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首页> 外文期刊>Journal of Clinical Microbiology >Nosocomial Outbreak of Infections by Proteus mirabilis That Produces Extended-Spectrum CTX-M-2 Type β-Lactamase
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Nosocomial Outbreak of Infections by Proteus mirabilis That Produces Extended-Spectrum CTX-M-2 Type β-Lactamase

机译：产生变形谱CTX-M-2型β-内酰胺酶的奇异变形杆菌的医院内感染暴发

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Nineteen multidrug-resistant Proteus mirabilis strains were isolated from 19 patients suffering from infections probably caused by P. mirabilis. These strains were recovered from urine or other urogenital specimens of 16 inpatients and three outpatients with a hospitalization history in a urology ward of Funabashi Medical Center, from July 2001 to August 2002. These strains demonstrated resistance to cefotaxime, ceftriaxone, cefpodoxime, and aztreonam, while they were highly susceptible to ceftazidime (MIC, ≤0.5 μg/ml). The resistance level of these strains to cefotaxime was decreased by the presence of clavulanic acid. Therefore, the strains were speculated to produce extended-spectrum class A β-lactamases. These strains were later found to carry blaCTX-M-2 genes by both PCR and sequencing analyses. The profiles of SmaI-digested genomic DNA of 19 isolates were distinguished into five different clusters by biased sinusoidal field gel electrophoresis. Four of them, consisting of 18 isolates, were suggested to be a clonal expansion. These findings suggested that a nosocomial outbreak of infections by CTX-M-2-producing P. mirabilis had occurred in our medical center. Most patients suffered from urogenital malignancies with long-term catheterization. Cefazolin, cefoperazone-sulbactam, and/or levofloxacin were mostly administered to the patients, but these agents seemed ineffective for eradication of CTX-M-2 producers. Early recognition and rapid identification of colonizing antimicrobial-resistant bacteria, including CTX-M-2-producing P. mirabilis, would be the most effective measures to cope with further spread of this kind of hazardous microorganism in clinical environments.
机译：从19例可能由 P引起的感染的患者中分离出19种耐多药的 Proteus mirabilis 菌株。奇迹。从2001年7月至2002年8月在船桥医学中心泌尿科病房住院的16例住院患者和3名有住院病史的门诊患者的尿液或其他泌尿生殖系统标本中回收了这些菌株。这些菌株显示出对头孢噻肟，头孢曲松，头孢泊肟和氨曲南的耐药性，而他们对头孢他啶高度敏感（MIC，≤0.5μg/ ml）。棒酸的存在降低了这些菌株对头孢噻肟的抗性水平。因此，推测菌株产生了广谱A类β-内酰胺酶。后来通过PCR和测序分析发现这些菌株携带 bla CTX-M-2 基因。通过偏正弦电场凝胶电泳将19个分离株的 Sma I消化的基因组DNA谱分为五个不同的簇。其中四个由18个分离株组成，被认为是克隆扩增。这些发现表明，医院内爆发了由生产CTX-M-2的 P引起的感染。我们的医疗中心发生了奇迹。大多数患者患有长期泌尿生殖系统恶性肿瘤。头孢唑林，头孢哌酮舒巴坦和/或左氧氟沙星主要用于患者，但这些药物似乎对消除CTX-M-2生产者无效。早期识别和快速鉴定定植的抗微生物细菌，包括产生CTX-M-2的 P。奇异菌，将是应对这种危险微生物在临床环境中进一步传播的最有效措施。

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