三级护理医院肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌对碳青霉烯类抗生素耐药性的表型检测
Phenotypic Detection of Carbapenem Resistance in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species at a Tertiary Care Hospital.
摘要(中文译文)
背景 革兰阴性ESKAPE病原体（包括肠球菌属、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌属）中的碳青霉烯类耐药已成为医院环境中的重大问题，尤其是在发展中地区，因其与多重耐药及治疗选择有限相关。本研究旨在采用临床和实验室标准协会（CLSI）M100第33版（2023年）推荐的方法，包括改良碳青霉烯灭活法（mCIM）和EDTA改良碳青霉烯灭活法（eCIM），评估三级医疗环境中这些病原体的碳青霉烯酶产生的流行率、标本分布及表型检测情况。 方法 这是一项前瞻性观察性研究，于2024年1月至12月在马哈拉施特拉邦西南部的一家三级医疗医院进行。共纳入从各种临床标本中分离的312株非重复革兰阴性ESKAPE病原体。鉴定和抗菌药物敏感性试验按照CLSI M100第33版（2023年版）进行。对碳青霉烯类耐药分离株进一步通过表型方法mCIM和eCIM分析碳青霉烯酶产生的检测情况。 结果 在研究的312株革兰阴性ESKAPE分离株中，94株（30.13%）被鉴定为碳青霉烯类耐药。肺炎克雷伯菌占碳青霉烯类耐药分离株的最大比例，为41/94（43.62%），而物种特异性碳青霉烯类耐药率最高的是鲍曼不动杆菌，57株中有23株（40.35%）对碳青霉烯类耐药。尿液是最常见的标本来源（54.24%）。通过mCIM在62/94（65.96%）的碳青霉烯类耐药分离株中检测到碳青霉烯酶产生，其中39/62（62.90%）通过eCIM被鉴定为金属β-内酰胺酶（MBL）产生菌。对头孢菌素类、氟喹诺酮类和氨基糖苷类观察到高耐药率。在研究环境中，黏菌素耐药率为8/94（8.51%），鲍曼不动杆菌中耐药率较高，为4/23（17.39%）。 结论 观察到碳青霉烯类耐药革兰阴性ESKAPE病原体负担相当大，其中大多数产生碳青霉烯酶，相当比例产生MBL。多重耐药的存在以及对最后防线药物耐药的出现令人担忧。加强常规碳青霉烯酶检测、感染控制措施和抗菌药物管理项目至关重要。
Abstract
Background Carbapenem resistance in Gram-negative , , , , , and species (ESKAPE) pathogens has emerged as a significant concern in hospital settings, particularly in developing regions, due to its association with multidrug resistance and limited therapeutic options. The present study was designed to assess the prevalence, specimen-wise distribution, and phenotypic detection of carbapenemase production among these pathogens in a tertiary care setting using Clinical and Laboratory Standards Institute (CLSI) M100, 33rd edition, 2023, recommended methods, including the modified carbapenem inactivation method (mCIM) and the EDTA-modified carbapenem inactivation method (eCIM). Methodology This is a prospective observational study conducted at a tertiary care hospital in southwest Maharashtra from January to December 2024. A total of 312 non-duplicate Gram-negative ESKAPE pathogens isolated from various clinical samples were included. Identification and antimicrobial susceptibility testing were performed according to the CLSI M100, 33rd edition, 2023 edition. Carbapenem-resistant isolates were further analyzed for the detection of carbapenemase production by the phenotypic method, mCIM, and eCIM. Results Among the 312 Gram-negative ESKAPE isolates studied, 94 (30.13%) were identified as carbapenem-resistant. accounted for the largest proportion of carbapenem-resistant isolates, 41/94 (43.62%), whereas the highest species-specific carbapenem resistance rate was observed in with 23/57 (40.35%) isolates carbapenem-resistant. Urine was the most frequent source of specimens (54.24%). Carbapenemase production was detected in 62/94 (65.96%) carbapenem-resistant isolates by mCIM, and among these, 39/62 (62.90%) were identified as metallo-β-lactamase (MBL) producers by eCIM. High resistance rates were observed against cephalosporins, fluoroquinolones, and aminoglycosides. In the study setting, colistin resistance was 8/94 (8.51%), with higher resistance in , 4/23 (17.39%). Conclusions A considerable burden of carbapenem-resistant Gram-negative ESKAPE pathogens was observed, with the majority producing carbapenemases and a significant proportion producing MBLs. The presence of multidrug resistance and emerging resistance to last-line agents is concerning. Strengthening routine carbapenemase detection, infection control practices, and antimicrobial stewardship programs is essential.
如何引用
AMA
Sujata P Korochikar, Priyanka M Mane, Satish R Patil, Yogendra P Shelke, Suvarna N Patil, Premkumar Korochikar. Phenotypic Detection of Carbapenem Resistance in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species at a Tertiary Care Hospital.. Cureus. 2026; doi:10.7759/cureus.109319.
APA
Sujata P Korochikar, Priyanka M Mane, Satish R Patil, Yogendra P Shelke, Suvarna N Patil, Premkumar Korochikar (2026). Phenotypic Detection of Carbapenem Resistance in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species at a Tertiary Care Hospital.. Cureus. https://doi.org/10.7759/cureus.109319
GB/T 7714
Sujata P Korochikar, Priyanka M Mane, Satish R Patil, Yogendra P Shelke, Suvarna N Patil, Premkumar Korochikar. Phenotypic Detection of Carbapenem Resistance in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species at a Tertiary Care Hospital.[J]. Cureus, 2026 doi:10.7759/cureus.109319.
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