• 【blaKPC-2基因的体内水平传播在肠杆菌科的临床分离株中在多种遗传平台上进行。】 复制标题 收藏 收藏
    DOI:10.1016/j.jgar.2015.05.001 复制DOI
    作者列表:Anchordoqui MS,De Belder D,Lucero C,Rapoport M,Faccone D,Rodriguez A,Di Martino A,Martino F,Herrero I,Pasteran F,Corso A,Gomez SA
    BACKGROUND & AIMS: :This study investigated the molecular characteristics of six blaKPC-positive Enterobacteriaceae recovered from three patients in Argentina. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standards Institute (CLSI) 2014 recommendations. Molecular characterisation of the isolates was performed by biparental conjugation, PCR, sequencing, S1 nuclease restriction, and Southern blot hybridisation with a blaKPC probe using standard protocols and conditions. The isolates studied were as follows. Case 1: Escherichia coli (ECO-P1) and Klebsiella pneumoniae (KPN-P1) isolated from a rectal swab harboured blaKPC-2 in transposon Tn4401a on non-typeable and non-conjugative plasmids. Case 2: Enterobacter cloacae (ECL-P2) and K. pneumoniae (KPN-P2) were isolated from two blood cultures. blaKPC-2 was found in a novel genetic variant of ISKpn8-blaKPC-2-ISKpn6-like on conjugative plasmids of IncL/M type. Case 3, Citrobacter freundii (CFR-P3) and Klebsiella oxytoca (KOX-P3) were isolated from skin and skin-structure infection. The blaKPC gene was detected on ISKpn8-ΔblaTEM-blaKPC-2-ISKpn6-like located on an IncA/C conjugative plasmid. CFR-P3 and KOX-P3 harboured blaPER-2 in addition to the blaKPC gene. In conclusion, we document the horizontal dissemination of blaKPC-2 from diverse Enterobacteriaceae clinical isolates with different genetic backgrounds. This is the first report of E. coli harbouring blaKPC associated with Tn4401a in Argentina.
    背景与目标: :这项研究调查了从阿根廷三名患者中回收的六株blaKPC阳性肠杆菌科的分子特征。按照临床和实验室标准协会(CLSI)2014的建议进行了药敏试验。使用标准方案和条件,通过双亲结合,PCR,测序,S1核酸酶限制以及与blaKPC探针的Southern杂交,对分离物进行分子鉴定。研究的分离株如下。案例1:从直肠拭子中分离的大肠杆菌(ECO-P1)和肺炎克雷伯菌(KPN-P1)在转座子Tn4401a中的不可分型和非结合性质粒上带有blaKPC-2。案例2:从两种血液培养物中分离出阴沟肠杆菌(ECL-P2)和肺炎克雷伯菌(KPN-P2)。在IncL / M型接合质粒上的ISKpn8-blaKPC-2-ISKpn6-like新遗传变异中发现了blaKPC-2。案例3,从皮肤和皮肤结构感染中分离出弗氏柠檬酸杆菌(CFR-P3)和产酸克雷伯菌(KOX-P3)。在位于IncA / C接合质粒上的ISKpn8-ΔblaTEM-blaKPC-2-ISKpn6-like上检测到blaKPC基因。除了blaKPC基因外,CFR-P3和KOX-P3还包含blaPER-2。总之,我们记录了从具有不同遗传背景的各种肠杆菌科临床分离株中水平传播blaKPC-2的情况。这是大肠杆菌在阿根廷首次携带与Tn4401a相关的blaKPC的报告。
  • 【牛肠杆菌。十一月,肠杆菌科的新物种。】 复制标题 收藏 收藏
    DOI:10.1007/s002840010160 复制DOI
    作者列表:Inoue K,Sugiyama K,Kosako Y,Sakazaki R,Yamai S
    BACKGROUND & AIMS: :The name Enterobacter cowanii sp. nov. is proposed for a group of organisms referred to as NIH Group 42. Members of this species are Gram-negative, motile rods conforming to the definition of the family Enterobacteriaceae. The DNA relatedness of nine strains of NIH Group 42 to the proposed type strain of this species averaged 85% at 70 degrees C, whereas the relatedness to other species within the family Enterobacteriaceae was less than 38%. Because the DNA relatedness (5-38%) is closer to species of the genus Enterobacter than to other species of the family, the members of NIH Group 42 were placed in the genus Enterobacter. The majority of strains of E. cowanii were isolated from clinical specimens. A culture of the type strain (888-76) has been deposited in the Japan Collection of Microorganisms as JCM 10956.
    背景与目标: :名称Enterobacter cowanii sp。十一月提出用于一组称为NIH组42的生物。该物种的成员是符合肠杆菌科定义的革兰氏阴性,能动杆。在70摄氏度下,NIH 42组的9个菌株与该物种的拟定类型菌株的DNA相关性平均为85%,而与肠杆菌科中其他物种的相关性则小于38%。由于DNA的相关性(5-38%)比肠杆菌属的物种更接近该家族的其他物种,因此NIH 42组成员被置于肠杆菌属中。从临床标本中分离出大多数的大肠杆菌。类型菌株(888-76)的培养物已以JCM 10956的形式保藏在日本微生物保藏中心。
  • 【在奥地利的废水处理厂中检测到KPC-2和OXA-48碳青霉烯类携带肠杆菌科。】 复制标题 收藏 收藏
    DOI:10.1111/1469-0691.12336 复制DOI
    作者列表:Galler H,Feierl G,Petternel C,Reinthaler FF,Haas D,Grisold AJ,Luxner J,Zarfel G
    BACKGROUND & AIMS: :Multiresistant Enterobacteriaceae, like carbapenemase-producing strains, have their primary reservoir in medical institutions. They can also be found with increasing tendency in other reservoirs. One possible way for entrance of multiresistant Enterobacteriaceae into the environment is via waste water. The aim of the study was to screen isolates from a wastewater treatment plant for the presence of carbapenemase-producing Enterobacteriaceae. Three isolates harboured carbapenemase genes, one Klebsiella pneumoniae harboured KPC-2 and one K. pneumoniae and one Escherichia coli harboured OXA-48. This is the first report of carbapenemase-harbouring Enterobacteriaceae isolated outside medical institutions in Austria and the first detection of KPC-harbouring K. pneumonia MLST ST 1245.
    背景与目标: :多抗性肠杆菌科细菌,与产生碳青霉烯酶的菌株一样,在医疗机构中具有主要的储库。在其他储层中也发现它们具有增加的趋势。使多抗肠杆菌科细菌进入环境的一种可能方法是通过废水。这项研究的目的是从废水处理厂的分离物中筛选出产生碳青霉烯酶的肠杆菌科细菌。三个分离株带有碳青霉烯酶基因,一个肺炎克雷伯氏菌带有KPC-2,一个肺炎克雷伯氏菌和一个大肠杆菌带有OXA-48。这是在奥地利医疗机构外部分离到的带有碳青霉烯酶的肠杆菌科的首次报道,也是首次发现具有KPC的肺炎克雷伯氏菌MLST ST 1245。
  • 【分离自猪的头孢菌素耐药肠杆菌科的TEM,SHV和AmpC型β-内酰胺酶的表征。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijfoodmicro.2008.03.009 复制DOI
    作者列表:Rayamajhi N,Kang SG,Lee DY,Kang ML,Lee SI,Park KY,Lee HS,Yoo HS
    BACKGROUND & AIMS: :Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacteriaceae are an increasing problem in human medicine and an emerging problem in the veterinary field. Our study, therefore, focused on assessing the prevalence of beta-lactamases isolated from swine. Sixty-six Salmonella enterica serovar Typhimurium (S. Typhimurium), 33 Salmonella enterica serovar Enteritidis (S. Enteritidis), 26 Klebsiella pneumonia (K. pneumoniae) and 130 Escherichia coli (E. coli) pig isolates collected from 1999-2006 were screened for beta-lactam resistance by the disk diffusion test (DDT) and micro-broth dilution. Among the isolates, five E. coli and five K. pneumoniae exhibited reduced susceptibility to the cephalosporins tested. PCR, plasmid profiling and Southern blot hybridization showed the presence of multiple beta-lactamases in these isolates of animal origin. Hybridization patterns of the DHA-1 specific probe indicated that dissemination of DHA-1 related beta-lactamases could be attributed to plasmids of one common size among the enteric microbes of animal origin. To the best of our knowledge, this study reports the first identification of SHV-28 and DHA-1 from microbes of animal origin.
    背景与目标: :广谱β-内酰胺酶(ESBL)和产生AmpC的肠杆菌科是人类医学中一个日益严重的问题,也是兽医领域中一个新出现的问题。因此,我们的研究集中在评估从猪中分离出的β-内酰胺酶的患病率。筛选了1999年至2006年收集的66株肠炎沙门氏菌鼠伤寒沙门氏菌(S. Typhimurium),33株肠炎沙门氏菌肠炎沙门氏菌(S. Enteritidis),26株肺炎克雷伯菌(K. pneumoniae)和130株猪大肠杆菌。通过圆盘扩散测试(DDT)和微肉汤稀释获得的β-内酰胺抗性。在分离物中,有五种大肠杆菌和五种肺炎克雷伯菌显示出对所测试的头孢菌素的敏感性降低。 PCR,质粒分析和Southern印迹杂交显示在这些动物来源的分离物中存在多种β-内酰胺酶。 DHA-1特异性探针的杂交模式表明,与DHA-1相关的β-内酰胺酶的传播可归因于动物来源的肠道微生物中一种常见大小的质粒。据我们所知,本研究报告首次从动物来源的微生物中鉴定出SHV-28和DHA-1。
  • 【使用更新的临床和实验室标准协会的解释性标准,在带有超广谱β-内酰胺酶的肠杆菌科中,超广谱头孢菌素的易感性模式。】 复制标题 收藏 收藏
    DOI:10.1016/j.ijantimicag.2012.12.003 复制DOI
    作者列表:Kristo I,Pitiriga V,Poulou A,Zarkotou O,Kimouli M,Pournaras S,Tsakris A
    BACKGROUND & AIMS: :We examined the effect of applying the updated 2010 Clinical and Laboratory Standards Institute (CLSI) susceptibility breakpoints for extended-spectrum cephalosporins (ESCs) to detect extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. In total, 202 ESBL-producing, plasmidic AmpC- and carbapenemase-negative isolates derived from separate patients were collected from three Greek hospitals during 2007-2011, including 150 Escherichia coli, 43 Klebsiella pneumoniae and 9 Enterobacter cloacae clinical isolates. ESBLs were detected using the ESBL CLSI confirmatory test and PCR assays. Sequencing analysis showed that 91 (45.0%) of the ESBL-producers carried the bla(CTX-M-3) gene, 66 (32.7%) carried the bla(CTX-M-15) gene and the remaining 45 (22.3%) carried the bla(SHV-5) gene. Minimum inhibitory concentrations for cefotaxime, ceftazidime and cefepime were determined by the agar dilution method. Based on the new CLSI breakpoints, 13 (6.4%) of the ESBL-producers were susceptible to cefotaxime, 90 (44.6%) to ceftazidime and 112 (55.4%) to cefepime; as many as 145 (71.8%) were susceptible to at least one ESC. Among the 150 E. coli, 12 (8.0%), 87 (58.0%) and 79 (52.7%) were susceptible to cefotaxime, ceftazidime and cefepime, respectively, whilst among the 43 K. pneumoniae, 1 (2.3%), 3 (7.0%) and 25 (58.1%) were susceptible to the above ESCs, respectively. None of the nine E. cloacae were susceptible to cefotaxime and ceftazidime, but all except one were susceptible to cefepime. By implementation of the new 2010 CLSI breakpoints, a considerable proportion of ESBL-possessing Enterobacteriaceae would be reported as susceptible, mostly to ceftazidime and cefepime, leading to possible infection control and therapeutic implications.
    背景与目标: :我们研究了应用更新的2010年临床和实验室标准协会(CLSI)敏感性点对超广谱头孢菌素(ESC)检测产生超广谱β-内酰胺酶(ESBL)的肠杆菌科的效果。在2007年至2011年期间,总共从三名希腊医院收集了202份来自不同患者的产ESBL的,质粒化的AmpC和碳青霉烯酶阴性的分离株,包括150株大肠杆菌,43株肺炎克雷伯菌和9株泄殖腔肠杆菌临床分离株。使用ESBL CLSI确证测试和PCR测定法检测ESBL。测序分析表明,有91个(45.0%)的ESBL生产者带有bla(CTX-M-3)基因,有66个(32.7%)带有bla(CTX-M-15)基因,其余45个(22.3%)携带bla(SHV-5)基因。用琼脂稀释法测定头孢噻肟,头孢他啶和头孢吡肟的最低抑菌浓度。根据新的CLSI断点,有13名(6.4%)的ESBL生产者易受头孢噻肟的影响,90名(44.6%)对头孢他啶易感,112名(55.4%)对头孢吡肟易感;多达145个(71.8%)易受至少一种ESC的影响。在150例大肠杆菌中,分别有12例(8.0%),87例(58.0%)和79例(52.7%)易受头孢噻肟,头孢他啶和头孢吡肟的影响,而43例肺炎克雷伯菌中有1例(2.3%),3例。 (7.0%)和25(58.1%)易受上述ESC影响。九种阴沟肠杆菌均不易受头孢噻肟和头孢他啶的影响,但除一个外,其余均易受头孢吡肟的影响。通过实施新的2010年CLSI断点,据报道,相当一部分拥有ESBL的肠杆菌科细菌很容易感染,其中大部分容易感染头孢他啶和头孢吡肟,从而可能导致感染控制和治疗意义。
  • 【BacT / Alert系统中早期阳性厌氧血液培养瓶中肠杆菌科细菌的优势。】 复制标题 收藏 收藏
    DOI:10.1002/jcla.21571 复制DOI
    作者列表:Chiueh TS,Lee SY,Tang SH,Lu JJ,Sun JR
    BACKGROUND & AIMS: :We collected and analyzed the time to detection (TTD) of blood cultures in the BacT/Alert automated system from 2002 to 2007. Among the 10,893 monomicrobial isolates from a total of 133,735 blood culture sets, the recoveries of aerobic bottles were compared with those of anaerobic bottles in this study. Significantly more Gram-positive cocci (except Staphylococcus aureus and enterococci), glucose nonfermentative Gram-negative bacteria, and yeast were recovered from aerobic bottles than from anaerobic bottles. The average TTD was 19.0 hr and 20.1 hr for the aerobic and anaerobic bottles, respectively, and 96.8% of the microorganisms were detected within the first 72 hr. Of the 5,489 microorganisms recovered from both of the blood culture bottle pair, microbial growth was significantly more often detected first in the anaerobic bottles than the aerobic bottles for Enterobacteriaceae except Serratia marcescens, while S. aureus, coagulase-negative staphylococci and Pseudomonas aeruginosa were more often detected first in the aerobic bottles. According to these data, we conclude that the earlier positivity of anaerobic bottles is a useful marker for rapid presumptive identification of Enterobacteriaceae infection.
    背景与目标: :我们收集并分析了2002年至2007年BacT / Alert自动化系统中血液培养物的检测时间(TTD)。在总共133,735个血液培养物中的10,893株微生物分离物中,将有氧瓶的回收率与回收率进行了比较。在这项研究中的厌氧瓶。从需氧瓶中回收的革兰氏阳性球菌(金黄色葡萄球菌和肠球菌除外),葡萄糖非发酵性革兰氏阴性菌和酵母的数量要比厌氧瓶中的多。好氧瓶和厌氧瓶的平均TTD分别为19.0小时和20.1小时,在前72小时内检测到96.8%的微生物。从两个血培养瓶对中回收的5,489种微生物中,除粘质沙雷氏菌外,在厌氧瓶中首先检测到的细菌生长要比需氧菌瓶中的细菌增长要多得多,而金黄色葡萄球菌,凝固酶阴性葡萄球菌和铜绿假单胞菌则更多。通常首先在有氧瓶中检测到。根据这些数据,我们得出结论,厌氧瓶的早期阳性是快速推定肠杆菌科感染的有用标志物。
  • 【台湾全国范围内监测替加环素对产生广谱β-内酰胺酶的肠杆菌科细菌临床分离株的体外活性。】 复制标题 收藏 收藏
    DOI:10.1016/S0924-8579(08)70024-4 复制DOI
    作者列表:Lu CT,Chuang YC,Sun W,Liu YC,Cheng YJ,Lu PL,Chen CM,Hsu GJ,Jang TN,Lee CM,Chiang PC,Shi ZY,Wang LS,Kung HC,Lin HC,Liao CH,Liu JW,Huang CH,Tsao SM,Hsueh PR
    BACKGROUND & AIMS: :Tigecycline In-vitro Surveillance in Taiwan (TIST), initiated in 2006, is a nationwide surveillance programme designed to monitor longitudinally the in-vitro activity of tigecycline against commonly encountered resistant bacteria. This study compared the in-vitro activity of tigecycline against clinical isolates of resistant Gram-negative bacteria determined by the broth microdilution and Etest methods. A total of 622 isolates were collected from patients treated at 20 teaching hospitals. Tigecycline had excellent in-vitro activity against extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (N = 275) with MIC(90) 0.5 microg/mL and a 99.6% susceptibility rate, and also against ESBL-producing Klebsiella pneumoniae (N = 324) with MIC(90) 2 microg/mL and a 98.5% susceptibility rate. For ESBL-producing Proteus mirabilis (N = 15) the MIC(90) was 4 microg/mL with a 73.3% susceptibility rate. For ESBL-producing Klebsiella oxytoca (N = 8) the MIC(50) and MIC(90) were 0.5 and 1 microg/mL, respectively, with a 100% susceptibility rate. Limited agreement (<80%) was found between the broth microdilution and the Etest methods when determining the in-vitro activity of tigecycline against ESBL- producing K. pneumoniae and K. oxytoca.
    背景与目标: 台湾的Tigecycline体外监测(TIST)于2006年启动,是一项全国性的监测计划,旨在纵向监测tigecycline对常见耐药菌的体外活性。这项研究比较了肉汤微稀释和Etest方法测定的替加环素对耐药革兰氏阴性菌临床分离株的体外活性。从20家教学医院接受治疗的患者中总共收集了622株分离株。 Tigecycline对产生超广谱β-内酰胺酶(ESBL)的大肠杆菌(N = 275)具有MIC(90)0.5 microg / mL和99.6%的敏感性,并且对产生ESBL的肺炎克雷伯菌具有优异的体外活性(N = 324)MIC(90)2 microg / mL,敏感性为98.5%。对于产生ESBL的变形杆菌(N = 15),MIC(90)为4 microg / mL,敏感性为73.3%。对于产ESBL的产酸克雷伯菌(N = 8),MIC(50)和MIC(90)分别为0.5和1 microg / mL,敏感性为100%。当确定替加环素对产生ESBL的肺炎克雷伯菌和产氧克雷伯氏菌的体外活性时,在肉汤微稀释法和Etest方法之间发现有限的一致性(<80%)。
  • 【整形外科手术中的抗生素耐药性:由于产生广谱β-内酰胺酶(ESBL)的肠杆菌科细菌引起的急性膝关节假体感染。】 复制标题 收藏 收藏
    DOI:10.1007/s10096-010-0950-y 复制DOI
    作者列表:Martínez-Pastor JC,Vilchez F,Pitart C,Sierra JM,Soriano A
    BACKGROUND & AIMS: :The aim of this study was to describe the prevalence and characteristics of knee prosthetic joint infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. From 2000 to 2007, 132 infections out of 5,076 arthroplasties (2.6%) were registered. Seven out of 132 infections (5.3%) were due to ESBL-producing Enterobacteriaceae, Escherichia coli in six cases and Klebsiella pneumoniae in one. Open debridement and retention of the implant was the first surgical approach and all patients received intravenous carbapenems. Relapse was documented in four cases and remission in three. Therefore, debridement without prosthesis removal was associated with a high failure rate.
    背景与目标: :这项研究的目的是描述由于产生超广谱β-内酰胺酶(ESBL)的肠杆菌科细菌引起的膝关节假体感染的患病率和特征。从2000年到2007年,共进行了5,076例关节置换术中的132例感染(占2.6%)。 132例感染中有7例(5.3%)是由于产生ESBL的肠杆菌科,6例大肠杆菌和1例肺炎克雷伯菌引起的。开放性清创术和保留植入物是第一种外科手术方法,所有患者均接受了静脉注射碳青霉烯类药物。记录有4例复发和3例缓解。因此,未清除假体的清创术与高失败率相关。
  • 【广谱β-内酰胺酶生产肠杆菌科】 复制标题 收藏 收藏
    DOI:10.1016/S0929-693X(12)71280-0 复制DOI
    作者列表:Mariani-Kurkdjian P,Doit C,Bingen E
    BACKGROUND & AIMS: :Extended-spectrum beta-lactamase (ESBLs) are defined as ß-lactamase able to hydrolyze all penicillins and cephalosporins with the exception of cephamycins (cefotixin, cefotetan), moxalactam and carbapenems and are encoded by mobile genes. The most frequently encountered ESBLs belong to the CTX-M, SHV, and TEM families. ESBLs were found first in Klebsiella pneumonia and then predominantly in E. coli. The incidence of patients with ESBLs E. coli increase since 2000 in Robert Debré Hospital in Paris. They were mainly implicated in urinary tract infections and less frequently in other infections such as materno-foetal infections or neonatal meningitis. An increase of consumption of carbapenems may lead to spread of carbapenem resistant organisms. Thus alternative to carbapenems for treatment of ESBL producers are needed.
    背景与目标: :广谱β-内酰胺酶(ESBLs)定义为ß-内酰胺酶,能够水解除头孢霉素(头孢替辛,头孢替坦),莫拉西坦和碳青霉烯外的所有青霉素和头孢菌素,并由流动基因编码。最常遇到的ESBL属于CTX-M,SHV和TEM系列。 ESBLs首先在肺炎克雷伯菌中发现,然后主要在大肠杆菌中发现。自2000年以来,巴黎罗伯特·德布雷医院的ESBLs大肠杆菌患者的发病率增加。它们主要与尿路感染有关,而与其他感染(例如,胎粪-胎儿感染或新生儿脑膜炎)相关的频率较低。碳青霉烯类的消费量增加可能导致对碳青霉烯类耐药生物的传播。因此,需要用碳青霉烯替代ESBL生产者。
  • 【俄罗斯圣彼得堡育龄妇女尿路致病性肠杆菌科的抗菌素耐药性和基因:对妊娠肾盂肾炎的治疗意义。】 复制标题 收藏 收藏
    DOI:10.1080/14767058.2020.1752655 复制DOI
    作者列表:Shipitsyna E,Khusnutdinova T,Razinkova M,Budilovskaya O,Grigoriev A,Savochkina Y,Khudovekova A,Savicheva A
    BACKGROUND & AIMS: :Background: Urinary tract infections (UTIs) are common in women, and during pregnancy can cause significant morbidity. Growing and greatly varying antimicrobial resistance (AMR) of Enterobacteriaceae, responsible for most UTIs, necessitates regular local AMR surveillance. In obstetric population, where beta-lactams are the mainstay for treatment of severe UTIs, particular focus should be placed on beta-lactam resistance. This study aimed to evaluate AMR rates and frequency of extended spectrum beta-lactamase (ESBL) and carbapenemase genes in uropathogenic Enterobacteriaceae among reproductive-age women in St. Petersburg, Russia.Materials/methods: Urine samples were collected from consecutive reproductive-age women, who attended the D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology from October 2017 to November 2019, and cultured according to routine procedures. Susceptibility to antibiotics and ESBL production was determined using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. All urine samples and Enterobacteriaceae isolates were tested for ESBL and carbapenemase genes using real-time PCR.Results: Enterobacteriaceae were detected in 91 (56 pregnant and 35 non-pregnant) of 119 (76%) included women. The vast majority of Enterobacteriaceae strains were susceptible to nitrofurantoin, fosfomycin and meropenem (99-100%). The frequency of strains susceptible to penicillins and cephalosporins ranged from 59% to 82%; 78% of strains were susceptible to ciprofloxacin. ESBL production was phenotypically detected in 15 (16%) Enterobacteriaceae strains, with CTX-M genes revealed in all cases. In all corresponding urine samples, CTX-M genes were also detected. The remaining 104 urine samples were negative for CTX-M genes. In none of the isolates and urine samples, carbapenemase genes were present.Conclusions: The frequency of ESBL producing Enterobacteriaceae was relatively high (16%), with CTX-M genes detected in all cases in both urine and urine cultures. Rapid PCR detection of CTX-M genes directly in urine samples from women with pyelonephritis can be valuable for timely informing treatment choices.
    背景与目标: 背景:泌尿系统感染(UTIs)在女性中很常见,在怀孕期间可能会导致严重的发病率。负责大多数UTI的肠杆菌科细菌耐药性(AMR)的增长和差异很大,因此需要定期进行局部AMR监测。对于以β-内酰胺类药物为主要治疗重度尿路感染的产科人群,应特别关注β-内酰胺类药物的耐药性。这项研究的目的是评估俄罗斯圣彼得堡育龄妇女泌尿系统致病性肠杆菌科细菌的AMR发生率和超广谱β-内酰胺酶(ESBL)和碳青霉烯酶基因的频率。材料/方法:从连续生育年龄的妇女中收集尿液样本,参加了DO奥特(Ott)妇产科与生殖研究所于2017年10月至2019年11月,并按常规程序进行培养。根据欧洲抗生素敏感性试验委员会(EUCAST)指南,使用圆盘扩散法确定对抗生素和ESBL的敏感性。结果:在包括119名女性在内的119名女性中,有91名(56名孕妇和35名非孕妇)检出了肠杆菌科。绝大多数肠杆菌科菌株对呋喃妥因,磷霉素和美罗培南敏感(99-100%)。对青霉素和头孢菌素敏感的菌株的频率范围为59%至82%。 78%的菌株对环丙沙星敏感。在15个(16%)肠杆菌科菌株中表型检测到ESBL产生,在所有情况下均显示CTX-M基因。在所有相应的尿液样本中,也检测到了CTX-M基因。其余104个尿液样本中CTX-M基因阴性。结论:产ESBL肠杆菌科细菌的频率相对较高(16%),在所有病例中尿液和尿液培养物中均检测到CTX-M基因。直接从肾盂肾炎妇女的尿液样本中快速检测CTX-M基因的PCR对及时告知治疗选择可能很有价值。
  • 【心脏手术后肠杆菌科手术部位感染:万古霉素的假设作用。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2013.04.023 复制DOI
    作者列表:Pham AD,Mouet A,Pornet C,Desgue J,Ivascau C,Thibon P,Morello R,Le Coutour X
    BACKGROUND & AIMS: BACKGROUND:In the middle of October 2011, the Hygiene Department of Caen University Hospital suspected an outbreak of surgical site infections (SSI) after open-heart operations with an unusually high proportion of microorganisms belonging to the Enterobacteriaceae family. The attack rate was 3.8%, significantly different (p = 0.035) from the attack rate of 1.2% in 2010 over the equivalent period. A case-control study was conducted to search specifically for risk factors for Enterobacteriaceae infections after median sternotomy in cardiac patients. METHODS:Case patients were defined retrospectively as patients with superficial or deep surgical site infection with Enterobacteriaceae within 30 days of median sternotomy. Four control patients were selected per case patient from patients matched for date of operation (± 15 days) and European System for Cardiac Operative Risk Evaluation (<5, [5-10], >10). RESULTS:Univariate analysis identified the following risk factors: inappropriate skin preparation on the morning of the intervention (p = 0.046), use of vancomycin (p = 0.030), and number of sternotomy dressings (p = 0.033). A multivariate logistic regression analysis found that vancomycin use was independently associated with an increased risk of postoperative SSI with Enterobacteriaceae (p = 0.019; odds ratio = 7.4). CONCLUSIONS:Although vancomycin is known to be effective for preventing infection with methicillin-sensitive organisms, our results suggest that it was associated with a risk for the development of SSI with gram-negative organisms after median sternotomy. This study led to a multidisciplinary meeting that defined new guidelines for prophylactic antibiotic therapy before open-heart operations.
    背景与目标: 背景:2011年10月中旬,卡昂大学医院卫生部怀疑在进行开胸手术后爆发了手术部位感染(SSI),其中肠杆菌科的微生物比例异常高。攻击率为3.8%,与2010年同期的1.2%的攻击率有显着差异(p = 0.035)。进行了一项病例对照研究,以明确寻找心脏病患者中位胸骨切开术后肠杆菌科感染的危险因素。
    方法:病例病例回顾性定义为在正中胸骨切开术后30天内患有肠杆菌科的浅表或深部手术部位感染的患者。每例患者从手术日期(±15天)和欧洲心脏手术风险评估系统(<5,[5-10],> 10)匹配的患者中选择四名对照患者。
    结果:单因素分析确定了以下危险因素:干预当天早上不适当的皮肤准备(p = 0.046),使用万古霉素(p = 0.030)和胸骨切开术敷料的数量(p = 0.033)。多元logistic回归分析发现,万古霉素的使用与肠杆菌科术后SSI风险增加独立相关(p = 0.019;优势比= 7.4)。
    结论:尽管已知万古霉素可有效预防对甲氧西林敏感的生物体感染,但我们的结果表明,在正中胸骨切开术后,它与革兰氏阴性生物体发生SSI的风险有关。这项研究导致了一个多学科会议,该会议确定了在进行心脏直视手术之前进行预防性抗生素治疗的新指南。
  • 【快速检测肠杆菌科细菌中与氟喹诺酮耐药性相关的gyrA和parC突变的方法。】 复制标题 收藏 收藏
    DOI:10.1016/j.mimet.2013.06.019 复制DOI
    作者列表:Nakano R,Okamoto R,Nakano A,Nagano N,Abe M,Tansho-Nagakawa S,Ubagai T,Kikuchi-Ueda T,Koshio O,Kikuchi H,Ono Y
    BACKGROUND & AIMS: :We developed a PCR-RFLP assay to detect mutations in the quinolone-resistance determining regions of gyrA and parC associated with fluoroquinolone resistance in Enterobacteriaceae. The assay detected mutations associated with reduced susceptibility to fluoroquinolones and may therefore serve as a specific, rapid, inexpensive, and simple testing alternative.
    背景与目标: :我们开发了一种PCR-RFLP分析法,以检测与肠杆菌科细菌中的氟喹诺酮耐药性相关的gyrA和parC喹诺酮耐药性确定区域中的突变。该测定法检测到与降低对氟喹诺酮类药物敏感性相关的突变,因此可以用作特异性,快速,廉价且简单的测试替代方法。
  • 【降级对肠杆菌科细菌血症患者预后的影响:来自多中心前瞻性队列的事后分析。】 复制标题 收藏 收藏
    DOI:10.1093/cid/ciy1032 复制DOI
    作者列表:
    BACKGROUND & AIMS: BACKGROUND:More data are needed about the safety of antibiotic de-escalation in specific clinical situations as a strategy to reduce exposure to broad-spectrum antibiotics. The aims of this study were to investigate predictors of de-escalation and its impact on the outcome of patients with bloodstream infection due to Enterobacteriaceae (BSI-E). METHODS:A post hoc analysis was performed on a prospective, multicenter cohort of patients with BSI-E initially treated with ertapenem or antipseudomonal β-lactams. Logistic regression was used to analyze factors associated with early de-escalation (EDE) and Cox regression for the impact of EDE and late de-escalation (LDE) on 30-day all-cause mortality. A propensity score (PS) for EDE vs no de-escalation (NDE) was calculated. Failure at end of treatment and length of hospital stay were also analyzed. RESULTS:Overall, 516 patients were included. EDE was performed in 241 patients (46%), LDE in 95 (18%), and NDE in 180 (35%). Variables independently associated with a lower probability of EDE were multidrug-resistant isolates (odds ratio [OR], 0.50 [95% confidence interval {CI}, .30-.83]) and nosocomial infection empirically treated with imipenem or meropenem (OR, 0.35 [95% CI, .14-.87]). After controlling for confounders, EDE was not associated with increased risk of mortality; hazard ratios (HR) (95% CIs) were as follows: general model, 0.58 (.25-1.31); model with PS, 0.69 (.29-1.65); and PS-based matched pairs, 0.98 (.76-1.26). LDE was not associated with mortality. De-escalation was not associated with clinical failure or length of hospital stay. CONCLUSIONS:De-escalation in patients with monomicrobial bacteremia due to Enterobacteriaceae was not associated with a detrimental impact on clinical outcome.
    背景与目标: 摘要背景:在减少临床广泛使用抗生素的策略中,还需要更多有关特定临床情况下抗生素降级安全性的数据。这项研究的目的是调查降级的预测因素及其对肠杆菌科(BSI-E)引起的血液感染患者预后的影响。
    方法:对先前接受厄他培南或抗假性β-内酰胺类药物治疗的BSI-E患者的前瞻性,多中心队列进行事后分析。使用Logistic回归分析与早期降级(EDE)和Cox回归相关的因素,以了解EDE和晚期降级(LDE)对30天全因死亡率的影响。计算了EDE的倾向得分(PS)与未降级(NDE)的差异。还分析了治疗结束时的失败和住院时间。
    结果:总共纳入516例患者。 241例患者(46%)进行了EDE,95例(18%)进行了LDE,180例(35%)进行了NDE。与较低的EDE概率独立相关的变量是耐多药菌株(比值比[OR],0.50 [95%置信区间{CI} ,. 30-.83])和根据经验用亚胺培南或美罗培南治疗的医院感染(OR, 0.35 [95%CI,.14-.87]。在控制了混杂因素之后,EDE并没有增加死亡率。危险比(HR)(95%CI)如下:通用模型,0.58(.25-1.31); PS为0.69(.29-1.65)的模型;和基于PS的匹配对,为0.98(.76-1.26)。 LDE与死亡率无关。降级与临床失败或住院时间无关。
    结论:肠杆菌科细菌引起的单菌菌血症患者的病情恶化与对临床结局的有害影响无关。
  • 【英国一家儿科医院出现对碳青霉烯类耐药的肠杆菌科。】 复制标题 收藏 收藏
    DOI:10.1016/j.jhin.2013.05.003 复制DOI
    作者列表:Drew RJ,Turton JF,Hill RL,Livermore DM,Woodford N,Paulus S,Cunliffe NA
    BACKGROUND & AIMS: BACKGROUND:Carbapenem-resistant Enterobacteriaceae are an emerging global infection threat. However, there are few data describing their clinical importance in children. AIM:This retrospective study reviewed the prevalence and resistance mechanisms of carbapenem-resistant Enterobacteriaceae grown from clinical and surveillance samples in a large tertiary referral children's hospital in the UK. METHODS:Carbapenem-resistant Enterobacteriaceae were sought in specimens submitted for diagnostic and surveillance purposes at Alder Hey Children's NHS Foundation Trust, Liverpool, between September 2011 and August 2012. Mechanisms of resistance were identified using phenotypic and/or molecular methods. Variable number tandem repeat profiling was used to type carbapenemase-producing strains. FINDINGS:During the 12-month study period, carbapenem-resistant Enterobacteriaceae were recovered from 24 patients. Five isolates were from clinical diagnostic specimens whereas 19 of 421 patients had positive rectal surveillance swabs (4.5%). Of the 24 isolates, seven (all Klebsiella spp.) harboured carbapenemases: three had blaKPC and four blaNDM, whereas 17 had resistance due to combinations of AmpC or extended-spectrum β-lactamase activity plus impermeability. CONCLUSION:Carbapenem-resistant Enterobacteriaceae and, in particular, those with carbapenemases, are an emerging infection problem in a major paediatric hospital in the UK. Active surveillance is required to monitor and control their spread.
    背景与目标: 背景:对碳青霉烯类耐药的肠杆菌科是新兴的全球感染威胁。但是,很少有数据描述它们在儿童中的临床重要性。
    目的:这项回顾性研究回顾了英国一家大型三级转诊儿童医院的临床和监测样本中产生的对碳青霉烯类耐药的肠杆菌科细菌的流行和耐药机制。
    方法:2011年9月至2012年8月间,在利物浦的Alder Hey儿童NHS基金会信托基金提交的用于诊断和监测目的的标本中寻找对碳青霉烯类耐药的肠杆菌科。使用表型和/或分子方法确定了耐药机制。可变数目的串联重复序列分析用于产生碳青霉烯酶的菌株的类型。
    结果:在为期12个月的研究期间,从24例患者中恢复了对碳青霉烯类耐药的肠杆菌科。从临床诊断标本中分离出5株,而421例患者中有19例直肠监测拭子阳性(4.5%)。在这24个分离株中,有7个(所有克雷伯菌属)都带有碳青霉烯酶:3个具有blaKPC和4个blaNDM,而17个由于AmpC或广谱β-内酰胺酶活性加不可渗透性的结合而具有耐药性。
    结论:对碳青霉烯类耐药的肠杆菌科,尤其是那些具有碳青霉烯酶的肠杆菌科,是英国一家大型儿科医院中正在出现的感染问题。需要主动监视以监视和控制其传播。
  • 【菲律宾医院污水和河水中产生碳青霉烯酶的肠杆菌科细菌的环境存在和遗传特征。】 复制标题 收藏 收藏
    DOI:10.1128/AEM.01906-19 复制DOI
    作者列表:Suzuki Y,Nazareno PJ,Nakano R,Mondoy M,Nakano A,Bugayong MP,Bilar J,Perez M 5th,Medina EJ,Saito-Obata M,Saito M,Nakashima K,Oshitani H,Yano H
    BACKGROUND & AIMS: :This study aimed to evaluate the prevalence and genetic characteristics of carbapenemase-producing Enterobacteriaceae (CPE) in hospital sewage and river water in the Philippines, which has a typical tropical maritime climate. We collected 83 water samples from 7 hospital sewage and 10 river water sites. CPE were identified using CHROMagar mSuperCARBA, and Gram-negative strains were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) or 16S rRNA gene sequencing. Resistance genes in Enterobacteriaceae strains were identified using PCR and DNA sequencing, and transferability of carbapenemase genes from the CPE was investigated with conjugation experiments. Genotyping was performed using multilocus sequence typing (MLST) for Escherichia coli and Klebsiella pneumoniae Out of 124 Enterobacteriaceae isolates, we identified 51 strains as CPE and divided these into 7 species, 11 E. coli, 14 Klebsiella spp., 15 Enterobacter spp., and 11 others, including 4 additional species. Conjugation experiments via broth mating and using E. coli J53 revealed that 24 isolates can transfer carbapenemase-encoding plasmids. MLST analysis showed that 6 of 11 E. coli isolates belonged to clonal complex 10 (CC10). Of 11 K. pneumoniae strains, 9 unique sequence types (STs) were identified, including ST147. Five types of carbapenemase genes were identified, with the most prevalent being NDM (n = 39), which is epidemic in clinical settings in the Philippines. E. coli CC10 and K. pneumoniae ST147, which are often detected in clinical settings, were the dominant strains. In summary, our results indicate that hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.IMPORTANCE Carbapenemase-producing Enterobacteriaceae (CPE) cause severe health care-associated infections, and their increasing prevalence is a serious concern. Recently, natural ecosystems have been recognized as important reservoirs of antibiotic resistance genes. We investigated the prevalence and genetic characteristics of CPE isolated from the environment (hospital sewage and river water) in the Philippines and found several CPE, including Escherichia coli and other species, with different carbapenemases. The most prevalent carbapenemase gene type was NDM, which is endemic in clinical settings. This study revealed that isolates belonging to carbapenemase-producing E. coli CC10 and K. pneumoniae sequence type 147 (ST147), which are often detected in clinical settings, were dominant in the natural environment. Our work here provides a report on the presence and characteristics of CPE in the environment in the Philippines and demonstrates that both hospital sewage and river water are contaminated by CPE strains belonging to clinically important clonal groups.
    背景与目标: :这项研究旨在评估菲律宾的医院污水和河水中产生碳青霉烯酶的肠杆菌科(CPE)的流行情况和遗传特征,菲律宾是典型的热带海洋性气候。我们从7个医院污水和10个河水站点收集了83个水样。使用CHROMagar mSuperCARBA鉴定CPE,并使用基质辅助激光解吸电离飞行时间质谱(MALDI-TOF MS)或16S rRNA基因测序鉴定革兰氏阴性菌株。利用PCR和DNA测序鉴定肠杆菌科细菌的抗性基因,并通过缀合实验研究了来自CPE的碳青霉烯酶基因的可转移性。使用多基因座序列分型(MLST)对大肠杆菌和肺炎克雷伯菌进行基因分型,从124株肠杆菌科细菌中分离出51株CPE,并将其分为7种,分别为11种大肠杆菌,14种克雷伯菌,15种肠杆菌,其他11种,包括另外4种。通过肉汤交配和使用大肠杆菌J53进行的缀合实验表明,有24种分离株可以转移编码碳青霉烯酶的质粒。 MLST分析显示11株大肠杆菌中有6株属于克隆复合物10(CC10)。在11株肺炎克雷伯菌中,鉴定出9种独特的序列类型(ST),包括ST147。鉴定出五种碳青霉烯酶基因,其中最流行的是NDM(n = 39),这在菲律宾的临床环境中很流行。在临床环境中经常检测到的大肠杆菌CC10和肺炎克雷伯菌ST147是主要菌株。总而言之,我们的结果表明,医院污水和河水被属于临床上重要的克隆群体的CPE菌株污染。近来,自然生态系统已被认为是抗生素抗性基因的重要储存库。我们调查了菲律宾从环境(医院污水和河水)中分离出的CPE的流行情况和遗传特征,发现了几种CPE,包括大肠杆菌和其他物种,具有不同的碳青霉烯酶。最流行的碳青霉烯酶基因类型是NDM,在临床环境中很流行。这项研究表明,在临床环境中经常发现属于产碳青霉烯酶的大肠杆菌CC10和肺炎克雷伯氏菌序列类型147(ST147)的分离株。我们在这里的工作提供了有关菲律宾环境中CPE的存在和特征的报告,并证明了医院污水和河水均被临床上重要的克隆组的CPE菌株污染。

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