{"title":"通过全基因组测序，证实在一次入院筛查中同时存在七种不同的碳青霉烯酶生产者。","authors":"","doi":"10.1016/j.jgar.2024.09.005","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine.</div></div><div><h3>Methods</h3><div>Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core-genome MLST.</div></div><div><h3>Results</h3><div>Seven Gram-negative pathogens (<em>Acinetobacter baumannii</em> (<em>n</em> = 2; ST78, ST2), <em>Klebsiella pneumoniae</em> (<em>n</em> = 2; ST395), <em>Pseudomonas aeruginosa</em> (<em>n</em> = 1; ST1047), <em>Escherichia coli</em> (<em>n</em> = 1; ST46), <em>Enterobacter cloacae</em> complex (<em>n</em> = 1; ST231)) were molecularly confirmed non-identical. Antimicrobial susceptibility testing showed resistance to carbapenems (7/7 isolates) and last-resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the <em>E. cloacae complex</em> as <em>Enterobacter hormaechei</em> subsp<em>. xiangfangensis</em>. Six acquired carbapenemase genes (<em>bla</em><sub>IMP-1</sub>, <em>bla</em><sub>NDM-1</sub>, <em>bla</em><sub>OXA-48</sub>, <em>bla</em><sub>NDM-5</sub>, <em>bla</em><sub>OXA-23</sub> and <em>bla</em><sub>OXA-72</sub>) were detected<em>.</em> Both <em>A. baumannii</em> isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both <em>K. pneumoniae</em> isolates shared sequence type and some resistance genes on an IncR plasmid but were different in core-genome MLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant <em>Enterococcus faecium</em> was also detected (<em>VanA</em>).</div></div><div><h3>Conclusions</h3><div>War-injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":null,"pages":null},"PeriodicalIF":3.7000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing\",\"authors\":\"\",\"doi\":\"10.1016/j.jgar.2024.09.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine.</div></div><div><h3>Methods</h3><div>Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core-genome MLST.</div></div><div><h3>Results</h3><div>Seven Gram-negative pathogens (<em>Acinetobacter baumannii</em> (<em>n</em> = 2; ST78, ST2), <em>Klebsiella pneumoniae</em> (<em>n</em> = 2; ST395), <em>Pseudomonas aeruginosa</em> (<em>n</em> = 1; ST1047), <em>Escherichia coli</em> (<em>n</em> = 1; ST46), <em>Enterobacter cloacae</em> complex (<em>n</em> = 1; ST231)) were molecularly confirmed non-identical. Antimicrobial susceptibility testing showed resistance to carbapenems (7/7 isolates) and last-resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the <em>E. cloacae complex</em> as <em>Enterobacter hormaechei</em> subsp<em>. xiangfangensis</em>. Six acquired carbapenemase genes (<em>bla</em><sub>IMP-1</sub>, <em>bla</em><sub>NDM-1</sub>, <em>bla</em><sub>OXA-48</sub>, <em>bla</em><sub>NDM-5</sub>, <em>bla</em><sub>OXA-23</sub> and <em>bla</em><sub>OXA-72</sub>) were detected<em>.</em> Both <em>A. baumannii</em> isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both <em>K. pneumoniae</em> isolates shared sequence type and some resistance genes on an IncR plasmid but were different in core-genome MLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant <em>Enterococcus faecium</em> was also detected (<em>VanA</em>).</div></div><div><h3>Conclusions</h3><div>War-injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.</div></div>\",\"PeriodicalId\":15936,\"journal\":{\"name\":\"Journal of global antimicrobial resistance\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of global antimicrobial resistance\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213716524001735\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of global antimicrobial resistance","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213716524001735","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing
Objective
To molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war-injured patient from Ukraine.
Methods
Admission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core-genome MLST.
Results
Seven Gram-negative pathogens (Acinetobacter baumannii (n = 2; ST78, ST2), Klebsiella pneumoniae (n = 2; ST395), Pseudomonas aeruginosa (n = 1; ST1047), Escherichia coli (n = 1; ST46), Enterobacter cloacae complex (n = 1; ST231)) were molecularly confirmed non-identical. Antimicrobial susceptibility testing showed resistance to carbapenems (7/7 isolates) and last-resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the E. cloacae complex as Enterobacter hormaechei subsp. xiangfangensis. Six acquired carbapenemase genes (blaIMP-1, blaNDM-1, blaOXA-48, blaNDM-5, blaOXA-23 and blaOXA-72) were detected. Both A. baumannii isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both K. pneumoniae isolates shared sequence type and some resistance genes on an IncR plasmid but were different in core-genome MLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant Enterococcus faecium was also detected (VanA).
Conclusions
War-injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.
期刊介绍：
The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes.
JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR).
Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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