2014 年至 2023 年乌克兰战争相关创伤伤口感染中细菌种类及其抗菌药耐药性特征的时间演变。

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC ACS Applied Electronic Materials Pub Date : 2024-07-10 DOI:10.1016/j.jhin.2024.06.011

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摘要

背景：本研究继续监测乌克兰与战伤有关的抗菌药耐药性：目的：比较 2014-2020 年和 2022-2023 年间的物种组成、抗生素耐药性概况以及新耐药基因的出现情况：方法：在乌克兰医院进行回顾性多中心微生物学调查。对 2022-2023 年间从 125 名伤员身上获得的 154 种微生物进行了抗生素敏感性、全基因组测序和 MLST 分型：数据显示革兰氏阴性菌占主导地位，尤其是鲍曼不动杆菌（35.7%）、铜绿假单胞菌（14.9%）和肺炎克雷伯菌（20.7%）。6%[（29/32）95% CI 75.0-98.0]，亚胺培南 81.2%[（26/32）95% CI 63.6-92.8]]）和铜绿假单胞菌（美罗培南 47.8%[（11/23）95% CI 26.8-69.4]，亚胺培南 60.8%[（14/23）95% CI 38.5-80.3]）菌株。鲍曼尼氏菌 ST-78 和 ST-400 在 2014 年至 2020 年期间流行，而新发现的 ST-1077 菌株有 5 株。铜绿假单胞菌菌株在 16 种序列类型（ST）中表现出多样性，ST-773 的频率增加，新的 ST 出现，但缺乏碳青霉烯酶基因。随着时间的推移，肺炎克雷伯菌的遗传多样性也在增加，2014年至2020年出现了3种ST，近年来又出现了6种新的ST，包括blaNDM-1、blaOXA-48和blaKPC2携带者：结论：来自全球分布的序列类型的耐多药分离株越来越普遍。

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Temporal evolution of bacterial species and their antimicrobial resistance characteristics in wound infections of war-related injuries in Ukraine from 2014 to 2023

Background

This study continues surveillance of antimicrobial resistance associated with combat injuries in Ukraine.

Aim

To compare species composition, antibiotic resistance profiles, and emergence of new resistance genes between 2014–2020 and 2022–2023.

Methods

This was a retrospective multi-centre microbiological survey in Ukrainian hospitals. Antibiotic susceptibility, whole-genome sequencing and multi-locus sequence typing were conducted on 154 organisms obtained from 125 casualties between 2022 and 2023.

Findings

The data revealed a predominance of Gram-negative bacteria, particularly Acinetobacter baumannii (35.7%), Pseudomonas aeruginosa (14.9%) and Klebsiella pneumoniae (20.7%). High levels of carbapenem resistance were observed among A. baumannii {meropenem 72.2% [39/54, 95% confidence interval (CI) 58.4–83.5]; imipenem 66.7% (36/54, 95% CI 52.5–78.9)}, K. pneumoniae [meropenem 90.6% (29/32, 95% CI 75.0–98.0); imipenem 81.2% (26/32, 95% CI 63.6–92.8)] and P. aeruginosa [meropenem 47.8% (11/23, 95% CI 26.8–69.4); imipenem 60.8% (14/23, 95% CI 38.5–80.3)] strains. A. baumannii sequence type (ST)-78 and ST-400 were prevalent from 2014 to 2020, while five strains of ST-1077 were newly identified in 2022–2023. P. aeruginosa strains showed diversity across 16 STs, with ST-773 increasing in frequency and new STs emerging, but lacking carbapenemase genes. K. pneumoniae exhibited increased genetic diversity over time, with three STs from 2014 to 2020 and six new STs, including bla_NDM-1, bla_OXA-48 and bla_KPC2 carriers, in 2022–2023.