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Plasmid-mediated blaGES-24 in Acinetobacter nosocomialis: Genetic context and resistance profile 医院不动杆菌质粒介导的blaGES-24:遗传背景和耐药谱。
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-13 DOI: 10.1016/j.jgar.2025.10.003
Raita Yano , Shizuo Kayama , Masato Suzuki , Koji Yahara , Junzo Hisatsune , Liansheng Yu , Chika Arai , Taijiro Sueda , Shinya Takahashi , Yumiko Koba , Hiroki Ohge , Motoyuki Sugai

Objectives

A clinical isolate of Acinetobacter spp. MS5394 carrying a novel GES-type β-lactamase gene, blaGES-24, was first identified in 2013. This study aimed to characterize the genetic and phenotypic features of GES-24.

Methods

The complete genome of A. nosocomialis MS5394 was sequenced using Illumina MiSeq and Oxford Nanopore technologies. Plasmid pAC-GES-24 was analysed for resistance gene content and sequence. Site-directed mutagenesis was used to examine the functional role of amino acid substitutions at positions 62, 104, and 170 in GES-24. Antimicrobial susceptibility testing was performed in E. coli expressing different GES variants.

Results

The blaGES-24, is on a ∼153-kb plasmid pAC-GES-24. The complete nucleotide sequence of the pAC-GES-24 indicated that the backbone sequence was possibly a hybrid of two independent plasmids, pNDM-AP_882 and pOXA-588-AP_882, carrying blaNDM and blaOXA, respectively, from Acinetobacter pitti AP_882 isolated in Malaysia. A comparison of the amino acid sequence of GES-24 with that of highly homologous GES identified three amino acid differences at ambler positions 62, 104, and 170. Phenotypic investigation of E. coli producing GES-24 in comparison with E. coli producing GES variants at Ambler positions 62, 104, and 170 under isogenic conditions confirmed that GES-24 is a β-lactamase that possesses carbapenemase activity but is relatively weak in hydrolysing CTX, CAZ, AZT, and CFPM when compared to the other GES-type tested.

Conclusions

GES-24 represents a GES-type β-lactamase with carbapenemase activity but relatively weak hydrolytic activity against certain β-lactams. The genetic analysis suggests that the plasmid carrying blaGES-24 may have evolved from a hybrid plasmid.
目的:2013年首次发现一株携带新型ges型β-内酰胺酶基因blaGES-24的不动杆菌MS5394临床分离株。本研究旨在研究GES-24的遗传和表型特征。方法:采用Illumina MiSeq和Oxford Nanopore技术对医院蠓MS5394全基因组进行测序。质粒pAC-GES-24进行抗性基因含量和序列分析。利用定点诱变技术研究了GES-24中62、104和170位氨基酸取代的功能作用。对表达不同GES变异的大肠杆菌进行药敏试验。结果:blaGES-24位于约153 kb的质粒pAC-GES-24上。pAC-GES-24的全核苷酸序列表明,该主链序列可能是两个独立质粒pNDM-AP_882和pOXA-588-AP_882的杂交产物,这两个质粒分别携带马来西亚pitti不动杆菌AP_882的blaNDM和blaOXA。将GES-24的氨基酸序列与高度同源的GES进行比较,发现在第62位、104位和170位存在3个氨基酸差异。在等基因条件下,将产生GES-24的大肠杆菌与在Ambler位点62、104和170产生GES变体的大肠杆菌进行表型研究,证实GES-24是一种β-内酰胺酶,具有碳青霉烯酶活性,但与其他GES型相比,其水解CTX、CAZ、AZT和CFPM的能力相对较弱。结论:GES-24为ges型β-内酰胺酶,具有碳青霉烯酶活性,但对某些β-内酰胺的水解活性相对较弱。基因分析表明,携带blaGES-24的质粒可能是从一个杂交质粒进化而来的。
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引用次数: 0
96-week real-world effectiveness of bictegravir/emtricitabine/tenofovir alafenamide in HIV-infected adults with pre-existing NRTI resistance: A retrospective cohort study 比替替韦/恩曲他滨/替诺福韦阿拉那胺治疗已存在NRTI耐药的hiv感染成人的96周实际疗效:一项回顾性队列研究
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-11 DOI: 10.1016/j.jgar.2025.10.002
Laura Mezzogori , Marco Muccio , Riccardo Schiavoni , Lucia Taramasso , Filippo Giacomini , Bianca Bruzzone , Federica Stefanelli , Nadia Randazzo , Franco Maggiolo , Maurizio Zazzi , Matteo Bassetti , Antonio Di Biagio

Objectives

This study evaluated the impact of pre-existing resistance-associated mutations (RAMs) to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) on treatment outcomes in people living with HIV (PWH) receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in a real-world setting.

Methods

We conducted a single-centre, retrospective review of treatment-experienced adult PWH switched to B/F/TAF, comparing those with and without NRTI RAMs. The primary endpoint was virological success at week 96 (<50 HIV RNA copies/mL). Secondary endpoints were changes in absolute CD4+ counts and CD4+/CD8+ ratio. Continuous variables were analysed using the Wilcoxon rank sum test and categorical variables with the Chi-square or Fisher’s exact test. Longitudinal changes in absolute CD4+ counts and CD4+/CD8+ ratio were assessed using linear mixed-effects models, accounting for repeated measurements over time.

Results

A total of 257 PWH were included, of whom 21 were viraemic at the time of switch; 41 had pre-existing NRTI RAMs, while no RAMs were documented in the remaining 216 participants. At week 96, virological suppression was achieved in 100% of individuals with RAMs and 97.2% of those without NRTI RAMs, respectively (P = ns). Absolute CD4+ counts increased in 44.4% of participants, with no significant impact of NRTI RAMs. The CD4+/CD8+ ratio showed an apparent increase of more than 50% in 73.2% and 62.0% of participants with and without NRTI RAMs, respectively. However, longitudinal trend analysis revealed a significant negative rate of change in both groups, which was less pronounced among participants with RAMs.

Conclusions

B/F/TAF is an effective treatment option for PWH with NRTI RAMs.
目的:本研究评估了核苷/核苷酸逆转录酶抑制剂(NRTIs)预先存在的耐药相关突变(RAMs)对接受比替替韦/恩曲他滨/替诺福韦阿拉那胺(B/F/TAF)治疗的HIV感染者(PWH)治疗结果的影响。方法:我们进行了一项单中心回顾性研究,将治疗经验的成人PWH转换为B/F/TAF,比较使用和不使用NRTI RAMs的患者。主要终点是第96周的病毒学成功(结果:共纳入257名PWH,其中21人在转换时是病毒携带者,41人已有NRTI RAMs,而其余216名参与者没有记录RAMs。在第96周,100%的非NRTI羊鼠和97.2%的非NRTI羊鼠的病毒学抑制分别达到了100%和97.2% (p=ns)。绝对CD4+计数增加了44.4%的参与者,NRTI RAMs没有显著影响。CD4+/CD8+比值在有NRTI RAMs和没有NRTI RAMs的受试者中分别有73.2%和62.0%的人明显升高50%以上。然而,纵向趋势分析显示,两组都有显著的负变化率,这在RAMs参与者中不太明显。结论:B/F/TAF是NRTI RAMs合并PWH的有效治疗方案。
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引用次数: 0
Emergence of ST23-K1 blaKPC-3-positive hypervirulent carbapenem-resistant Klebsiella pneumoniae from China: A molecular, biological, and epidemiological study 来自中国的ST23-K1 blakpc -3阳性高毒力耐碳青霉烯肺炎克雷伯菌的出现:分子、生物学和流行病学研究
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-10 DOI: 10.1016/j.jgar.2025.09.007
Ling Xin, Jing Wang, Cong Qin, Yi Sun, Hongwei Zhou, Rong Zhang, Gongxiang Chen

Objective

A highly virulent Klebsiella pneumoniae ST23-K1 carrying blaKPC-3, named as Kpn_24-5, was identified in the blood samples of a patient with multiple complications. We investigated the transfer and pathogenic mechanism of this strain, and elucidated the epidemiological situation of the strain.

Methods

A blaKPC-3-positive ST23-K1 K. pneumoniae was isolated. Antimicrobial susceptibility test and whole genome sequencing were used to study the phenotypes and genotypes of the strain. The transmission and pathogenic mechanism were investigated by means of conjugation transfer test, neutrophil killing test, and serum inhibition test.

Results

The Kpn_24-5 strain was ST23 sequence type and K64:O1 capsular serotype, which contains four plasmids. Plasmid 1 carries several virulence genes, belonging to the same clade as K. pneumoniae plasmid isolated from the USA in 2023. Plasmid 2 is an anti-plasmid containing blaKPC-3 carbapenem resistance gene, belonging to the same clade as K. pneumoniae plasmid isolated from China in 2024. The genetic characteristics of plasmids indicated that the genetic environment of blaKPC-3 in plasmid 2 of Kpn_24-5 strain was IS26-ISKpn27-blaKPC-3-Tn21. The resistance plasmid 2 of Kpn_24-5 strain was transferable. The Kpn_24-5 strain has higher tolerance to neutrophils, is not easily inhibited by serum, and has significantly higher infectivity.

Conclusions

The present study corroborates the emergence of hypervirulent CR-hvKP in the Zhejiang region, a phenomenon that is presumably attributable to the acquisition of an IncFIB virulence plasmid and a blaKPC-3 resistance plasmid by the ST23-K1 type K. pneumoniae. Our findings highlight the urgent need to use antibiotics more wisely to limit the emergence of resistance.
目的:在一例多发性并发症患者的血液样本中发现一株携带blaKPC-3的高毒力肺炎克雷伯菌ST23-K1,命名为Kpn_24-5。研究了该菌株的转移和致病机制,并阐明了该菌株的流行病学情况。方法:分离一株blakpc -3阳性的ST23-K1肺炎克雷伯菌。采用药敏试验和全基因组测序对该菌株进行表型和基因型研究。通过偶联转移试验、嗜中性粒细胞杀伤试验和血清抑制试验,探讨其传播和致病机制。结果:Kpn_24-5菌株为ST23血清型,含K1胶囊,包含4个质粒。质粒1携带多个毒力基因,与2023年从美国分离的肺炎克雷伯菌质粒属于同一进化支。质粒2为含有blaKPC-3碳青霉烯类耐药基因的抗质粒,与2024年从中国分离到的肺炎克雷伯菌质粒属同一支。质粒遗传特征表明,菌株Kpn_24-5质粒2中blaKPC-3的遗传环境为IS26-ISKpn27-blaKPC-3-Tn21。Kpn_24-5菌株的抗性质粒2具有可转移性。Kpn_24-5菌株对中性粒细胞有较高的耐受性,不易被血清抑制,具有明显较高的传染性。结论:本研究证实了高毒力CR-hvKP在浙江地区的出现,这一现象可能是由于ST23-K1型肺炎克雷伯菌获得了IncFIB毒力质粒和blaKPC-3抗性质粒。我们的发现强调了迫切需要更明智地使用抗生素来限制耐药性的出现。
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引用次数: 0
30-d mortality risk factors in paediatric patients with bloodstream infection due to Enterobacterales: A retrospective observational cohort study 肠杆菌所致血流感染患儿30天死亡率危险因素:一项回顾性观察队列研究
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-10 DOI: 10.1016/j.jgar.2025.09.014
Ojeda-Diezbarroso Karla , Jimenez-Juarez Rodolfo Norberto , Avilés-Robles Martha , Laris-González Almudena , Bonilla-Pellegrini Sergio , Pichardo-Villalón Liliana , Castellanos-Cruz Carmen

Objective

Data on paediatric bloodstream infection (BSI) in low- and middle-income countries remain scarce. Consequently, this study aims to elucidate the risk factors associated with mortality in paediatric patients with enterobacterial BSIs.

Methods

This was a retrospective analysis of patients with bloodstream infection due to Enterobacterales attended at Hospital Infantil de Mexico during 2013–2019. Factors influencing mortality were assessed. The baseline characteristics of the population, bloodstream infection and antimicrobial treatment were compared between survivors and non-survivors as well.

Results

Of 527 cases of BSIs, 63.6% (n = 335) were caused by Enterobacterales and 307 cases were included. The overall mortality rate was 11.1% (n = 34). In the multivariable regression model, septic shock/multiorgan failure (HR 9.69, 95% CI: 3.28–28.63), and empirical treatment failure (HR 3.4, 95% CI: 1.36–8.45) were associated with an increased mortality risk.

Conclusions

in this study, the mortality in paediatric BSIs was driven by severe clinical presentation and failure to control inflammatory response and infection. Improving outcomes requires proactive measures, including early detection of sepsis by caregivers, education of healthcare providers for timely recognition and treatment, vigilant monitoring of systemic inflammatory response with adaptable therapeutic approaches and reinforcement of antimicrobial stewardship programs.
目的:关于低收入和中等收入国家儿童血液感染(BSI)的数据仍然很少。因此,本研究旨在阐明与肠杆菌性脑损伤患儿死亡率相关的危险因素。方法:回顾性分析2013-2019年在墨西哥婴儿医院就诊的肠杆菌血流感染患者。评估影响死亡率的因素。在幸存者和非幸存者之间比较了人群、血液感染和抗菌治疗的基线特征。结果:527例bsi中,肠杆菌引起的占63.6%(335例),共307例。总死亡率为11.1% (n=34)。在多变量回归模型中,感染性休克/多器官衰竭(HR 9.69, 95% CI: 3.28-28.63)和经验性治疗失败(HR 3.4, 95% CI: 1.36-8.45)与死亡风险增加相关。结论:在本研究中,儿童脑损伤的死亡率是由严重的临床表现和未能控制炎症反应和感染引起的。改善结果需要采取积极的措施,包括护理人员早期发现败血症,教育医疗保健提供者及时识别和治疗,使用适应性治疗方法对全身炎症反应进行警惕监测,并加强抗菌药物管理计划。
{"title":"30-d mortality risk factors in paediatric patients with bloodstream infection due to Enterobacterales: A retrospective observational cohort study","authors":"Ojeda-Diezbarroso Karla ,&nbsp;Jimenez-Juarez Rodolfo Norberto ,&nbsp;Avilés-Robles Martha ,&nbsp;Laris-González Almudena ,&nbsp;Bonilla-Pellegrini Sergio ,&nbsp;Pichardo-Villalón Liliana ,&nbsp;Castellanos-Cruz Carmen","doi":"10.1016/j.jgar.2025.09.014","DOIUrl":"10.1016/j.jgar.2025.09.014","url":null,"abstract":"<div><h3>Objective</h3><div>Data on paediatric bloodstream infection (BSI) in low- and middle-income countries remain scarce. Consequently, this study aims to elucidate the risk factors associated with mortality in paediatric patients with enterobacterial BSIs.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients with bloodstream infection due to Enterobacterales attended at Hospital Infantil de Mexico during 2013–2019. Factors influencing mortality were assessed. The baseline characteristics of the population, bloodstream infection and antimicrobial treatment were compared between survivors and non-survivors as well.</div></div><div><h3>Results</h3><div>Of 527 cases of BSIs, 63.6% (n = 335) were caused by Enterobacterales and 307 cases were included. The overall mortality rate was 11.1% (n = 34). In the multivariable regression model, septic shock/multiorgan failure (HR 9.69, 95% CI: 3.28–28.63), and empirical treatment failure (HR 3.4, 95% CI: 1.36–8.45) were associated with an increased mortality risk.</div></div><div><h3>Conclusions</h3><div>in this study, the mortality in paediatric BSIs was driven by severe clinical presentation and failure to control inflammatory response and infection. Improving outcomes requires proactive measures, including early detection of sepsis by caregivers, education of healthcare providers for timely recognition and treatment, vigilant monitoring of systemic inflammatory response with adaptable therapeutic approaches and reinforcement of antimicrobial stewardship programs.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 299-304"},"PeriodicalIF":3.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Detection of zoonotic Coxiella burnetii causing chronic Q fever endocarditis in a Chinese geriatric patient by mNGS mNGS检测中国老年人慢性Q热心内膜炎的人畜共患伯纳蒂克希菌。
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-06 DOI: 10.1016/j.jgar.2025.09.015
Hui Wang , Jie Sheng , Ying Zhang , Hao Lan , Xiaofeng Lu , Xi Li , Xiaofei Zhao

Objective

Q (query) fever, caused by Coxiella burnetii, is often linked to negative bacterial cultures, with infective endocarditis with negative cultures difficult to diagnose and treat. Our case demonstrates that metagenomic next-generation sequencing (mNGS) is able to provide a rapid and accurate method for pathogenetic diagnosis in infectious diseases.

Case presentation

A case of infective endocarditis with negative blood cultures is reported in a male patient with a history of sheep farming and previous aortic valve replacement and atrial septal defect atrial septal defect repair. Blood tests showed positive serum immunofluorescent antibodies to Rickettsia, while mNGS of perivalvular abscess tissue suggested C. burnetii. Doxycycline 0.1 g q12h and hydroxychloroquine 0.2 g q12h were used for postoperative antibiotic treatment. The genome of C. burnetii C2245173Z was assembled on the Illumina platform and no known antibiotic resistance genes were detected. Phylogenetic analysis of the C. burnetii genome showed a genetic relationship between animal- and human-derived strains.

Conclusions

mNGS could provide a rapid and accurate assay for clinical diagnosis and play a decisive role in the pathogenetic diagnosis of some infectious diseases. Doxycycline plus hydroxychloroquine remains an effective treatment for chronic Q fever endocarditis. In addition, phylogenetic tree analysis indicates that C. burnetii infection may pose a potential risk to humans working with livestock.
目的:由伯纳氏克希菌引起的发热通常与阴性细菌培养有关。阴性培养的感染性心内膜炎很难诊断和治疗。我们的案例表明,新一代宏基因组测序(mNGS)可以为传染病的病理诊断提供快速准确的方法。病例介绍:我们报告了一例感染性心内膜炎伴阴性血培养的男性患者,有养羊史,有主动脉瓣置换术(AVT)和房间隔缺损(ASD)修复史。血液检查显示血清立克次体免疫荧光抗体阳性,而瓣膜周围脓肿组织的mNGS提示伯氏原体感染。术后应用强力霉素0.1 g q12h、羟氯喹0.2 g q12h给予抗生素治疗。在Illumina平台上组装burnetii C2245173Z基因组,未检测到已知的抗生素耐药基因。伯纳蒂胞杆菌基因组的系统发育分析显示动物源性菌株和人源性菌株之间存在遗传关系。结论:应用mNGS可为临床诊断提供快速、准确的检测方法,在某些感染性疾病的发病诊断中具有决定性作用。强力霉素加羟氯喹仍然是治疗慢性Q热心内膜炎的有效方法。此外,系统发育树分析表明,伯纳蒂胞杆菌感染可能对与牲畜一起工作的人构成潜在风险。
{"title":"Detection of zoonotic Coxiella burnetii causing chronic Q fever endocarditis in a Chinese geriatric patient by mNGS","authors":"Hui Wang ,&nbsp;Jie Sheng ,&nbsp;Ying Zhang ,&nbsp;Hao Lan ,&nbsp;Xiaofeng Lu ,&nbsp;Xi Li ,&nbsp;Xiaofei Zhao","doi":"10.1016/j.jgar.2025.09.015","DOIUrl":"10.1016/j.jgar.2025.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>Q (query) fever, caused by <em>Coxiella burnetii</em>, is often linked to negative bacterial cultures, with infective endocarditis with negative cultures difficult to diagnose and treat. Our case demonstrates that metagenomic next-generation sequencing (mNGS) is able to provide a rapid and accurate method for pathogenetic diagnosis in infectious diseases.</div></div><div><h3>Case presentation</h3><div>A case of infective endocarditis with negative blood cultures is reported in a male patient with a history of sheep farming and previous aortic valve replacement and atrial septal defect atrial septal defect repair. Blood tests showed positive serum immunofluorescent antibodies to <em>Rickettsia</em>, while mNGS of perivalvular abscess tissue suggested <em>C. burnetii</em>. Doxycycline 0.1 g q12h and hydroxychloroquine 0.2 g q12h were used for postoperative antibiotic treatment. The genome of <em>C. burnetii</em> C2245173Z was assembled on the Illumina platform and no known antibiotic resistance genes were detected. Phylogenetic analysis of the <em>C. burnetii</em> genome showed a genetic relationship between animal- and human-derived strains.</div></div><div><h3>Conclusions</h3><div>mNGS could provide a rapid and accurate assay for clinical diagnosis and play a decisive role in the pathogenetic diagnosis of some infectious diseases. Doxycycline plus hydroxychloroquine remains an effective treatment for chronic Q fever endocarditis. In addition, phylogenetic tree analysis indicates that <em>C. burnetii</em> infection may pose a potential risk to humans working with livestock.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 192-195"},"PeriodicalIF":3.2,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Epidemiological and genetic profiles of ceftazidime/avibactam-resistant Klebsiella pneumoniae conferred by KPC variants in a tertiary hospital in China 中国某三级医院KPC变异致头孢他啶/阿维巴坦耐药肺炎克雷伯菌的流行病学和遗传特征
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-10-03 DOI: 10.1016/j.jgar.2025.09.013
Min Xu , Xiaofen Mo , Yuchao Zhang , Huinan Xia , Huiqiong Jia , Haishen Kong , Qixia Luo , Yiqi Fu

Objective

The emergence of Klebsiella pneumoniae carbapenemase variants (KPCVs), conferring resistance to ceftazidime/avibactam (CAZ/AVI), represents a critical clinical challenge. However, investigations into KPCV-producing K. pneumoniae (KPCV-Kp) are confined to sporadic clinical cases.

Methods

Clinical isolates of KPCV-Kp exhibiting resistance to CAZ/AVI were collected from a Chinese tertiary hospital from February 2015 to March 2024. The clinical characteristics, antimicrobial susceptibility, molecular epidemiology and genetic phylogeny were subjected to analysis.

Results

A total of 25 KPCV-Kp strains displaying high-level resistance to CAZ/AVI were identified, with their initial isolation in 2018 and the majority obtained in 2023 (64.0%, 16/25). All patients except one had prior CAZ/AVI exposure for 3 to 38 days. Twelve KPCVs, including four novel variants (designated as KPC-219 to KPC-222), were identified. KPC-33 predominated (40.0%, 10/25), followed by KPC-71 (12.0%, 3/25), KPC-14, and KPC-90 (8.0%, 2/25 for each). Notably, 50.0% (6/12) of the KPCVs exhibited multiple mutations in the Ω-loop as well as in other regions, which were associated with a significantly longer CAZ/AVI exposure (P = 0.033). Molecular analysis highlighted the circulation of ST11-KL64 clone (72.0%, 18/25), followed by ST11-KL47 and ST11-KL25 clones (12.0%, 3/25 for each). Phylogenetic analysis revealed no epidemiological linkage between cases, and the KPCV-Kp evolved from their individual parental KPC-2-producing strains.

Conclusions

Our study provided a preliminary glimpse into the epidemiology and genetic characteristics of KPCV-Kp in China, underscoring the critical need for continuous monitoring in patients treated with CAZ/AVI, even in short-term therapy, to better grasp the evolving threat posed by these variants.
目的:肺炎克雷伯菌碳青霉烯酶变异(KPCVs)的出现,赋予了对头孢他啶/阿维巴坦(CAZ/AVI)的耐药性,这是一个关键的临床挑战。然而,对产生kpcv的肺炎克雷伯菌(KPCV-Kp)的调查仅限于散发的临床病例。方法:收集2015年2月至2024年3月在某三级医院临床分离的对CAZ/AVI耐药的KPCV-Kp。对其临床特征、药敏、分子流行病学及遗传系统发育进行分析。结果:共鉴定出25株对CAZ/AVI高水平耐药的KPCV-Kp菌株,首次分离于2018年,大部分在2023年获得(64.0%,16/25)。除1名患者外,所有患者均有3至38天的CAZ/AVI暴露史。鉴定出12种kpcv,包括4种新的变种(指定为KPC-219到KPC-222)。KPC-33占多数(40.0%,10/25),其次是KPC-71(12.0%, 3/25)、KPC-14和KPC-90(8.0%, 2/25)。值得注意的是,50.0%(6/12)的kpcv在Ω-loop和其他区域表现出多重突变,这与较长的CAZ/AVI暴露有关(P = 0.033)。分子分析显示,ST11-KL64克隆的循环率最高(72.0%,18/25),其次是ST11-KL47和ST11-KL25克隆(12.0%,3/25)。系统发育分析显示,病例之间无流行病学联系,KPCV-Kp是从个体亲本产kpc2菌株进化而来的。结论:我们的研究为中国KPCV-Kp的流行病学和遗传特征提供了初步的了解,强调了对CAZ/AVI患者进行持续监测(即使是短期治疗)的迫切需要,以更好地掌握这些变异带来的不断变化的威胁。
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引用次数: 0
Molecular characterization and resistance mechanisms of linezolid-resistant enterococci clinical isolates and identification of a clinical Enterococcus faecium strain co-harboring optrA, poxtA, and cfr(D) in a tertiary hospital in China 国内某三级医院耐利奈唑胺肠球菌临床分离株的分子特征和耐药机制及一株共携带optrA、poxtA和cfr(D)的屎肠球菌临床菌株的鉴定
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-09-29 DOI: 10.1016/j.jgar.2025.09.008
Ni Suo , Jing Yu , Haijun Li , Nan Yi , Cailin Liu , Wanhai Wang

Objectives

The emergence of linezolid-resistant enterococci has become a significant global health concern. This study aimed to investigate the molecular characterization and resistance mechanisms in clinical isolates in a tertiary hospital in China.

Methods

The VITEK®2 Compact system, VITEK® MS, and whole-genome sequencing (WGS) were used to identify 59 linezolid-resistant enterococci isolates. Antimicrobial susceptibilities were assessed by broth microdilution. WGS and bioinformatics tools analyzed resistance mechanisms and molecular characteristics. Plasmid-borne linezolid resistance gene transfer was assessed via conjugation and transformation assays.

Results

We collected 59 linezolid-resistant enterococci isolates, including 54 Enterococcus faecalis and 5 Enterococcus faecium strains. One strain carried the poxtA gene, one isolate carried the G2576T mutation in the 23S rRNA gene, and 56 isolates harbored the optrA gene. Notably, one isolate co-harbored the optrA, poxtA, and cfr(D) genes. Twenty-three sequence types (STs) were identified. ST16 (48.1%, 26/54) predominated in E. faecalis. Multilocus sequence typing (MLST) and evolutionary analysis indicated that E. faecalis strains of the same ST were genetically related. Among the seven strains (two E. faecium and five E. faecalis strains) selected for further investigation, IS1216E was detected on plasmids carrying linezolid resistance genes in all five strains. Additionally, transposon Tn554 was detected on the chromosome of an optrA-carrying strain.

Conclusion

This study describes the molecular characteristics and resistance mechanisms of linezolid-resistant enterococci in our hospital, including a novel E. faecium isolate with optrA, poxtA, and cfr(D), highlighting the need for enhanced surveillance to control the dissemination of resistant strains.
目的:耐利奈唑胺肠球菌的出现已成为一个重大的全球卫生问题。本研究旨在了解国内某三级医院临床分离株的分子特征及耐药机制。方法:采用VITEK®2 Compact系统、VITEK®MS和全基因组测序(WGS)对59株耐利奈唑胺肠球菌进行鉴定。采用微量肉汤稀释法测定其抗菌敏感性。WGS和生物信息学工具分析了耐药机制和分子特征。通过偶联和转化试验评估质粒携带的利奈唑胺抗性基因转移。结果:共收集到耐利奈唑胺肠球菌59株,其中粪肠球菌54株,粪肠球菌5株。1株携带poxtA基因,1株携带23S rRNA基因G2576T突变,56株携带optrA基因。值得注意的是,一个分离物同时携带optrA、poxtA和cfr(D)基因。共鉴定出23种序列类型。粪伊蚊中以ST16型为主(48.1%,26/54)。多位点序列分型(MLST)和进化分析表明,同一株粪肠球菌具有遗传亲缘关系。在选择的7株菌株(2株粪肠杆菌和5株粪肠杆菌)中,5株菌株携带利奈唑胺耐药基因的质粒上均检测到IS1216E。此外,在携带optra的菌株的染色体上检测到转座子Tn554。结论:本研究描述了我院耐利奈唑胺肠球菌的分子特征和耐药机制,包括一株含有optrA、poxtA和cfr(D)的新型屎肠球菌,强调需要加强监测以控制耐药菌株的传播。
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引用次数: 0
Molecular characterization of blaVIM-2-carrying Pseudomonas asiatica L2126: identification of a ∼44 kb untypable plasmid with intra-genus dissemination potential 携带blavim -2的亚洲假单胞菌L2126的分子特性:鉴定一个具有属内传播潜力的~ 44 kb不可分质粒。
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-09-27 DOI: 10.1016/j.jgar.2025.09.012
Jinhua Zhang , Yi Liu , Lei Fang , Xinrui Wang , Hao Xu , Danfeng Lou

Objectives

This study aims to elucidate the molecular characteristics of a blaVIM-2-carrying Pseudomonas asiatica isolate (L2126) from China and to characterize a ∼44 kb untypable plasmid harboring blaVIM-2. We investigated the genetic context of blaVIM-2, assessed the associated antimicrobial resistance determinants, and explored the role of this plasmid in mediating gene dissemination.

Methods

The isolate L2126 was recovered from an intestinal colonization sample in a patient from Hangzhou, China. Species identification was confirmed by average nucleotide identity (ANI) analysis. Hybrid whole-genome sequencing was performed using Illumina short-read and Oxford Nanopore long-read platforms. Genome assembly was conducted using Unicycler and annotated with Prokka. Antimicrobial resistance genes were identified via ResFinder and CARD. The genetic context of blaVIM-2 was delineated using IntegronFinder. Plasmid profiles were determined by S1-nuclease pulsed-field gel electrophoresis (S1-PFGE) and in silico replicon analysis.

Results

L2126 exhibited a multidrug-resistant profile with high-level resistance to carbapenems, cephalosporins, and fluoroquinolones. Genome analysis revealed 7 resistance genes, including blaVIM-2 and sul1. Notably, blaVIM-2 resides within a class 1 integron (intI1-attI1-blaVIM-2-qacEΔ1-sul1) embedded in a Tn402-like platform on a ∼44 kb untypable plasmid. The adjacent tni module (tniR-tniQ-tniB-tniA) is encoded on the opposite strand, indicating that it is part of the transposition platform rather than the integron cassette array. S1-PFGE confirmed the presence of the ∼44 kb plasmid, and in silico analysis provided a schematic representation of its genetic organization. BLAST analysis demonstrated that this plasmid shares high sequence homology with a plasmid previously identified in Pseudomonas monteilii, despite the two isolates belonging to different species.

Conclusions

Our findings demonstrate that the carriage of blaVIM-2 on a novel ∼44 kb untypable plasmid in P. asiatica L2126 could facilitate horizontal gene transfer of carbapenem resistance. The plasmid’s high homology to one previously identified in P. monteilii suggests that it has the potential for intra-genus dissemination, posing a significant threat to the spread of carbapenem resistance.
目的:本研究旨在阐明来自中国的携带blaVIM-2的亚洲假单胞菌分离物(L2126)的分子特征,并对携带blaVIM-2的约44 kb不可分质粒进行表征。我们研究了blaVIM-2的遗传背景,评估了相关的抗菌素耐药性决定因素,并探讨了该质粒在介导基因传播中的作用。方法:从中国杭州1例患者的肠道定植样本中分离得到L2126。物种鉴定采用平均核苷酸同源性(ANI)分析。使用Illumina short-read和Oxford Nanopore long-read平台进行杂交全基因组测序。用Unicycler进行基因组组装,并用Prokka进行注释。通过ResFinder和CARD鉴定耐药基因。使用IntegronFinder描述blaVIM-2的遗传背景。质粒谱由s1 -核酸酶脉冲场凝胶电泳(S1-PFGE)和硅复制子分析确定。结果:L2126表现出多药耐药特征,对碳青霉烯类、头孢菌素和氟喹诺酮类药物具有高水平耐药。基因组分析发现7个抗性基因,包括blaVIM-2和sul1。值得注意的是,blaVIM-2位于1类整合子(intI1-attI1- blaVIM-2-qacEΔ1-sul1)内,该整合子嵌入在tn402样平台上的约44 kb不可分质粒上。相邻的tni模块(tniR-tniQ-tniB-tniA)编码在相反的链上,表明它是转置平台的一部分,而不是整合子盒式阵列的一部分。S1-PFGE证实了~ 44 kb质粒的存在,硅分析提供了其遗传组织的示意图。BLAST分析表明,该质粒与之前在蒙氏假单胞菌中鉴定出的一个质粒具有高度的序列同源性,尽管这两个菌株属于不同的物种。结论:我们的研究结果表明,在亚洲p.a L2126中,一种新的~ 44 kb不可分型质粒上携带blaVIM-2可以促进碳青霉烯类耐药性的水平基因转移。该质粒与先前在蒙泰利假体中发现的一个质粒高度同源,表明它具有属内传播的潜力,对碳青霉烯类耐药性的传播构成重大威胁。
{"title":"Molecular characterization of blaVIM-2-carrying Pseudomonas asiatica L2126: identification of a ∼44 kb untypable plasmid with intra-genus dissemination potential","authors":"Jinhua Zhang ,&nbsp;Yi Liu ,&nbsp;Lei Fang ,&nbsp;Xinrui Wang ,&nbsp;Hao Xu ,&nbsp;Danfeng Lou","doi":"10.1016/j.jgar.2025.09.012","DOIUrl":"10.1016/j.jgar.2025.09.012","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to elucidate the molecular characteristics of a <em>bla</em><sub>VIM-2</sub>-carrying <em>Pseudomonas asiatica</em> isolate (L2126) from China and to characterize a ∼44 kb untypable plasmid harboring <em>bla</em><sub>VIM-2</sub>. We investigated the genetic context of <em>bla</em><sub>VIM-2</sub>, assessed the associated antimicrobial resistance determinants, and explored the role of this plasmid in mediating gene dissemination.</div></div><div><h3>Methods</h3><div>The isolate L2126 was recovered from an intestinal colonization sample in a patient from Hangzhou, China. Species identification was confirmed by average nucleotide identity (ANI) analysis. Hybrid whole-genome sequencing was performed using Illumina short-read and Oxford Nanopore long-read platforms. Genome assembly was conducted using Unicycler and annotated with Prokka. Antimicrobial resistance genes were identified via ResFinder and CARD. The genetic context of <em>bla</em><sub>VIM-2</sub> was delineated using IntegronFinder. Plasmid profiles were determined by S1-nuclease pulsed-field gel electrophoresis (S1-PFGE) and <em>in silico</em> replicon analysis.</div></div><div><h3>Results</h3><div>L2126 exhibited a multidrug-resistant profile with high-level resistance to carbapenems, cephalosporins, and fluoroquinolones. Genome analysis revealed 7 resistance genes, including <em>bla</em><sub>VIM-2</sub> and <em>sul1</em>. Notably, <em>bla</em><sub>VIM-2</sub> resides within a class 1 integron (<em>intI1-attI1-bla</em><sub>VIM-2</sub><em>-qacEΔ1-sul1</em>) embedded in a Tn<em>402</em>-like platform on a ∼44 kb untypable plasmid. The adjacent <em>tni</em> module (<em>tniR-tniQ-tniB-tniA</em>) is encoded on the opposite strand, indicating that it is part of the transposition platform rather than the integron cassette array. S1-PFGE confirmed the presence of the ∼44 kb plasmid, and <em>in silico</em> analysis provided a schematic representation of its genetic organization. BLAST analysis demonstrated that this plasmid shares high sequence homology with a plasmid previously identified in <em>Pseudomonas monteilii</em>, despite the two isolates belonging to different species.</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate that the carriage of <em>bla</em><sub>VIM-2</sub> on a novel ∼44 kb untypable plasmid in <em>P. asiatica</em> L2126 could facilitate horizontal gene transfer of carbapenem resistance. The plasmid’s high homology to one previously identified in <em>P. monteilii</em> suggests that it has the potential for intra-genus dissemination, posing a significant threat to the spread of carbapenem resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 173-175"},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The efficacy and safety of eravacycline in the treatment of patients with pneumonia in respiratory departments: A real-world multicenter retrospective study 依拉瓦环素治疗呼吸内科肺炎患者的有效性和安全性:一项真实世界的多中心回顾性研究。
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-09-27 DOI: 10.1016/j.jgar.2025.09.011
Zhengyu Luo , Li Zhang , Zhengyin Liu , Minya Lu , Yingchun Xu , Menglan Zhou

Introduction

Eravacycline (ERV), a novel fluorocycline antibiotic, demonstrates broad-spectrum activity against multidrug-resistant (MDR) pathogens. This multicenter retrospective study evaluates the real-world clinical effectiveness of ERV in treating various infections of the patients hospitalized in the respiratory departments.

Methods

We analyzed 113 adult patients treated with ERV from respiratory departments in China, examining antimicrobial susceptibility profiles and serial laboratory parameters during therapy. Microbiological and clinical outcomes were systematically evaluated at treatment completion and 30-day follow-up. Subgroup analyses focused on Acinetobacter baumannii and Klebsiella pneumoniae infections.

Results

ERV exhibited 87.6% clinical efficacy and 85.8% microbiological eradication rate, accompanied by an 85.0% 30-day survival rate. The antibiotic maintained robust activity against MDR pathogens, particularly A. baumannii (n = 51) and K. pneumoniae (n = 27). Adverse events occurred in only 1.8% (2/113) of cases. Clinical outcomes showed no statistically significant differences between monotherapy (n = 70) and combination regimens (n = 43).

Conclusion

This real-world evidence confirms ERV as an effective and well-tolerated therapeutic option for managing patients in the respiratory departments, particularly those caused by MDR Gram-negative pathogens. The comparable efficacy of monotherapy and combination approaches warrants further investigation.
Eravacycline (ERV)是一种新型的氟环类抗生素,对多重耐药(MDR)病原体具有广谱活性。本多中心回顾性研究评估了ERV治疗呼吸内科住院患者各种感染的实际临床效果。方法:我们分析了来自中国呼吸科的113例ERV治疗的成人患者,检查了治疗期间的抗菌药物敏感性和一系列实验室参数。在治疗完成和30天随访时系统评估微生物学和临床结果。亚组分析主要集中在鲍曼不动杆菌和肺炎克雷伯菌感染。结果:ERV的临床疗效为87.6%,微生物根除率为85.8%,30天生存率为85.0%。该抗生素对耐多药病原菌,特别是鲍曼芽胞杆菌( = 51)和肺炎克雷伯菌( = 27)保持强劲的活性。不良事件发生率仅为1.8%(2/113)。临床结果显示,单药治疗(n = 70)和联合治疗(n = 43)之间无统计学差异。结论:这一真实世界的证据证实了ERV是一种有效且耐受性良好的治疗选择,可用于管理呼吸内科患者,特别是那些由耐多药革兰氏阴性病原体引起的患者。单药治疗和联合治疗的可比疗效值得进一步研究。
{"title":"The efficacy and safety of eravacycline in the treatment of patients with pneumonia in respiratory departments: A real-world multicenter retrospective study","authors":"Zhengyu Luo ,&nbsp;Li Zhang ,&nbsp;Zhengyin Liu ,&nbsp;Minya Lu ,&nbsp;Yingchun Xu ,&nbsp;Menglan Zhou","doi":"10.1016/j.jgar.2025.09.011","DOIUrl":"10.1016/j.jgar.2025.09.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Eravacycline (ERV), a novel fluorocycline antibiotic, demonstrates broad-spectrum activity against multidrug-resistant (MDR) pathogens. This multicenter retrospective study evaluates the real-world clinical effectiveness of ERV in treating various infections of the patients hospitalized in the respiratory departments.</div></div><div><h3>Methods</h3><div>We analyzed 113 adult patients treated with ERV from respiratory departments in China, examining antimicrobial susceptibility profiles and serial laboratory parameters during therapy. Microbiological and clinical outcomes were systematically evaluated at treatment completion and 30-day follow-up. Subgroup analyses focused on <em>Acinetobacter baumannii</em> and <em>Klebsiella pneumoniae</em> infections.</div></div><div><h3>Results</h3><div>ERV exhibited 87.6% clinical efficacy and 85.8% microbiological eradication rate, accompanied by an 85.0% 30-day survival rate. The antibiotic maintained robust activity against MDR pathogens, particularly <em>A. baumannii</em> (<em>n</em> = 51) and <em>K. pneumoniae</em> (<em>n</em> = 27). Adverse events occurred in only 1.8% (2/113) of cases. Clinical outcomes showed no statistically significant differences between monotherapy (<em>n</em> = 70) and combination regimens (<em>n</em> = 43).</div></div><div><h3>Conclusion</h3><div>This real-world evidence confirms ERV as an effective and well-tolerated therapeutic option for managing patients in the respiratory departments, particularly those caused by MDR Gram-negative pathogens. The comparable efficacy of monotherapy and combination approaches warrants further investigation.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 196-201"},"PeriodicalIF":3.2,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Metronidazole and Giardia: In vitro viability assay under microaerobic conditions indicates a multifactorial basis for metronidazole treatment failure 甲硝唑和贾第鞭毛虫:微氧条件下的体外活力测定表明甲硝唑治疗失败的多因素基础。
IF 3.2 3区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2025-09-25 DOI: 10.1016/j.jgar.2025.09.010
Eva Nohynkova, Aneta Perglerova, Vlasta Korenkova, Pavla Tumova

Objectives

Giardiasis, a worldwide intestinal infection caused by the protozoan parasite Giardia intestinalis, is treatable with metronidazole (MTZ). However, MTZ-refractory giardiasis is common. It remains unclear, however, whether MTZ-resistant pathogens cause treatment failure because the natural resistance of Giardia to MTZ has not yet been demonstrated.

Methods

We developed a simple 24 h viability assay to assess the MTZ sensitivity of Giardia parasites in vitro under two atmospheric conditions, microaerobic and anaerobic. The results of the assay were statistically evaluated.

Results

We tested 18 clinical isolates. Based on the minimum lethal concentration (MLC), hierarchical cluster analysis separated the isolates into three categories: sensitive, intermediate resistant, and resistant. The resistant cluster consisted of two isolates with an MLC of 400 µg/mL MTZ, which exhibited natural MTZ resistance. Interestingly, this resistance was only manifested under microaerobic conditions. The effect of oxygen on the in vitro drug response was evident in the greater variability of MLC values among the other isolates. Two in vitro-resistant isolates originated from patients with MTZ-refractory giardiasis, suggesting that parasite resistance likely contributes to treatment failure. However, two additional isolates from patients with MTZ-refractory giardiasis showed in vitro susceptibility under both test conditions. This indicates that treatment failure in giardiasis likely stems from multiple factors.

Conclusions

Our study highlights the critical importance of oxygen concentration during assessment of Giardia parasite resistance to MTZ. However, it also indicates that MTZ-refractory giardiasis may result from reasons other than parasite resistance.
目的:贾第虫病是由原生寄生虫肠贾第虫引起的一种世界性的肠道感染,甲硝唑(MTZ)可以治疗。然而,mtz难治性贾第虫病很常见。然而,目前尚不清楚耐MTZ病原体是否导致治疗失败,因为贾第鞭毛虫对MTZ的自然耐药性尚未得到证实。方法:我们建立了一种简单的24小时活力测定法,以评估贾第鞭毛虫寄生虫在体外微氧和厌氧两种大气条件下对MTZ的敏感性。对测定结果进行统计学评价。结果:共分离18株临床分离株。基于最小致死浓度(MLC),分层聚类分析将分离物分为敏感、中间耐药和耐药3类。耐药簇由2株菌株组成,MTZ的MLC为400µg/ml,表现出天然的MTZ抗性。有趣的是,这种阻力仅在微氧条件下表现出来。氧对体外药物反应的影响在其他菌株的MLC值的较大差异中是明显的。两个体外耐药分离株来自mtz难治性贾第虫病患者,表明寄生虫耐药性可能导致治疗失败。然而,另外两株来自难治性鞭毛虫病患者的分离株在两种试验条件下均表现出体外敏感性。这表明贾第虫病的治疗失败可能是由多种因素造成的。结论:我们的研究强调了氧浓度在贾第虫对MTZ的耐药性评估中的关键重要性。然而,这也表明MTZ难治性贾第虫病可能是由寄生虫耐药性以外的其他原因引起的。
{"title":"Metronidazole and Giardia: In vitro viability assay under microaerobic conditions indicates a multifactorial basis for metronidazole treatment failure","authors":"Eva Nohynkova,&nbsp;Aneta Perglerova,&nbsp;Vlasta Korenkova,&nbsp;Pavla Tumova","doi":"10.1016/j.jgar.2025.09.010","DOIUrl":"10.1016/j.jgar.2025.09.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Giardiasis, a worldwide intestinal infection caused by the protozoan parasite <em>Giardia intestinalis</em>, is treatable with metronidazole (MTZ). However, MTZ-refractory giardiasis is common. It remains unclear, however, whether MTZ-resistant pathogens cause treatment failure because the natural resistance of <em>Giardia</em> to MTZ has not yet been demonstrated.</div></div><div><h3>Methods</h3><div>We developed a simple 24 h viability assay to assess the MTZ sensitivity of <em>Giardia</em> parasites in vitro under two atmospheric conditions, microaerobic and anaerobic. The results of the assay were statistically evaluated.</div></div><div><h3>Results</h3><div>We tested 18 clinical isolates. Based on the minimum lethal concentration (MLC), hierarchical cluster analysis separated the isolates into three categories: sensitive, intermediate resistant, and resistant. The resistant cluster consisted of two isolates with an MLC of 400 µg/mL MTZ, which exhibited natural MTZ resistance. Interestingly, this resistance was only manifested under microaerobic conditions. The effect of oxygen on the in vitro drug response was evident in the greater variability of MLC values among the other isolates. Two in vitro-resistant isolates originated from patients with MTZ-refractory giardiasis, suggesting that parasite resistance likely contributes to treatment failure. However, two additional isolates from patients with MTZ-refractory giardiasis showed in vitro susceptibility under both test conditions. This indicates that treatment failure in giardiasis likely stems from multiple factors.</div></div><div><h3>Conclusions</h3><div>Our study highlights the critical importance of oxygen concentration during assessment of <em>Giardia</em> parasite resistance to MTZ. However, it also indicates that MTZ-refractory giardiasis may result from reasons other than parasite resistance.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"45 ","pages":"Pages 157-163"},"PeriodicalIF":3.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of global antimicrobial resistance
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