Journal of global antimicrobial resistance最新文献_第3页

Impact of a persuasive antimicrobial stewardship programme on the appropriateness of surgical antimicrobial prophylaxis in a tertiary care hospital in southern Italy 意大利南部一家三级甲等医院的抗菌药物管理计划对外科抗菌药物预防措施合理性的影响。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-13 DOI: 10.1016/j.jgar.2024.09.003

Background and aim

The aim of our study was to evaluate the rate of compliance to institutional guidelines on surgical antimicrobial prophylaxis (SAP) among the surgical wards of our facility and to evaluate the impact of our antimicrobial stewardship programme (ASP) on the adherence rate.

Methods

We conducted a cross-sectional study including all 14 surgical wards of our hospital. Eight of these wards participate in a non-restrictive ASP. All patients admitted to one of the wards who had been prescribed SAP were included; the appropriateness of prophylaxis was defined according to the institutional protocols.

Results

During the study period, we evaluated 169 patients undergoing a surgical procedure, of whom 105 (62.1%) received SAP. Overall, 10 (10.5%) patients were prescribed unnecessary prophylaxis; among the remaining 95, 30 (31.6%) received appropriate prophylaxis, while 65 (68.4%) were prescribed SAP deemed inappropriate for one or more reasons (38.5% received a drug with a larger spectrum of activity, 9.2% a molecule with a narrower spectrum, 36.9% an incorrect dose and 76.9% a longer duration of prophylaxis). A higher number of patients in the inappropriate prophylaxis group received abdominal surgery (P = 0.001) and were admitted to a ward not participating in the ASP (P < 0.001). At multivariate analysis, being admitted to an ASP unit was the only factor independently related to having received appropriate prophylaxis.

Conclusions

A low rate of adherence to local guidelines on SAP was observed, but a non-restrictive ASP can significantly impact the appropriateness of surgical prophylaxis.

背景和目的：我们的研究旨在评估本院外科病房对医院外科抗菌药物预防指南（SAP）的遵守率，并评估我们的抗菌药物管理计划（ASP）对遵守率的影响：我们进行了一项横断面研究，包括本医院的所有 14 个外科病房。其中 8 个病房参加了非限制性 ASP。所有在其中一间病房住院并开具 SAP 处方的患者均被纳入研究范围；预防性治疗的适当性根据机构协议进行定义：在研究期间，我们对 169 名接受外科手术的患者进行了评估，其中 105 人（62.1%）接受了 SAP 治疗。总体而言，10 名患者（10.5%）接受了不必要的预防治疗；在其余 95 名患者中，30 名患者（31.6%）接受了适当的预防治疗，而 65 名患者（68.4%）因一种或多种原因接受了不适当的 SAP 治疗（38.5% 接受了活性谱更大的药物，9.2% 接受了活性谱更小的分子，36.9% 接受了不正确的剂量，76.9% 接受了更长的预防时间）。预防不当组中接受腹部手术（P=0.001）和入住未参加 ASP 的病房的患者人数较多（P结论：观察发现，遵守当地 SAP 指南的比例较低，但非限制性 ASP 可以显著影响手术预防的适当性。

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引用次数: 0

First report of a carbapenem-resistant Aeromonas veronii environmental isolate in the United States co-harboring two carbapenemase genes 首次报告美国环境中分离出的对碳青霉烯类耐药的维龙单胞菌同时携带两种碳青霉烯酶基因。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-11 DOI: 10.1016/j.jgar.2024.08.010

Objectives

The spread of carbapenem-resistant bacteria (CRB), and especially carbapenemase-producing CRB, is a global public health threat. Among them, Aeromonas species are of increasing concern because these emerging opportunistic pathogens are widespread in the environment and have increasingly been found to be resistant to carbapenems. The aim of this study was to investigate the genome and carbapenem-resistance determinants of Aeromonas veronii SS-M2–3, a highly carbapenem-resistant, carbapenemase-producing, river isolate from California (U.S.).

Methods

We first used disk diffusion assays to characterize the susceptibility profile to carbapenems and other antibiotics of A. veronii SS-M2–3. We next used whole-genome sequencing using the Illumina platform and bioinformatics analysis to characterize the resistome of this isolate and identify its carbapenemase genes.

Results

A. veronii SS-M2–3 was resistant to all carbapenems tested and amoxicillin-clavulanic acid, whereas it was sensitive to cefotaxime and all non-β-lactam antibiotics tested. Whole genome sequencing of this isolate revealed a complex resistome that included multidrug efflux pump genes and three chromosomal β-lactamase genes. These three genes encoded for highly conserved variants (82% to 97% amino acid identity) of the ChpA3 subclass B2 metallo-carbapenemase, OXA-12 class D carbapenemase and the FOX-2 class C β-lactamase. This is the first report of an environmental A. veronni isolate from the U.S. co-harbouring two carbapenemase genes.

Conclusions

These findings reveal that natural aquatic environments in the U.S. represent an underappreciated reservoir of carbapenem-resistant Aeromonas veronii isolates that can carry multiple carbapenemase genes.

目标：耐碳青霉烯类细菌（CRB），尤其是产生碳青霉烯类酶的 CRB 的传播是对全球公共卫生的威胁。其中，气单胞菌日益受到关注，因为这些新出现的机会性病原体在环境中广泛存在，而且越来越多地被发现对碳青霉烯类产生耐药性。本研究的目的是调查维龙单胞菌 SS-M2-3 的基因组和碳青霉烯类耐药性决定因素：方法：我们首先使用磁盘扩散法分析了维罗纳弧菌 SS-M2-3 对碳青霉烯类和其他抗生素的敏感性。接下来，我们使用 Illumina 平台进行全基因组测序，并进行生物信息学分析，以确定该分离株的耐药基因组特征并鉴定其碳青霉烯酶基因：结果：A. veronii SS-M2-3对所测试的所有碳青霉烯类抗生素和阿莫西林-克拉维酸均耐药，而对头孢他啶和所测试的所有非β-内酰胺类抗生素均敏感。对该分离株的全基因组测序发现了一个复杂的抗药性基因组，其中包括多药外排泵基因和三个染色体β-内酰胺酶基因。这三个基因编码 ChpA3 B2 亚类金属碳青霉烯酶、OXA-12 D 类碳青霉烯酶和 FOX-2 C 类 β-内酰胺酶的高度保守变体（82%-97% 氨基酸同一性）。这是首次报道美国环境中的维龙尼甲虫分离物同时携带两种碳青霉烯酶基因：结论：这些研究结果表明，美国的自然水生环境是一个未得到充分重视的耐碳青霉烯类的维龙单胞菌分离物库，这些分离物可携带多种碳青霉烯类酶基因。

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引用次数: 0

Whole-genome sequence analysis of morphological changes in Haemophilus influenzae after beta-lactam exposure 对接触β-内酰胺后流感嗜血杆菌形态变化的全基因组序列分析。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-06 DOI: 10.1016/j.jgar.2024.08.001

This report describes mutations in genes responsible for cell deformities in haemophili under beta-lactam pressure in vitro. Light and transmission electron microscopy confirmed a hypothesis regarding changes in the shape of haemophili that had become more filamentous in the presence of ampicillin (2 mg/L) and cefuroxime (8 mg/L) after 30 days of serial passage. Short-axis size increased by 28% (from 0.767 to 1.06 µm) and long-axis length increased by 54% (from 1 to 2.175 µm). Additionally, whole-genome sequencing analysis (Illumina platform, software PROKKA) revealed a variety of mutations in genes responsible for cell morphology in isolates examined in this study: ftsI (A1576 → C; G1154 → C; T986 → C; G1684 → C), mreB (C476 → T), mreC (A5 → G), mrdA (A1148 → G; C179 → T; G1613 → T), mrdB (T668 → G), mltC (C1016 → T) and rodA (T668 → G). The results of this study indicate that shifts in bacterial shape could play a role in the adaptation of haemophili to a new niche created by beta-lactams as a strategy of antibiotic therapy survival.

本报告描述了在体外β-内酰胺类药物的压力下，导致嗜血杆菌细胞畸形的基因突变。光镜和透射电子显微镜证实了一种假设，即在氨苄西林（2 毫克/升）和头孢呋辛（8 毫克/升）的作用下，嗜血杆菌的形状在连续通过 30 天后会发生变化，变得更像丝状。短轴的尺寸增加了 28%（从 0.767μm 增加到 1.06μm），长轴的长度增加了 54%（从 1μm 增加到 2.175μm）。此外，全基因组测序分析（Illumina 平台，软件 PROKKA）显示，本研究中检测的分离株中负责细胞形态的基因发生了多种突变：ftsI（A1576 → C；G1154 → C；T986 → C；G1684 → C）、mreB（C476 → T）、mreC（A5 → G）、mrdA（A1148 → G；C179 → T；G1613 → T）、mrdB（T668 → G）、mltC（C1016 → T）、rodA（T668 → G）。这项研究的结果表明，细菌形状的改变可能是嗜血杆菌适应β-内酰胺类药物创造的新生态位的一种策略。

引用次数: 0

Evaluation of gradient diffusion in vitro susceptibility testing of Aerococcus urinae 对尿道球菌体外药敏试验梯度扩散的评估

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-01 DOI: 10.1016/j.jgar.2024.07.014

Objective

Aerococcus urinae antimicrobial susceptibility testing can be performed via broth microdilution with Mueller-Hinton broth supplemented with lysed horse blood. We sought to compare this with the commonly used gradient diffusion method.

Methods

We compared broth microdilution with Mueller-Hinton broth supplemented with lysed horse blood and gradient diffusion via Mueller-Hinton agar supplemented with sheep blood for 190 A. urinae isolates against 16 antimicrobials.

Results

No antimicrobials demonstrated more than 90% essential and categorical agreement, and fewer than 3% demonstrated major and very major error rates. Trimethoprim-sulfamethoxazole demonstrated an 81% major error rate and ceftriaxone demonstrated a 76% very major error rate. Agar dilution with lysed horse blood was performed for trimethoprim-sulfamethoxazole against 94 isolates and showed 100% susceptibility, consistent with previous studies.

Conclusions

Given its limitations in detecting resistant strains, our findings cannot support the routine use of gradient diffusion with Mueller-Hinton agar supplemented with sheep blood for A. urinae in lieu of the Clinical and Laboratory Standards Institute method. Our results suggest that A. urinae is usually susceptible to penicillin, linezolid, tetracycline, and vancomycin. Future studies should evaluate alternative testing methods for clinical microbiology laboratories.

目的：尿道气球菌抗菌药物敏感性测试（AST）可通过肉汤微稀释法（BMD）进行，使用的肉汤为添加了裂解马血的穆勒-欣顿肉汤（MHB-LHB）。我们试图将其与常用的梯度扩散法进行比较：方法：我们比较了使用 MHB-LHB 的 BMD 法和通过补充了绵羊血的 MH 琼脂进行梯度扩散的方法，对 190 株尿囊菌分离物进行了 16 种抗菌药物的检测：结果：没有一种抗菌药物的基本一致率和分类一致率（EA 和 CA）超过 90%，重大和非常重大错误率（ME 和 VME）低于 3%。甲氧苄啶-磺胺甲噁唑（TMP-STX）的重大错误率为 81%，头孢曲松的极重大错误率为 76%。用溶解马血进行琼脂稀释 (AD)，对 94 个分离菌株进行 TMP-STX 检测，发现其药敏率为 100%，与之前的研究结果一致：我们的研究结果并不支持常规使用添加了绵羊血的 MH 琼脂梯度扩散法检测尿囊绦虫，以取代 CLSI 方法，因为该方法在检测耐药菌株方面存在局限性。我们的研究结果表明，A. urinae 通常对青霉素、利奈唑胺、四环素和万古霉素敏感。未来的研究应评估临床微生物实验室的其他检测方法。

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引用次数: 0

Antibiotic resistance rates in hypervirulent Klebsiella pneumoniae strains: A systematic review and meta-analysis 高病毒性肺炎克雷伯菌株的抗生素耐药率：系统综述和荟萃分析。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-01 DOI: 10.1016/j.jgar.2024.06.018

Objectives

In response to the growing global concerns regarding antibiotic resistance, we conducted a meta-analysis to assess the prevalence of antibiotic resistance in hypervirulent Klebsiella pneumoniae (hvKp) strains.

Methods

We conducted a meta-analysis of antibiotic resistance in the hvKp strains. Eligible studies published in English until April 10, 2023, were identified through a systematic search of various databases. After removing duplicates, two authors independently assessed and analysed the relevant publications, and a third author resolved any discrepancies. Data extraction included publication details and key information on antibiotic resistance. Data synthesis employed a random-effects model to account for heterogeneity, and various statistical analyses were conducted using R and the metafor package.

Results

This meta-analysis of 77 studies from 17 countries revealed the prevalence of antibiotic resistance in hvKp strains. A high resistance rates have been observed against various classes of antibiotics. Ampicillin-sulbactam faced 45.3% resistance, respectively, rendering them largely ineffective. The first-generation cephalosporin cefazolin exhibited a resistance rate of 38.1%, whereas second-generation cefuroxime displayed 26.7% resistance. Third-generation cephalosporins, cefotaxime (65.8%) and ceftazidime (57.1%), and fourth-generation cephalosporins, cefepime (51.3%), showed substantial resistance. The last resort carbapenems, imipenem (45.7%), meropenem (51.0%) and ertapenem (40.6%), were not spared.

Conclusion

This study emphasizes the growing issue of antibiotic resistance in hvKp strains, with notable resistance to both older and newer antibiotics, increasing resistance over time, regional disparities and methodological variations. Effective responses should involve international cooperation, standardized testing and tailored regional interventions.

研究目的针对全球日益关注的抗生素耐药性问题，我们进行了一项荟萃分析，以评估高病毒性肺炎克雷伯氏菌（hvKp）菌株的抗生素耐药性流行率：我们对 hvKp 菌株的抗生素耐药性进行了荟萃分析。通过对各种数据库进行系统检索，确定了 2023 年 4 月 10 日前发表的符合条件的英文研究。在去除重复内容后，两位作者独立评估并分析了相关出版物，第三位作者负责解决任何不一致之处。数据提取包括出版物详细信息和抗生素耐药性的关键信息。数据综合采用了随机效应模型来考虑异质性，并使用 R 和 metafor 软件包进行了各种统计分析：这项对来自 17 个国家的 77 项研究进行的荟萃分析揭示了 hvKp 菌株的抗生素耐药性流行情况。研究发现，hvKp菌株对各类抗生素的耐药率都很高。氨苄西林-舒巴坦的耐药率分别为 45.3%，使其基本失效。第一代头孢菌素头孢唑啉的耐药率为 38.1%，而第二代头孢呋辛的耐药率为 26.7%。第三代头孢菌素头孢他啶（65.8%）和头孢唑肟（57.1%）以及第四代头孢菌素头孢吡肟（51.3%）也出现了大量耐药性。最后一种碳青霉烯类药物亚胺培南（45.7%）、美罗培南（51.0%）和厄他培南（40.6%）也未能幸免。结论：本研究强调了 hvKp 菌株对抗生素的耐药性问题日益严重，对新旧抗生素都有明显的耐药性，耐药性随着时间的推移而增加，存在地区差异和方法差异。有效应对措施应包括国际合作、标准化测试和有针对性的地区干预。

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引用次数: 0

International Society of Antimicrobial Chemotherapy (ISAC) News and Information Page 国际抗菌化疗学会 (ISAC) 新闻和信息页面

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-09-01 DOI: 10.1016/j.jgar.2024.07.011

引用次数: 0

Virological impact of HIV drug-resistance testing in children, adolescents, and adults failing first-line ART in Tanzania 坦桑尼亚一线抗逆转录病毒疗法失败的儿童、青少年和成人中艾滋病毒耐药性检测的病毒学影响。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-08-27 DOI: 10.1016/j.jgar.2024.07.018

Background

Prospective data on the effectiveness of resistance testing in informing treatment decisions and outcomes in with first-line failure in these settings is limited. This study aimed to assess the virological impact of HIV drug-resistance testing in patients with virological failure in Tanzania.

Methods

Participants were randomly assigned to either the control or the experimental group. In addition to the standard of care, patients in the experimental group had access to genotypic drug-resistance testing, information used during treatment change and were followed up at six-and 12-months to determine virological suppression.

Results

A total of 261 patients with a median age of 32 (14.7–44.7) years were enrolled. In the intention-to-treat analysis, at 6-months, suppression was achieved in 58 (42.3%; 95% CI, 34.1–50.1) experimental group patients versus 51 (41.1%; 95% CI, 32.5–49.8) control group patients, with a p-value of 0.4. At-12 months, suppression was achieved in 110 (80.3%; 95% CI, 73.6–87) experimental patients versus 99 (79.8%; 95% CI, 72.8–86.9) control patients, with a P-value of 0.5. In the per-protocol analysis, at 6-months, suppression was observed in 38.46% (95% CI, 27.6–49.3) experimental patients versus 38.6% (95% CI, 26.0–51.2) control patients, with a P-value of 0.5. At 12-months, suppression was observed in 79.49% (95% CI, 70.5–88.5) of experimental patients versus 75.44% (95% CI, 64.3–86.6) of control patients, with a P-value of 0.3.

Conclusion

Conducting HIV drug-resistance testing, and switch to individualised second-line regimens did not significantly improve virological suppression in patients experiencing first-line ART failure in Tanzania.

背景：有关耐药性检测对一线治疗失败患者的治疗决策和治疗效果的影响的前瞻性数据十分有限。这项研究旨在评估耐药性检测对坦桑尼亚病毒学治疗失败患者的病毒学影响：方法：参与者被随机分配到对照组或实验组。除了接受标准治疗外，实验组患者还可接受基因型耐药性检测，这些信息用于更换治疗方案，并在6个月和12个月后接受随访，以确定病毒学抑制情况：共有 261 名患者入组，中位年龄为 32（14.7-44.7）岁。在意向治疗分析中，6 个月时，58 例（42.3%；95% CI，34.1-50.1）实验组患者达到病毒抑制，51 例（41.1%；95% CI，32.5-49.8）对照组患者达到病毒抑制，P 值为 0.4。在 12 个月时，110 名实验组患者（80.3%；95% CI，73.6-87）与 99 名对照组患者（79.8%；95% CI，72.8-86.9）实现了抑制，P 值为 0.5。在按协议分析中，6 个月时，实验组患者的抑制率为 38.46%（95% CI，27.6-49.3），对照组患者的抑制率为 38.6%（95% CI，26.0-51.2），P 值为 0.5。12 个月后，79.49%（95% CI，70.5-88.5）的实验患者与 75.44%（95% CI，64.3-86.6）的对照组患者相比，P 值为 0.3：在坦桑尼亚，对一线抗逆转录病毒疗法失败的患者进行艾滋病耐药性检测并转用个性化的二线治疗方案，并不能显著提高病毒抑制率。

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引用次数: 0

Shotgun metagenomic analysis reveals the emergence of plasmid-encoded mcr-5.1 gene in hospital wastewater in Bangladesh 射枪元基因组分析发现孟加拉国医院废水中出现了质粒编码的 mcr-5.1 基因。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-08-27 DOI: 10.1016/j.jgar.2024.08.007

Colistin is considered the last line therapy for treating multidrug-resistant (MDR) bacterial infections in humans. Therefore, the spread of colistin resistance poses a serious threat to human, and environmental health. Though Bangladesh is known as a hotspot of AMR, limited studies have been carried out regarding the status of colistin resistance. Information on the emerging bacterial resistance is inevitable for protecting public health. Nowadays, wastewater analysis has been prioritized for metagenomics-enabled AMR surveillance. Our study on the metagenomic analysis of untreated hospital effluents first detected the colistin resistance-conferring mcr-5.1 gene in the hospital environment of Bangladesh. Phylogenetic tree and in silico AMR analysis confirmed the detection of this mcr-5 variant, which is located in a plasmid contig. The plasmid was untypeable and belonged to the bacteria from the Enterobacteriaceae family. The mcr-5.1 operon was embedded in a Tn3 transposon, suggesting the mobility of the gene. Tnshfr1 transposon, chromate resistance protein ChrB, DNA invertase hin, and two MFS-type proteins were present in the genetic environment of mcr-5.1. Our findings provide evidence of the occurrence of mcr-5.1 in a hospital environment in Bangladesh, which calls for immediate attention and effective measures to contain the dissemination of colistin resistance in the environment.

可乐定被认为是治疗人类耐多药（MDR）细菌感染的最后一种疗法。因此，可乐定耐药性的传播对人类和环境健康构成严重威胁。尽管孟加拉国是众所周知的 AMR 热点国家，但有关可乐定耐药性状况的研究却十分有限。要保护公众健康，就必须了解新出现的细菌耐药性。如今，废水分析已被优先用于元基因组学的 AMR 监测。我们对未经处理的医院污水进行的元基因组分析研究首次在孟加拉国的医院环境中检测到了可乐定耐药性确认基因 mcr-5.1。系统发生树和默观 AMR 分析证实了这一 mcr-5 变异基因的检测结果，该基因位于一个质粒等位基因中。该质粒无法分型，属于肠杆菌科细菌。mcr-5.1 操作子嵌入了一个 Tn3 转座子，这表明该基因具有流动性。在 mcr-5.1 的遗传环境中存在 Tnshfr1 转座子、铬酸盐抗性蛋白 ChrB、DNA 转化酶 hin 和两种 MFS 型蛋白。我们的研究结果提供了孟加拉国医院环境中出现 mcr-5.1 的证据，因此需要立即关注并采取有效措施遏制环境中可乐定耐药性的传播。

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引用次数: 0

Systematic review and meta-analysis on antimicrobial resistance and drug resistance in Saudi Arabia 关于沙特阿拉伯抗菌药耐药性和抗药性的系统回顾和元分析。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-08-27 DOI: 10.1016/j.jgar.2024.07.013

Background

Antimicrobial resistance (AMR) and drug resistance have emerged as major global health concerns, threatening the effectiveness of antimicrobial agents and compromising patient outcomes [21]. The rapid spread of resistant pathogens poses significant challenges to healthcare systems worldwide, leading to increased morbidity, mortality, and healthcare costs [20].

Methods

Search Strategy

To find pertinent studies released up until September 2023, a thorough search was done in electronic databases like PubMed, Embase, and Scopus. The search method combined terms linked to Saudi Arabia, drug resistance, and antimicrobial resistance (AMR). The specific search terms and Boolean operators used were tailored to the requirements and functionalities of each database.

Results

The systematic review includes 25 papers in total, representing various Saudi Arabian healthcare environments and patient groups. The prevalence of AMR varied across different pathogens and antimicrobial agents. The most resistant Enterobacteriaceae were carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum -lactamase-producing Enterobacteriaceae (ESBL), and methicillin-resistant Staphylococcus aureus (MRSA). The full manuscript will report the pooled prevalence rates and 95% CIs for each resistance type. The rates for such bacteria were 38.7%, 26.4%, and 15.2% respectively suggesting an imminent need for improvement in surveillance measures & interventions to reduce the burden of AMR (Antimicrobial Resistance).

Conclusion

The prevalence of antibiotic resistance (AMR) is alarmingly high in Saudi Arabia. The aim of this study was to examine the prevalence of AMR across different types of pathogens and antimicrobial agents. A meta-analysis was conducted to quantify the pooled prevalence of each type of resistance across hospitals, environments, and food samples from Saudi Arabian locations. The study identified three types of resistance: carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum -lactamaseproducing Enterobacilli (ESBL), and methicillin-resistant Staphylococcus aureus (MRSA). Furthermore, the study identified several risk factors associated with AMR, including prior antibiotic use, healthcare-associated infections, and prolonged hospital stays.

这项对 25 项研究进行的荟萃分析表明，抗菌药耐药性（AMR）是沙特阿拉伯的一个严重问题。研究显示，MRSA、产生 ESBLs 的肠杆菌科细菌、耐碳青霉烯类的肠杆菌科细菌、铜绿假单胞菌和鲍曼不动杆菌的耐药性水平较高。这些细菌的耐药率分别为 38.7%、26.4% 和 15.2%，这表明迫切需要改进监控措施和干预措施，以减轻 AMR（抗菌药耐药性）的负担。在这方面，必须同时实施有效的感染控制计划和有针对性的全球政策，同时促进抗生素管理，以有效保护抗生素的疗效。此外，相关风险因素（包括之前使用抗生素药物、长期住院以及与医疗保健相关的感染）也增加了检出率，进一步凸显了这一迫切需要有关部门立即关注的问题。通过使用适当的统计程序收集的研究数据绘制了森林图，并显示了置信区间（CIs）。结论表明，实施更好的政策/控制建议，重点关注可实现的目标，可以提出旨在减少 AMR 的对策，确保及时进行适当的治疗，避免耐药微生物带来的潜在风险，同时适当保护抗生素的现有生命力。

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引用次数: 0

Escherichia coli novel sequence type 11873 harbours a new CTX-M-15–carrying multidrug resistance type 1/2 hybrid IncC plasmid 11873型大肠埃希菌新序列中携带一种新的CTX-M-15携带多重耐药1/2型杂交IncC质粒。

IF 3.7 3区医学 Q2 INFECTIOUS DISEASES

Journal of global antimicrobial resistance

Pub Date : 2024-08-26 DOI: 10.1016/j.jgar.2024.08.008

Objective

The aim of the current study was to determine the genomic map of the resistance genes of two CTX-M-15–carrying Escherichia coli strains belonging to novel sequence type (ST) 11873. Complete, closed genome sequences of the E. coli strains were obtained by applying a combination of short-read Illumina and long-read Oxford Nanopore-based sequencing.

Methods

Isolation of E. coli was performed using ECC CHROMagar and antibiotic sensitivity patterns were determined using Sensititre EUVSEC plates. Whole-genome sequencing was performed for two E. coli strains (3–338 and 5–325) using Illumina MiSeq- and Oxford Nanopore MinION-based sequencing.

Results

The complete genome of strain 3–338 (GenBank accession no. CP130007–17) was assembled into a circular chromosome of 4.65 Mb and 10 plasmids (between 2 and 148 kb). Strain 5–325 (CP130018–27) exhibited a circular chromosome of 4.7 Mb and 9 plasmids (between 2 and 148 kb). Both strains carried an identical type 1/2 hybrid IncC plasmid (∼148 kb) harbouring multiple antibiotic resistance genes (ARGs), including bla_CTX−M-15, bla_OXA-1, bla_TEM-1, qnrS1, sul2, aphA1, aacC2, mph(A) and floR. This plasmid also carried heavy metal resistance genes, such as chrA and arsR. Strain 5–325 carried an additional IncFIB plasmid (∼78 kb) harbouring additional ARGs, including bla_TEM-1, qnrS1, tet(A), dfrA14, sul2, strA and strB.

Conclusions

Our study shows the emergence of a CTX-M-15–carrying type 1/2 hybrid IncC plasmid in novel E. coli ST11873. These findings emphasise the need for population-based sewage surveillance for understanding the prevalence of antibiotic resistance in pathogens in order to mitigate the further spread of such resistance factors.

研究目的本研究旨在确定属于新型序列类型（ST）11873 的两株携带 CTX-M-15 的大肠埃希菌耐药基因的基因组图谱。大肠杆菌菌株的完整闭合基因组序列是通过基于短读程 Illumina 和长读程 Oxford Nanopore 的测序组合获得的：使用 ECC CHROMagar™ 进行大肠杆菌分离，并使用 Sensititre™ EUVSEC 平板确定抗生素敏感性模式。使用基于 Illumina MiSeq 和 Oxford Nanopore MinION 的测序技术对两株大肠杆菌（3-338 和 5-325）进行了全基因组测序：结果：菌株 3-338 的完整基因组（GenBank 编号：CP130007-17）被组装成一个 4.65 Mb 的环状染色体和 10 个质粒（2 kb 至 148 kb）。菌株 5-325（CP130018-27）的环状染色体为 4.7 Mb，有 9 个质粒（介于 2 kb 和 148 kb 之间）。两株菌株都携带有一个相同的 1/2 型杂交 IncC 质粒（148 kb），其中含有多个抗生素抗性基因（ARGs），包括 blaCTX-M-15、blaOXA-1、blaTEM-1、qnrS1、sul2、aphA1、aacC2、mph(A) 和 floR。该质粒还携带重金属抗性基因，如 chrA 和 arsR。菌株 5-325 还携带一个额外的 IncFIB 质粒（∼78 kb），该质粒还携带其他 ARGs，包括 blaTEM-1、qnrS1、tet(A)、dfrA14、sul2、strA 和 strB：我们的研究表明，在新型大肠杆菌 ST11873 中出现了携带 CTX-M-15 的 1/2 型混合 IncC 质粒。这些发现强调了以人群为基础进行污水监测的必要性，以了解病原体中抗生素耐药性的流行情况，从而减少此类耐药性因素的进一步扩散。

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