Background:Although the prevalence of the carbapenem-resistant A. baumannii (CRAB) has increased in Taiwan, few studies have elucidated the prevalence of different carbapenemase genes in Taiwan. The first objective of this study was to identify the types and prevalence of different carbapenemase genes, and the second objective was to determine the carbapenem antimicrobial susceptibility of carbapenemase producing isolates. Methods:In total, 269 CRAB blood isolates from four medical centres in Taiwan from 1/1/2009 to 31/12/2013 were analysed. Antimicrobial susceptibilities were determined using the Vitek 2 system. Carbapenemase genes were identified by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) was used to identify the different pulsotypes. Results:All 269 CRAB isolates had the blaOXA-51-like gene, while 237 (88.1%) had the blaOXA-23-like gene, and 11 (4.09%) had the blaOXA-24-like gene. Twenty-one CRAB isolates (7.81%) contained only the blaOXA-51-like gene. None of the isolates had the blaOXA-58-like gene or the metallo-β-lactamases (MBL)-encoding genes. In 28.69% of isolates with the blaOXA-23-like gene and 90.91% of isolates with the blaOXA-24-like gene, the minimum inhibitory concentrations (MICs) for imipenem were 64 mg/L or more. In 37.55% of isolates with the blaOXA-23-like gene and 100% of isolates with the blaOXA-24-like gene, meropenem MICs were 64 mg/L or more. PFGE analyses indicated that six highly similar genomes which harbored the blaOXA-24-like gene came from three different medical centres. Conclusion:Our study determined the prevalence of CRAB, the types and prevalence of carbapenemase genes, carbapenem susceptibility among CRAB isolates, and documented that the blaOXA-24-like gene had greater resistance to carbapenem than the blaOXA-23-like gene. We also demonstrated inter-hospital transmission of the highly resistant blaOXA-24-like gene.

译文

背景:尽管台湾地区对碳青霉烯耐药的鲍曼不动杆菌(CRAB)的流行有所增加,但很少有研究阐明台湾不同碳青霉烯酶基因的流行。这项研究的第一个目标是确定不同碳青霉烯酶基因的类型和流行程度,第二个目标是确定产生碳青霉烯酶的分离株对碳青霉烯的抗菌敏感性。
方法:对2009年1月1日至2013年12月31日台湾地区四个医疗中心的269份CRAB血分离物进行分析。使用Vitek 2系统测定抗菌药的敏感性。通过聚合酶链反应(PCR)和测序鉴定碳青霉烯酶基因。脉冲场凝胶电泳(PFGE)用于鉴定不同的脉冲型。
结果:所有269株CRAB菌株均具有blaOXA-51样基因,其中237株(88.1%)具有blaOXA-23样基因,其中11株(4.09%)具有blaOXA-24样基因。 21个CRAB分离株(7.81%)仅包含blaOXA-51-like基因。分离株均没有blaOXA-58样基因或金属β-内酰胺酶(MBL)编码基因。在具有blaOXA-23-like基因的分离株和具有blaOXA-24-like基因的分离株中有90.91%的亚胺培南的最低抑菌浓度(MICs)为64 mg / L或更高。在37.55%的具有blaOXA-23样基因的分离株和100%的具有blaOXA-24样基因的分离株中,美洛培南的MIC均为64 mg / L或更高。 PFGE分析表明,含有blaOXA-24样基因的六个高度相似的基因组来自三个不同的医学中心。
结论:我们的研究确定了CRAB的患病率,碳青霉烯酶基因的类型和流行度,CRAB分离株中的碳青霉烯易感性,并证明blaOXA-24样基因对碳青霉烯的抵抗力要高于blaOXA-23样基因。我们还证明了高度耐药的blaOXA-24-like基因在医院之间的传播。

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