antibioticsАнтибиотики и ХимиотерапияAntibiot Khimioter = Antibiotics and Chemotherapy0235-2990ООО «Издательство ОКИ»antibiotics-695Research ArticleВ ПОМОЩЬ ПРАКТИКУЮЩЕМУ ВРАЧУGUIDELINES FOR PRACTITIONERSРаспространение и антибактериальная резистентность грамотрицательных бактерий, продуцентов карбапенемаз, в Санкт-Петербурге и некоторых других регионах Российской ФедерацииPrevalence and Antibiotic Resistance of Carbapenemase-Producing Gram-Negative Bacteria in Saint Petersburg and Some Other Regions of the Russian FederationЛазареваИ. В.LazarevaI. V.noemail@neicon.ruАгеевецВ. А.AgeevetsV. A.noemail@neicon.ruЕршоваТ. А.ErshovaT. A.noemail@neicon.ruЗуеваЛ. П.ZuevaL. P.noemail@neicon.ruГончаровА. Е.GoncharovA. E.noemail@neicon.ruДарьинаМ. Г.DarinaM. G.noemail@neicon.ruСветличнаяЮ. С.SvetlichnayaYu. S.noemail@neicon.ruУсковА. Н.UskovA. N.noemail@neicon.ruСидоренкоС. В.SidorenkoS. V.noemail@neicon.ruНаучно-исследовательский институт детских инфекцийRussian FederationСеверо-Западный государственный медицинский университет им. И.И. МечниковаRussian FederationСеверо-Западный государственный медицинский университет им. И.И. Мечникова; Институт экспериментальной медицины; Санкт-Петербургский государственный университетRussian FederationСеверо-Западный государственный медицинский университет им. И.И. Мечникова; Медицинский информационно-аналитический центрRussian FederationФедеральное государственное бюджетное учреждение «Научно-исследовательский институт детских инфекций Федерального медико-биологического агентства»Russian FederationСеверо-Западный государственный медицинский университет им. И.И. Мечникова; Научно-исследовательский институт детских инфекций; Санкт-Петербургский научный центр РАНRussian Federation2016130520206111-122838Copyright © ООО «Издательство ОКИ», 20202020ООО «Издательство ОКИ»ООО «Издательство ОКИ»https://www.antibiotics-chemotherapy.ru/jour/about/submissions#copyrightNoticehttps://www.antibiotics-chemotherapy.ru/jour/article/view/695

Грамотрицательные бактерии, продуцирующие карбапенемазы (ферменты, разрушающие карбапенемные антибиотики), являются одной из глобальных угроз системе здравоохранения. Количество известных карбапенемаз постоянно увеличивается, однако только четыре типа получили наибольшее распространение: NDM-тип, KPC-тип, OXA-48-тип и VIM-тип. В стационарах Санкт-Петербурга среди Klebsiella pneumoniae частота продукции карбапенемаз достигает 9,2% (5,9% - NDM-тип, 1,4% - ОХА-48-тип, 1,9% - NDM-тип + ОХА-48-тип). Продуценты карбапенемаз также обнаруживали в стационарах Москвы, Екатеринбурга, Вологды, Мурманска, Кургана, Красноярска, Ижевска, Краснодара и Перми. Всего в период с 2011 по 2016 гг. получено 281 продуцентов карбапенемаз, выделенных от инфицированных или колонизованных пациентов (247 изолятов K.pneumoniae; 29 - Acinetobacter spp.; 2 - Enterobacter cloacae; 1 - Serratia marcescens; 1 - Escherichia coli и 1 - Proteus mirabilis). K.pneumoniae, продуцирующие карбапенемазы, отличались значительным генетическим разнообразием, так продуценты NDM-типа относились к восьми различным сиквенс-типам (Sequence Types - ST), КРС-типа - к трём и ОХА-48-типа - к четырём. Обнаружены представители глобально доминирующей генетической линии - клональной группы (Clonal Group - CG) CG258, а также ряда менее распространённых линий: ST147, ST273, ST307 и ST377. K.pneumoniae отличалась высокой частотой перекрёстной и ассоциированной резистентности с антибиотиками разных групп. Частота устойчивости к цефалоспоринам и фторхинолонам приближалась к 100%. Среди продуцентов NDM частота устойчивости к аминогликозидам превосходила 90%, среди продуцентов КРС частота устойчивости к амикацину была на уровне 66%, а к гентамицину - 93%, среди продуцентов ОХА-48 частота устойчивости была ещё ниже 50 и 73%, соответственно. Высокий уровень устойчивости к имипенему и меропенему проявляли около 80% продуцентов NDM, приблизительно 90% продуцентов КРС и только 60% продуцентов ОХА-48. Частота устойчивости к тигециклину колебалась от 6,7 до 14,8%; к полимиксину - от 4,2% до 20%. Acinetobacter spp., продуцирующие карбапенемазы ОХА-40- и ОХА-23-ти-пов сохраняли чувствительность только к полимиксину. Очевидно, что возможности этиотропной терапии инфекций, вызываемых продуцентами карбапенемаз, ограничены.

Carbapenemase-producing gramnegative bacteria, which hydrolyze most ofв-lactams, including carbapenems, is of global health care system threat. The number of the known carbapenemases is constantly increasing, however only four types are widely distributed: NDM-type, KPC-type, OXA-48-type and VIM-type. The frequency of carbapenemase-producing Klebsiella pneumoniae in hospitals of Saint Petersburg reached 9.2% (5.9% for NDM-type, 1.4% for ОХА-48-type, 1.9% for NDM-type + ОХА-48-type). Carbapenemase producers were also detected in hospitals of Moscow, Yekaterinburg, Vologda, Murmansk, Kurgan, Krasnoyarsk, Izhevsk, Krasnodar and Perm. In total 281 carbapenemase producers were recorded within 2011-2016, which were isolated from infected or colonized patients (K.pneumoniae - 247 isolates, Acinetobacter spp - 29 isolates, Enterobacter cloacae - 2 isolates, Serratia marcescens - 1 isolate, Escherichia coli - 1 isolate and Proteus mirabilis - 1 isolate). The carbapenemase-producing K.pneumoniae isolates were distinguished by considerable genetic diversity, the NDM-type carbapenemase-producers belonged to eight, КРС-type - to three and ОХА-48-type - to four different sequence-types (STs) respectively. The representatives of the globally dominant genetic line, Clonal Group 258 (CG258), and also a number of the less common lines (ST147, ST273, ST307 and ST377) were detected. The K.pneumoniae strains were distinguished by a high frequency of cross-resistance and the associated resistance to antibiotics of different groups. The frequency of resistance to cephalosporins and fluoroquinolones reached 100%. Among the NDM-type carbapenemase producers the frequency of resistance to aminoglycosides exceeded 90%, among the КРС-type carbapenemase producers the frequency of resistance corresponded to 66% for amikacin and 93% for gentamicin, among the ОХА-48 type carbapenemase producers the frequency of resistance was even lower (50% and 73% respectively). Approximately 80% of the NDM-type, 90% of the КРС-type and only 60% of the ОХА-48-type carbapenemase producers showed a high level of resistance to imipenem and meropenem. The frequency of resistance to tigecycline varied within 6.7% to 14.8% and the frequency of resistance to polymyxin was within 4.2% to 20%. The ОХА-40- and ОХА-23-types carbapenemase-producing Acinetobacter spp. remained susceptible only to polymyxin. It is obvious that the possibility of antibacterial therapy of infections caused by carbapenemases producers is limited.

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The authors declare that there are no conflicts of interest present.