Inactivation of mgrB gene regulator and resistance to colistin is becoming endemic in carbapenem-resistant Klebsiella pneumoniae in Greece: A nationwide study from 2014 to 2017

被引:38
作者
Hamel, Mouna [1 ]
Chatzipanagiotou, Stylianos [2 ]
Hadjadj, Linda [1 ]
Petinaki, Efthimia [3 ]
Papagianni, Sophia [4 ]
Charalampaki, Nikoletta [4 ]
Tsiplakou, Sophia [5 ]
Papaioannou, Vassiliki [5 ]
Skarmoutsou, Nikoletta [6 ]
Spiliopoulou, Iris [7 ]
Christofidou, Myrto [7 ]
Papamichalopoulos, Nikolaos [8 ]
Skalidis, Tilemachos [9 ]
Legakis, Nicholaos [9 ]
Fountoulis, Kimon [9 ]
Perivolioti, Efstathia [10 ]
Kraniotaki, Heleni [10 ]
Bournia, Maria [10 ]
Ioannidis, Anastasios [2 ]
Sophie, Alexandra Baron [1 ]
Rolain, Jean-Marc [1 ,11 ]
机构
[1] Aix Marseille Univ, AP HM, IHU Mediterranee Infect, IRD,MEPHI, 19-21 Blvd Jean Moulin, F-13385 Marseille 05, France
[2] Natl & Kapodistrian Univ Athens, Aeginit Hosp, Athens Med Sch, Dept Med Biopathol & Clin Microbiol, Ave Vassilissis Sophias 72, Athens 11528, Greece
[3] Univ Hosp Larissa, Dept Microbiol, Larisa, Greece
[4] Thriasio Gen Hosp, Dept Clin Microbiol, Magoula, Greece
[5] KAT Gen Hosp, Athens, Greece
[6] Sismanogleio Gen Hosp, Athens, Greece
[7] Univ Hosp, Patras, Greece
[8] Natl & Kapodistrian Univ Athens, Med Sch, Aiginite Hosp, Athens, Greece
[9] Iaso Matern & Gynecol Hosp, Athens, Greece
[10] Evagelismos Gen Hosp, Athens, Greece
[11] IHU Mediterranee Infect, 19-21 Blvd Jean Moulin, F-13385 Marseille 05, France
关键词
Klebsiella pneumoniae; Greece; carbapenems; colistin resistance; mgrB gene; BETA-LACTAMASE; INFECTIONS; ENTEROBACTERIACEAE; EMERGENCE; BACTERIA; OUTBREAK; KPC-2; NDM-1;
D O I
10.1016/j.ijantimicag.2020.105930
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Introduction: In Greece, the spread of carbapenem-resistant Enterobacteriaceae in humans has led to the reintroduction of colistin as a therapeutic agent. Unfortunately, colistin resistance with different mechanisms has emerged. The present work aims to determine the prevalence of carbapenem and colistin resistance and the corresponding mechanisms in Klebsiella pneumoniae clinical isolates from Greece. Methods: From 2014 to 2017, 288 carbapenem-resistant K. pneumoniae clinical strains were gathered from a collection of 973 isolates from eight different hospitals in Greece. Antibiotic susceptibility testing was performed using three different methods. Screening of carbapenem and colistin resistance genes was conducted using polymerase chain reaction (PCR) amplification and sequencing. Results: Among the 288 (29.6 %) carbapenem-resistant isolates, 213 (73.9%) were colistin-resistant (minimum inhibitory concentration [MIC] >2 mg/L). The KPC type was the most common carbapenemase gene (116; 40.3%), followed by VIM (41; 14.2%), NDM (33; 11.5%) and OXA-48 (22; 7.6%). Moreover, 44 (15.3%) strains co-produced two types of carbapenemases. No mcr genes were detected for colistin resistance but mutations in chromosomal genes were found. These included inactivation of the mgrB gene for 148 (69.5%) strains, including insertion sequences for 94 (44.1%), nonsense mutations for 4 (1.9%) and missense mutations for 24 (11.3%). Moreover, PCR amplification of mgrB gene was negative for 26 (12.2%) strains. Finally, 65 (30.5%) colistin-resistant strains exhibited a wild-type mgrB, the mechanisms of which remain to be elucidated. Conclusion: This study shows that K. pneumoniae clinical strains in Greece are resistant to both carbapenems and colistin and this is endemic and is likely chromosomally encoded. (C) 2020 Published by Elsevier B.V.
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