Rectal and Tracheal Carriage of Carbapenemase Genes and Class 1 and 2 Integrons in Patients in Neurosurgery Intensive Care Unit

Abstract

The spread of multidrug-resistant Gram-negative bacteria, which is associated with the distribution of beta-lactamase genes and class 1 and 2 integrons, is a global problem. In this study, in the Moscow neurosurgery intensive care unit (neuro-ICU), the high prevalence of the above-stated genes was found to be associated with intestinal and tracheal carriage. Seven-point prevalence surveys, which included 60 patients in the neuro-ICU, were conducted weekly in the period from Oct. to Nov. 2019. A total of 293 clinical samples were analyzed, including 146 rectal and 147 tracheal swabs; 344 Gram-negative bacteria isolates were collected. Beta-lactamase genes (n = 837) were detected in the isolates, including beta-lactamase blaTEM (n = 162), blaSHV (n = 145), cephalosporinase blaCTX–M (n = 228), carbapenemase blaNDM (n = 44), blaKPC (n = 25), blaOXA–48 (n = 126), blaOXA–51–like (n = 54), blaOXA–40-like (n = 43), blaOXA–23-like (n = 8), and blaVIM (n = 2), as well as class 1 (n = 189) and class 2 (n = 12) integrons. One extensively drug-resistant Klebsiella pneumoniae strain (sequence type ST39 and capsular type K23), simultaneously carried beta-lactamase genes, blaSHV–40 and blaTEM–1B, three carbapenemase genes, blaNDM, blaKPC, and blaOXA–48, the cephalosporinase gene blaCTX–M, and two class 1 integrons. Before this study, such heavily armed strains have not been reported, suggesting the ongoing evolution of antibiotic resistance.

High-Molecular-Weight Plasmids Carrying Carbapenemase Genes blaNDM-1, blaKPC-2, and blaOXA-48 Coexisting in Clinical Klebsiella pneumoniae Strains of ST39

“…In this study, we described in detail the plasmids identified in XDR K. pneumoniae clinical strains belonging to sequence type ST39 and capsular type K-23, which were isolated at a point-prevalence study from four patients in a neuro-ICU in Moscow; two of them died [ 26 ]. Previously, strains of the same genetic line were discovered in Moscow ICUs [ 16 , 41 ].…”

“…In a previous report, we described the emergence of K. pneumoniae isolates carrying three carbapenemase genes ( bla NDM-1 , bla KPC-2 , and bla OXA-48) , the cephalosporinase gene ( bla CTX-M-15 ), and two class 1 integron genes simultaneously in the Moscow neuro-ICU at seven-point prevalence surveys, which included 60 patients in the neuro-ICU. A total of 293 clinical samples were analyzed, including 146 rectal and 147 tracheal swabs, and 344 gram-negative bacteria isolates were collected [ 26 ]. In this article, we characterized the complete genomes of four clonally related XDR K. pneumoniae carbapenem-resistant clinical strains harboring large hybrid plasmids and determined the location of the resistance and virulence genes.…”

Risk predict model using multi-drug resistant organism infection from Neuro-ICU patients: a retrospective cohort study

“…Studies have shown that there is a correlation between the length of stay in the ICU and the infection rate of MDRO 11 , the prevalence of infections acquired in Intensive Care Units (ICU) is higher than it is in other hospital units 12 , ICU MDRO infection rate can be as high as 50% 13 . The incidence of MDRO infections in the neuro ICU is high 14 , but studies are still relatively limited. Therefore, the prevention and control of Neuro-ICU MDRO infection become an urgent problem to be solved, and prevention is the most economical and effective way to control MDRO infection.…”