{"title":"保加利亚一家医院出现 blaNDM-5 和 blaOXA-232 阳性耐考利星和卡巴培南肺炎克雷伯菌。","authors":"Rumyana Markovska, Petya Stankova, Georgi Popivanov, Ivanka Gergova, Kalina Mihova, Ventsislav Mutafchiyski, Lyudmila Boyanova","doi":"10.3390/antibiotics13070677","DOIUrl":null,"url":null,"abstract":"<p><p>The rapid spread of carbapenemase-producing strains has led to increased levels of resistance among Gram-negative bacteria, especially enterobacteria. The current study aimed to collect and genetically characterize the colistin- and carbapenem-resistant isolates, obtained in one of the biggest hospitals (Military Medical Academy) in Sofia, Bulgaria. Clonal relatedness was detected by RAPD and MLST. Carbapenemases, ESBLs, and <i>mgrB</i> were investigated by PCR amplification and sequencing, replicon typing, and 16S rRNA methyltransferases with PCRs. Fourteen colistin- and carbapenem-resistant <i>K. pneumoniae</i> isolates were detected over five months. Six carbapenem-resistant and colistin-susceptible isolates were also included. The current work revealed a complete change in the spectrum of carbapenemases in Bulgaria. <i>bla</i><sub>NDM-5</sub> was the only NDM variant, and it was always combined with <i>bla</i><sub>OXA-232</sub>. The coexistence of <i>bla</i><sub>OXA-232</sub> and <i>bla</i><sub>NDM-5</sub> was observed in 10/14 (72%) of colistin- and carbapenem-resistant <i>K. pneumoniae</i> isolates and three colistin-susceptible isolates. All <i>bla</i><sub>NDM-5</sub>- and <i>bla</i><sub>OXA-232</sub>-positive isolates belonged to the ST6260 (ST101-like) MLST type. They showed great <i>mgrB</i> variability and had a higher mortality rate. In addition, we observed <i>bla</i><sub>OXA-232</sub> ST14 isolates and KPC-2-producing ST101, ST16, and ST258 isolates. The colistin- and carbapenem-resistant isolates were susceptible only to cefiderocol for <i>bla</i><sub>NDM-5</sub>- and <i>bla</i><sub>OXA-232</sub>-positive isolates and to cefiderocol and ceftazidime/avibactam for <i>bla</i><sub>OXA-232</sub>- or <i>bla</i><sub>KPC-2</sub>-positive isolates. All <i>bla</i><sub>OXA-232</sub>-positive isolates carried <i>rmtB</i> methylase and the colE replicon type. The extremely limited choice of appropriate treatment for patients infected with such isolates and their faster distribution highlight the need for urgent measures to control this situation.</p>","PeriodicalId":54246,"journal":{"name":"Antibiotics-Basel","volume":null,"pages":null},"PeriodicalIF":4.3000,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11274196/pdf/","citationCount":"0","resultStr":"{\"title\":\"Emergence of <i>bla</i><sub>NDM-5</sub> and <i>bla</i><sub>OXA-232</sub> Positive Colistin- and Carbapenem-Resistant <i>Klebsiella pneumoniae</i> in a Bulgarian Hospital.\",\"authors\":\"Rumyana Markovska, Petya Stankova, Georgi Popivanov, Ivanka Gergova, Kalina Mihova, Ventsislav Mutafchiyski, Lyudmila Boyanova\",\"doi\":\"10.3390/antibiotics13070677\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>The rapid spread of carbapenemase-producing strains has led to increased levels of resistance among Gram-negative bacteria, especially enterobacteria. The current study aimed to collect and genetically characterize the colistin- and carbapenem-resistant isolates, obtained in one of the biggest hospitals (Military Medical Academy) in Sofia, Bulgaria. Clonal relatedness was detected by RAPD and MLST. Carbapenemases, ESBLs, and <i>mgrB</i> were investigated by PCR amplification and sequencing, replicon typing, and 16S rRNA methyltransferases with PCRs. Fourteen colistin- and carbapenem-resistant <i>K. pneumoniae</i> isolates were detected over five months. Six carbapenem-resistant and colistin-susceptible isolates were also included. The current work revealed a complete change in the spectrum of carbapenemases in Bulgaria. <i>bla</i><sub>NDM-5</sub> was the only NDM variant, and it was always combined with <i>bla</i><sub>OXA-232</sub>. The coexistence of <i>bla</i><sub>OXA-232</sub> and <i>bla</i><sub>NDM-5</sub> was observed in 10/14 (72%) of colistin- and carbapenem-resistant <i>K. pneumoniae</i> isolates and three colistin-susceptible isolates. All <i>bla</i><sub>NDM-5</sub>- and <i>bla</i><sub>OXA-232</sub>-positive isolates belonged to the ST6260 (ST101-like) MLST type. They showed great <i>mgrB</i> variability and had a higher mortality rate. In addition, we observed <i>bla</i><sub>OXA-232</sub> ST14 isolates and KPC-2-producing ST101, ST16, and ST258 isolates. The colistin- and carbapenem-resistant isolates were susceptible only to cefiderocol for <i>bla</i><sub>NDM-5</sub>- and <i>bla</i><sub>OXA-232</sub>-positive isolates and to cefiderocol and ceftazidime/avibactam for <i>bla</i><sub>OXA-232</sub>- or <i>bla</i><sub>KPC-2</sub>-positive isolates. All <i>bla</i><sub>OXA-232</sub>-positive isolates carried <i>rmtB</i> methylase and the colE replicon type. The extremely limited choice of appropriate treatment for patients infected with such isolates and their faster distribution highlight the need for urgent measures to control this situation.</p>\",\"PeriodicalId\":54246,\"journal\":{\"name\":\"Antibiotics-Basel\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-07-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11274196/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antibiotics-Basel\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3390/antibiotics13070677\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antibiotics-Basel","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3390/antibiotics13070677","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Emergence of blaNDM-5 and blaOXA-232 Positive Colistin- and Carbapenem-Resistant Klebsiella pneumoniae in a Bulgarian Hospital.
The rapid spread of carbapenemase-producing strains has led to increased levels of resistance among Gram-negative bacteria, especially enterobacteria. The current study aimed to collect and genetically characterize the colistin- and carbapenem-resistant isolates, obtained in one of the biggest hospitals (Military Medical Academy) in Sofia, Bulgaria. Clonal relatedness was detected by RAPD and MLST. Carbapenemases, ESBLs, and mgrB were investigated by PCR amplification and sequencing, replicon typing, and 16S rRNA methyltransferases with PCRs. Fourteen colistin- and carbapenem-resistant K. pneumoniae isolates were detected over five months. Six carbapenem-resistant and colistin-susceptible isolates were also included. The current work revealed a complete change in the spectrum of carbapenemases in Bulgaria. blaNDM-5 was the only NDM variant, and it was always combined with blaOXA-232. The coexistence of blaOXA-232 and blaNDM-5 was observed in 10/14 (72%) of colistin- and carbapenem-resistant K. pneumoniae isolates and three colistin-susceptible isolates. All blaNDM-5- and blaOXA-232-positive isolates belonged to the ST6260 (ST101-like) MLST type. They showed great mgrB variability and had a higher mortality rate. In addition, we observed blaOXA-232 ST14 isolates and KPC-2-producing ST101, ST16, and ST258 isolates. The colistin- and carbapenem-resistant isolates were susceptible only to cefiderocol for blaNDM-5- and blaOXA-232-positive isolates and to cefiderocol and ceftazidime/avibactam for blaOXA-232- or blaKPC-2-positive isolates. All blaOXA-232-positive isolates carried rmtB methylase and the colE replicon type. The extremely limited choice of appropriate treatment for patients infected with such isolates and their faster distribution highlight the need for urgent measures to control this situation.
Antibiotics-BaselPharmacology, Toxicology and Pharmaceutics-General Pharmacology, Toxicology and Pharmaceutics
CiteScore
7.30
自引率
14.60%
发文量
1547
审稿时长
11 weeks
期刊介绍:
Antibiotics (ISSN 2079-6382) is an open access, peer reviewed journal on all aspects of antibiotics. Antibiotics is a multi-disciplinary journal encompassing the general fields of biochemistry, chemistry, genetics, microbiology and pharmacology. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. Therefore, there is no restriction on the length of papers.