摘要

很少有研究涉及阿拉伯半岛碳青霉烯类抗生素肠杆菌科（CRE）分离株的分子流行病学，而迪拜是该地区主要的经济，旅游和医疗中心。确定了2015年6月至2016年6月在迪拜五家主要医院分离的89株CRE菌株的抗生素敏感性，碳青霉烯酶类型和克隆性。 70株肺炎克雷伯菌，13株大肠杆菌和6株其他肠杆菌科细菌中，33％的菌株耐药性极强，27％对粘菌素耐药，4.5％（4株肺炎克雷伯菌分离株）对所有抗生素耐药。肺炎克雷伯菌中的粘菌素耐药率为31.4％。没有一个分离物携带可移动的粘菌素抗性基因。产生碳青霉烯酶的七十七个分离株分别为53.3％OXA-48样，24.7％NDM和22.1％OXA-48样和NDM。 PFGE将50％的肺炎克雷伯菌聚集成35人组，其显示与双碳青霉烯酶产生显着相关，具有极度的耐药性，并且从阿米拉蒂患者中分离。簇的成员属于序列类型ST14。肺炎克雷伯菌ST14中粘菌素耐药率为37.1％，而肺炎克雷伯菌分离株为27.1％。两种泛耐药肺炎克雷伯菌菌株也属于ST14，而另两种分别是ST15和ST231。总之，除了CRE的总体高粘菌素耐药率外，在所有迪拜医院中出现高度耐药克雷伯氏肺炎克雷伯菌ST14是一个需要立即关注的严重问题。

Few studies have addressed the molecular epidemiology of carbapenem resistant Enterobacteriaceae (CRE) isolates in the Arabian Peninsula, and such investigations have been missing from Dubai, a major economical, tourism and medical centre of the region. Theantibiotic susceptibility, the carbapenemase type produced, and the clonality of 89 CRE strains isolated in five major Dubai hospitals in June 2015 - June 2016 were determined. Thirty three percent of the collection of 70 K. pneumoniae, 13 E. coli and 6 other Enterobacteriaceae were extremely drug resistant, 27% were resistant to colistin, and 4.5% (four K. pneumoniae isolates) were resistant to all antibiotics tested. The colistin resistance rate in K. pneumoniae was 31.4%. None of the isolates carried mobile colistin resistance genes. Seventy-seven isolates produced carbapenemase: 53.3% OXA-48-like, 24.7% NDM, and 22.1% both OXA-48-like and NDM, respectively. PFGE clustered 50% of K. pneumoniae into a 35-membered group, which showed significant association with double carbapenemase production, with extreme drug resistance, and with being isolated from Emirati patients. Members of the cluster belonged to sequence type ST14. The rate of colistin resistance in K. pneumoniae ST14 was 37.1% vs. 27.1% of K. pneumoniae isolates outside of the cluster. Two of the panresistant K. pneumoniae isolates also belonged to ST14, whereas the other two were ST15 and ST231, respectively. In conclusion, beyond the overall high colistin resistance rate in CRE, the emergence of a highly resistant clone of K. pneumoniae ST14 in all Dubai hospitals investigated is a serious problem requiring immediate attention.

https://www.ncbi.nlm.nih.gov/pubmed/29530587