻的治疗挑战。
方法
2017 年至 2018 年期间，从泰国春武里府的诗丽吉王后海军医院采集了 431 株 MDR ESKAPEE 病原体。采用 CLSI 和 EUCAST 指南在 BD Phoenix 系统上进行种属鉴定和抗生素耐药表型（AMR）检测。通过聚合酶链反应（PCR）、实时 PCR 检测和全基因组测序（WGS）对抗生素耐药基因进行分子鉴定。
结果
在采集的 431 株 MDR 分离株中，1.2%为屎肠球菌，5.8%为金黄色葡萄球菌，23.7%为肺炎克雷伯菌，22.5%为鲍曼不动杆菌，4.6%为铜绿假单胞菌，0.9%为肠杆菌属，41.3%为大肠埃希菌。在 401 株革兰氏阴性 MDR 分离株中，51%为碳青霉烯类耐药，45%仅为 ESBL 生产者，2%为多粘菌素耐药和 ESBL 生产者（2%），2%为非 ESBL 生产者。最常见的碳青霉烯酶基因是 bla（23%），仅在鲍曼不动杆菌中发现，其次是 bla（17%）和 bla（13%）。检测到的β-内酰胺酶基因包括 bla、bla、bla、bla、bla、bla 和 bla。7 株大肠埃希菌和肺炎克雷伯菌分离株对多粘菌素表现出耐药性，并携带 mcr-1 或 mcr-3，其中 2 株大肠埃希菌同时携带这两种基因。在 30 株革兰氏阳性 MDR ESKAPEE 中，所有万古霉素耐药肠球菌（VRE）分离株均携带 vanA 基因（100%），84%的金黄色葡萄球菌分离株携带 mecA 基因。
结论
本报告强调了泰国东部临床 ESKAPEE 病原体中抗生素耐药性的流行情况。大肠埃希菌是最常见的 MDR 病原体，其次是肺炎克雷伯菌和鲍曼不动杆菌。碳青霉烯类耐药肠杆菌科（CRE）和扩展谱β-内酰胺酶（ESBLs）生产者是最常见的耐药谱。还报告了 2 株大肠埃希菌中同时存在 mcr-1 和 mcr-3，但这并未影响多粘菌素的耐药水平。全球利益相关者的参与和 MDR 监测对于控制和管理 MDR ESKAPEE 病原体仍然至关重要。
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