英国军队队列中产扩展谱β-内酰胺酶肠杆菌和耐碳青霉烯酶肠杆菌的流行率。

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2024-10-26 DOI:10.1136/military-2024-002837
Romeo Toriro, S J C Pallett, W Nevin, T M Ross, I Hale, M Routledge, C Bennett, J Knott, D S Burns, T Edwards, M K O'Shea, T E Fletcher, N J Beeching, S D Woolley
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引用次数: 0

摘要

导言:众所周知,在资源有限的环境中旅行可能会感染产扩展谱β-内酰胺酶肠杆菌(ESBL-PE)和耐碳青霉烯类肠杆菌(CRE),这两种细菌都会增加发病率和死亡率。我们调查了英国军人(SP)中 ESBL-PE 和 CRE 的基线流行率:方法:2021 年 9 月至 2022 年 4 月期间,英国军人为多个不同环境下的研究项目提供了粪便样本。从培养 ChromID ESBL 板(法国马西埃托尔生物梅里埃公司)上回收粪便分离物中的细菌菌落,并使用 Qiagen DNeasy 提取试剂盒(英国 Qiagen 公司)提取 DNA。使用 Rotor-Gene Q (RGQ) (Qiagen, UK) 进行 PCR 检测β-内酰胺酶和 CRE 编码基因,并使用 RGQ 软件检测阳性。未对抗菌药敏感性进行表型评估:在接触的 250 人中,239 人(85.5% 为男性,中位数(IQR)年龄为 31(26-37)岁)提供了适合分析的粪便样本。ESBL感染率为40/239(16.7%),其中39份样本(16.3%)检测到产ESBL大肠埃希菌,1份样本(0.4%)检测到产ESBL肺炎克雷伯菌。在 18 个样本(7.5%)、33 个样本(13.8%)、16 个样本(6.7%)和 8 个样本(3.3%)中分别检测到包括特莫尼拉、巯基试剂变量(SHV)、头孢他啶水解β-内酰胺酶(慕尼黑)(CTX-M)1 和 CTX-M 9 基因在内的组合。大肠杆菌样本混合了所有四种基因型,以 SHV 型为主。一个样本(0.4%)携带所有四种基因型,唯一的肺炎双球菌样本携带单一的 SHV 基因。未检测到 CRE:ESBL-PE在SP队列中的流行率与英格兰平民人群的流行率非常接近;但是,我们注意到ESBL基因型分布存在差异。国际旅行和职业创伤对 SP 造成的潜在暴露风险强调了反复监测的必要性,以描述和检测 ESBL 感染流行病学和携带的变化。此类前瞻性数据对于优化临床结果、控制耐药性和指导经验性抗生素处方政策建议具有重要的抗菌药物管理意义。
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Prevalence of extended-spectrum β-lactamase-producing Enterobacterales and carbapenemase-resistant Enterobacterales in British military cohorts.

Introduction: Travel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated the ESBL-PE and CRE baseline prevalence in British service personnel (SP).

Methods: SP provided faecal samples for research projects in several different settings, between September 2021 and April 2022. Bacterial colonies from faecal isolates were recovered from incubated ChromID ESBL plates (bioMérieux, Marcy-l'Étoile, France) and DNA extracted using Qiagen DNeasy extraction kits (Qiagen, UK). PCR to identify β-lactamase and CRE encoding genes was performed using the Rotor-Gene Q (RGQ) (Qiagen, UK), with positivity detected by RGQ software. Phenotypic assessment of antimicrobial susceptibility was not performed.

Results: Out of 250 personnel approached, 239 (85.5% men, median (IQR) age 31 (26-37) years) provided faecal samples suitable for analysis. The ESBL prevalence was 40/239 (16.7%), with ESBL-producing Escherichia coli detected in 39 (16.3%) samples and ESBL-producing Klebsiella pneumoniae in 1 (0.4%) sample. Combinations including Temoniera, sulfhydryl reagent variable (SHV), cefotaxime hydrolysing β-lactamase (Munich) (CTX-M) 1 and CTX-M 9 genes were detected in 18 (7.5%), 33 (13.8%) 16 (6.7%) and 8 (3.3%) samples, respectively. E. coli samples had mixtures of all four genotypes with SHV predominating. One (0.4%) sample carried all four gene types and the only K. pneumoniae sample carried a single SHV gene. No CRE were detected.

Conclusions: The prevalence of ESBL-PE in cohorts of SP closely matches that of civilian populations in England; however, we noted differences in ESBL genotype distribution. Potential exposure risks for SP from international travel and occupational trauma emphasise the need for repeated surveillance to characterise and detect changes in acquisition epidemiology and carriage of ESBL. Such prospective data have important antimicrobial stewardship implications in optimising clinical outcomes, controlling resistance and guiding empirical antibiotic formulary policy recommendations.

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Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
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116
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