Bacterial resistance to antibiotics has proven difficult to control over the past few decades. The large group of multidrug-resistant bacteria includes carbapenemase-producing bacteria (CPB), for which limited therapeutic options and infection control measures are available. Furthermore, carbapenemases associate with high-risk clones that are defined by the sequence type (ST) to which each bacterium belongs. The objectives of this cross-sectional and retrospective study were to describe the CPB population isolated in a third-level hospital in Southern Spain between 2015 and 2020 and to establish the relationship between the ST and the epidemiological situation defined by the hospital. CPB were microbiologically studied in all rectal and pharyngeal swabs and clinical samples received between January 2015 and December 2020, characterizing isolates using MicroScan and mass spectrometry. Carbapenemases were detected by PCR and Sanger sequencing, and STs were assigned by multilocus sequence typing (MLST). Isolates were genetically related by pulsed-field gel electrophoresis using Xbal, Spel, or Apal enzymes. The episodes in which each CPB was isolated were recorded and classified as involved or non-involved in an outbreak. There were 320 episodes with CPB during the study period: 18 with K. pneumoniae, 14 with Klebisella oxytoca, 9 with Citrobacter freundii, 11 with Escherichia coli, 46 with Enterobacter cloacae, 70 with Acinetobacter baumannii, and 52 with Pseudomonas aeruginosa. The carbapenemase groups detected were OXA, VIM, KPC, and NDM with various subgroups. Synchronous relationships were notified between episodes of K. pneumoniae and outbreaks for ST15, ST258, ST307, and ST45, but not for the other CPB. There was a major increase in infections with CPB over the years, most notably during 2020, coinciding with the COVID-19 pandemic. This study highlights the usefulness of gene sequencing techniques to control the spread of these microorganisms, especially in healthcare centers. These techniques offer faster results, and a reduction in their cost may make their real-time application more feasible. The combination of epidemiological data with real-time molecular sequencing techniques can provide a major advance in the transmission control of these CPB and in the management of infected patients. Real-time sequencing is essential to increase precision and thereby control outbreaks and target infection prevention measures in a more effective manner.

中文翻译：

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在西班牙中型城市地区医院进行的一项研究表明，与 COVID-19 大流行相吻合的碳青霉烯类细菌的感染/定植显着增加

在过去的几十年里，细菌对抗生素的耐药性已被证明难以控制。大量的多重耐药菌包括碳青霉烯酶产生菌 (CPB)，可用于治疗选择和感染控制措施有限。此外，碳青霉烯酶与由每个细菌所属的序列类型 (ST) 定义的高风险克隆相关联。这项横断面和回顾性研究的目的是描述 2015 年至 2020 年在西班牙南部一家三级医院隔离的 CPB 人群，并建立 ST 与医院定义的流行病学情况之间的关系。在 2015 年 1 月至 2020 年 12 月期间收到的所有直肠和咽拭子和临床样本中，对 CPB 进行了微生物学研究，使用 MicroScan 和质谱法表征分离株。通过PCR和Sanger测序检测碳青霉烯酶，通过多位点序列分型（MLST）分配ST。通过使用 Xbal、Spel 或 Apal 酶的脉冲场凝胶电泳，分离物在遗传上相关。记录了每个 CPB 被隔离的事件，并将其分类为涉及或不涉及爆发。在研究期间有 320 次 CPB 发作：18 次与肺炎克雷伯菌，14 例含催产素克雷伯菌，9 例含弗氏柠檬酸杆菌，11 例含大肠杆菌，46 例含阴沟肠杆菌，70 例含鲍曼不动杆菌，52 例含铜绿假单胞菌。检测到的碳青霉烯酶组为 OXA、VIM、KPC 和 NDM，具有不同的亚组。肺炎克雷伯氏菌发作之间的同步关系得到通知和 ST15、ST258、ST307 和 ST45 的爆发，但不是其他 CPB。多年来，CPB 感染大幅增加，最显着的是在 2020 年期间，恰逢 COVID-19 大流行。这项研究强调了基因测序技术在控制这些微生物传播方面的作用，尤其是在医疗中心。这些技术提供更快的结果，并且成本的降低可能使它们的实时应用更加可行。流行病学数据与实时分子测序技术相结合，可以在这些 CPB 的传播控制和受感染患者的管理方面取得重大进展。实时测序对于提高精确度至关重要，从而以更有效的方式控制疫情和针对感染预防措施。