Hoạt tính kháng khuẩn của các kháng sinh beta-lactam phối hợp mới trên vi khuẩn đường ruột kháng carbapenem=In vitro activity of new β-lactamase inhibitor combinations against carbapenem resistant Enterobacteriaceae

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Tác giả: Anh Tuấn Đặng, Thị Lan Hương Huỳnh, Lữ Linh Lê, Phương Mai Lê, Thị Nam Phương Nguyễn, Văn Thành Nguyễn, Tuấn Khanh Tạ, Trọng Tín Trần, Thiên Phú Trương

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.Bệnh viện Chợ Rẫy

Bộ sưu tập: Metadata

ID: 478178

Thêm vào giỏ

Khảo sát hoạt tính kháng khuẩn của bốn kháng sinh β-lactam phối hợp mới ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, meropenem-vaborbactam trên các chủng trực khuẩn Gram âm đường ruột kháng carbapenem (Carbapenem-Resistant Enterobacteriaceae: CRE) và mối liên quan với kiểu gene mã hoá carbapenemase. Đối tượng và phương pháp nghiên cứu: các chủng CRE không nhạy cảm với cả ba loại kháng sinh nhóm carbapenem, phân lập trong khoảng thời gian từ tháng 5 - 7/2024. Mức độ nhạy cảm kháng sinh được thử nghiệm bằng card kháng sinh đồ N439 trên hệ thống tự động Vitek-2 compact (Biomerieux). Kết quả nhạy cảm kháng sinh được phiên giải theo tiêu chuẩn CLSI năm 2024. Kiểu gene mã hoá carbapenemase được xác định bằng phản ứng chuỗi polymerase thời gian thực (realtime PCR) cho các gene blaKPC, blaNDM, blaOXA-48, blaIMP, và blaVIM của bộ kit Sacace (Sacace Biotechnologie, Ý). Kết quả: có 107 chủng CRE được thử nghiệm bao gồm: Klebsiella pneumoniae (81 chủng, 75,7%), Klebsiella aerogenes (15 chủng, 14,0%), Escherichia coli (7 chủng, 6,5%), Enterobacter cloacae complex (4 chủng, 3,7%). Mức độ nhạy cảm với ceftolozane-tazobactam là 1,9%, imipenem-relebactam 10,3%, meropenemvaborbactam 16,8%, ceftazidime-avibactam 31,8%. Kết quả PCR cho thấy 70,1% các chủng có mang ít nhất 1 gene nhóm B (blaNDM, blaIMP hoặc blaVIM), các chủng mang hai gene blaNDM và blaOXA-48 chiếm tỷ lệ cao nhất (43,9%), chủng chỉ mang 1 gene blaOXA-48 là 15,9%, 1 gene blaKPC là 9,3%. Có 2 chủng (1,9%) âm tính với 5 loại gene. Trong các chủng mang gene blaKPC, tỷ lệ nhạy cảm với meropenem-vaborbactam là 80%, imipenem-relebactam 70%, ceftazidimeavibactam 60%. Kết luận: Tỷ lệ đề kháng với bốn kháng sinh β-lactam phối hợp mới khá cao. Hầu hết các chủng trực khuẩn Gram âm đều có mang gene mã hoá carbapenemase, chủ yếu là metallo-β-lactamase.To investigate the antibacterial activity of four new combined β-lactam antibiotics, ceftazidime-avibactam, ceftolozane-tazobactam, imipenem-relebactam, and meropenemvaborbactam, on Carbapenem-Resistant Enterobacteriaceae (CRE) and their relationship with gene-encoding carbapenemase. Method: Nonsusceptible CRE strains to all three carbapenem antibiotics were isolated from May to July 2024. Susceptibility to four new β-lactam combination agents was tested using the N439 card on the Vitek-2 compact system (Biomerieux, U.S.). Antibiotic susceptibility results were interpreted according to CLSI 2024 standards. Carbapenemase genotypes were determined by real-time polymerase chain reaction for the genes blaKPC, blaNDM, blaOXA-48, blaIMP, and blaVIM of the Sacace kit (Sacace Biotechnologie, Italie). Results: 107 CRE strains were tested, including Klebsiella pneumoniae (81 isolates, 75.7%), Klebsiella aerogenes (15 isolates, 14.0%), Escherichia coli (7 isolates, 6.5%), and Enterobacter cloacae complex (4 strains, 3.7%). The susceptibility rate to ceftolozane-tazobactam was 1.9%, imipenemrelebactam 10.3%, meropenem-vaborbactam 16.8%, and ceftazidime-avibactam 31.8%. PCR results showed that 70.1% of strains carried at least one group B gene (blaNDM or blaIMP)
coharbored carbapenemase gene blaNDM and blaOXA- 48 isolates accounted for the highest proportion (43.9%)
isolate carrying blaOXA-48 was 15.9%, blaKPC 9.3%. There were 2 isolates (1.9%) negative for 5 genes. In strains carrying the blaKPC, the susceptibility rate to meropenemvaborbactam was 80%, imipenem-relebactam 70%, and ceftazidime-avibactam 60%. Conclusion: The resistance rate to four new β- lactam combination agents was quite high. Most strains carried genes encoding carbapenemases, mainly the metallo-β-lactamase group.

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