RESUMO
In 2003-2023, amid 5,436 Acinetobacter baumannii isolates collected globally through the Multidrug-Resistant Organism Repository and Surveillance Network, 97 were ST19PAS, 34 of which carbapenem-resistant. Strains (n = 32) sampled after 2019 harboured either bla OXA-23, bla OXA-72, and/or bla NDM-5. Phylogenetic analysis of the 97 isolates and 11 publicly available ST19 genomes revealed three sub-lineages of carbapenemase-producing isolates from mainly Ukraine and Georgia, including an epidemic clone carrying all three carbapenemase genes. Infection control and global surveillance of carbapenem-resistant A. baumannii remain important.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Proteínas de Bactérias , Testes de Sensibilidade Microbiana , beta-Lactamases , beta-Lactamases/genética , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/enzimologia , Humanos , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/epidemiologia , Proteínas de Bactérias/genética , Ucrânia/epidemiologia , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Filogenia , Farmacorresistência Bacteriana Múltipla/genética , República da Geórgia/epidemiologia , Tipagem de Sequências MultilocusRESUMO
BackgroundThe war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.AimTo investigate the genomic epidemiology of New Delhi metallo-ß-lactamase (NDM)-producing Providencia stuartii from Ukrainian patients among European countries.MethodsWhole-genome sequencing of 66 isolates sampled in 2022-2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five bla NDM-1-carrying-P. stuartii isolates underwent antimicrobial susceptibility testing (AST). Transferability to Escherichia coli of a bla NDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing P. stuartii were gathered by questionnaire.ResultswgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised bla NDM-1-carrying-P. stuartii and the third bla NDM-5-carrying-P. stuartii. The bla NDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The bla NDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring bla NDM-1, bla OXA-10, bla CMY-16, rmtC and armA, which was transferrable in vitro and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam-avibactam. Patients with data on age (n = 41) were 19-74 years old; of 49 with information on sex, 38 were male.ConclusionXDR P. stuartii were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.
Assuntos
Antibacterianos , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Plasmídeos , Providencia , Sequenciamento Completo do Genoma , beta-Lactamases , Humanos , Ucrânia/epidemiologia , beta-Lactamases/genética , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla/genética , Providencia/genética , Providencia/isolamento & purificação , Providencia/efeitos dos fármacos , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Europa (Continente)/epidemiologia , Plasmídeos/genética , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Idoso , Adulto JovemRESUMO
BACKGROUND: This study continues surveillance of antimicrobial resistance associated with combat injuries in Ukraine. AIM: To compare species composition, antibiotic resistance profiles, and emergence of new resistance genes between 2014-2020 and 2022-2023. METHODS: Retrospective multicentre microbiological survey in Ukrainian hospitals. Antibiotic susceptibility, whole genome sequencing, and MLST typing were conducted on 154 organisms obtained from 125 casualties from 2022-2023. FINDINGS: The data reveals a predominance of gram-negative bacteria, particularly Acinetobacter baumannii (35.7%), Pseudomonas aeruginosa (14.9%), and Klebsiella pneumoniae (20.7%). High levels of carbapenem resistance was observed among A. baumannii (meropenem 72,2% [(39/54) 95% CI 58.4-83.5], imipenem 66.7% [(36/54) 95% CI 52.5-78.9]), Klebsiella (meropenem 90.6% [(29/32) 95% CI 75.0-98.0], imipenem 81.2% [(26/32) 95% CI 63.6-92.8]), and P. aeruginosa (meropenem 47.8% [(11/23) 95% CI 26.8-69.4], imipenem 60.8% [(14/23) 95% CI 38.5-80.3]) strains. A. baumannii ST-78 and ST-400 were prevalent from 2014 to 2020, while 5 strains of ST-1077 were newly identified. Pseudomonas aeruginosa strains showed diversity across 16 sequence types (STs), with ST-773 increasing in frequency and new STs emerging, but lacking carbapenemase genes. K. pneumoniae exhibited increased genetic diversity over time, with three STs from 2014 to 2020 and six new STs, including blaNDM-1, blaOXA-48, and blaKPC2 carriers, in recent years. CONCLUSION: There is a growing prevalence of multidrug resistant isolates from globally distributed sequence types.