Nationwide epidemiology of carbapenem resistant Klebsiella pneumoniae isolates from Greek hospitals, with regards to plazomicin and aminoglycoside resistance

被引：73

作者：

Galani, Irene ^{[1
,3
]}

Nafplioti, Konstantina ^{[1
]}

Adamou, Panagiota ^{[1
]}

Karaiskos, Ilias ^{[2
]}

Giamarellou, Helen ^{[2
]}

Souli, Maria ^{[1
]}

Maraki, Sofia ^{[4
]}

Mauromanolaki, Viktoria Eirini ^{[4
]}

Papaioannou, Vassiliki ^{[5
]}

Tsiplakou, Sofia ^{[5
]}

Kazila, Polyzo ^{[6
]}

Diamanti, Ioanna ^{[6
]}

Charalampaki, Nikoletta ^{[7
]}

Trikka-Graphakos, Eleftheria ^{[7
]}

Toutouza, Marina ^{[8
]}

Vagiakou, Helen ^{[9
]}

Pappas, Konstantinos ^{[10
]}

Kyratsa, Anna ^{[11
]}

Paschali, Angeliki ^{[11
]}

Kontopoulou, Konstantina ^{[12
]}

Legga, Olga ^{[13
]}

Petinaki, Efthymia ^{[14
]}

Papadogeorgaki, Helen ^{[15
]}

Chinou, Efrosini ^{[16
]}

机构：

[1] Univ Athens, Infect Dis Lab, Dept Internal Med 4, Fac Med, Athens, Greece

[2] Hygeia Hosp, Dept Internal Med 6, Athens, Greece

[3] Univ Gen Hosp ATTIKON, Rimini 1, Chaidari 12462, Greece

[4] Univ Hosp Heraklion, Dept Clin Bacteriol Parasitol Zoonoses & Geog Med, Iraklion, Greece

[5] KAT Hosp, Dept Microbiol, Athens, Greece

[6] Canc Hosp Thessaloniki THEAGENEIO, Thessaloniki, Greece

[7] THRIASSIO Gen Hosp, Dept Clin Microbiol, Athens, Greece

[8] Hippokrat Athens Gen Hosp, Dept Microbiol, Athens, Greece

[9] Gen Hosp Athens G Gennimatas, Microbiol Lab, Athens, Greece

[10] Athens Naval Hosp, Athens, Greece

[11] Gen Hosp Corfu, Microbiol Lab, Corfu, Greece

[12] Gen Hosp Thessaloniki G Gennimatas, Dept Microbiol, Thessaloniki, Greece

[13] Gen Hosp Lamia, Dept Microbiol, Lamia, Greece

[14] Univ Hosp Larissa, Dept Microbiol, Larisa, Greece

[15] Hygeia Gen Hosp, Microbiol Lab, Athens, Greece

[16] St Savvas Canc Hosp, Dept Microbiol, Athens, Greece

来源：

BMC INFECTIOUS DISEASES | 2019年 / 19卷

关键词：

Plazomicin; K; pneumoniae; Carbapenemase; Greece; MODIFYING ENZYMES; ESCHERICHIA-COLI; ENTEROBACTERIACEAE; EMERGENCE; SPECTRUM; STRAINS;

D O I：

10.1186/s12879-019-3801-1

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

BackgroundTo evaluate the in vitro activities of plazomicin and comparator aminoglycosides and elucidate the underlying aminoglycoside resistance mechanisms among carbapenemase-producing K. pneumoniae isolates collected during a nationwide surveillance study in Greek hospitals.MethodsThree hundred single-patient carbapenemase-producing K. pneumoniae isolates were studied, including 200 KPC-, 50 NDM-, 21 VIM-, 14 KPC & VIM-, 12 OXA-48-, two NDM & OXA- and one KPC & OXA-producing isolates. Susceptibility testing was performed by broth microdilution, and minimum inhibitory concentrations (MICs) interpreted per EUCAST breakpoints. Carbapenemase-, aminoglycoside modifying enzyme- and 16S rRNA methylase- encoding genes were detected by PCR.ResultsOf 300 isolates tested, 5.7% were pandrug resistant and 29.3% extensively drug resistant. Plazomicin inhibited 87.0% of the isolates at 2mg/L, with MIC50/MIC90 of 0.5/4mg/L. Apramycin (a veterinary aminoglycoside) inhibited 86.7% of the isolates at 8mg/L and was the second most active drug after plazomicin, followed by gentamicin (S, 43%; MIC50/MIC90, 4/>256) and amikacin (S, 18.0%; MIC50/MIC90, 32/128). Twenty-three (7.7%) isolates (16 KPC-, 6 VIM- and one KPC & OXA-48-producers) exhibited MICs 64mg/L for plazomicin, and harbored rmtB (n=22) or armA (n=1). AAC(6)-b was the most common aminoglycoside modifying enzyme (84.7%), followed by AAC(3?)-IIa (25.3%), while those two enzymes were co-produced by 21.4% of the isolates.ConclusionsPlazomicin retains activity against most carbapenemase-producing K. pneumoniae isolated from Greek hospitals, with MICs consistently lower than those of the other aminoglycosides, even in the presence of aminoglycoside modifying enzymes. Dissemination of 16S- rRNA methylases in 8% of the isolates is an unwelcome event that needs strict infection control measures and rigorous stewardship interventions.

引用

页数：12

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