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Abstract：
BACKGROUND: Carbapenems are β-lactam antibiotics which are used to treat severe infections caused by multidrug resistant Enterobacteriacea. The recent emergence and rapid spread of Enterobacteriaceae resistant to carbapenems is a global concern. We undertook a systematic review of the antibiotic susceptibility and genotypic characteristics of carbapenem-resistant Enterobacteriaceae in Chinese neonates.
METHODS: Systematic literature reviews were conducted (PubMed/Medline, Embase, Wanfang medical online databases, China National Knowledge Infrastructure (CNKI) database) regarding sepsis caused by carbapenem-resistant Enterobacteriaceae in Chinese neonates aged 0-30 days.
RESULTS: 17 studies were identified. Eleven patients in the six studies reported the source of infection. Ten patients (10/11, 90.9%) were hospital-acquired infections. Genotypic data were available for 21 isolates in 11 studies (20 K. pneumoniae, 1 E. coli). NDM-1 was the most frequently reported carbapenem-resistant genotype (81.0%, 17/21). Carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were resistant to many antibiotic classes with the exception of colistin and fosfomycin. Sequence type 105 (ST105) was the most commonly reported K. pneumoniae ST type (30.8%; 4/13), which was from the same hospital in Western China. ST17 and ST20 were the second and third most common K. pneumoniae ST type, 23.1% (3/13) and 15.4% (2/13) respectively. The three strains of ST17 are all from the same hospital in central China. The two strains of ST20, although not from the same hospital, belong to the eastern part of China.
CONCLUSIONS: Klebsiella pneumoniae with the NDM-1 genotype was the leading cause of neonatal carbapenem resistant sepsis in China. Hospital acquired infection is the main source of carbapenem resistant sepsis. There is currently no licenced antibiotic regimen available to treat such an infection in China. Improved surveillance, controlling nosocomial infection and the rational use of antibiotics are the key factors to prevent and reduce its spread.
METHODS: Systematic literature reviews were conducted (PubMed/Medline, Embase, Wanfang medical online databases, China National Knowledge Infrastructure (CNKI) database) regarding sepsis caused by carbapenem-resistant Enterobacteriaceae in Chinese neonates aged 0-30 days.
RESULTS: 17 studies were identified. Eleven patients in the six studies reported the source of infection. Ten patients (10/11, 90.9%) were hospital-acquired infections. Genotypic data were available for 21 isolates in 11 studies (20 K. pneumoniae, 1 E. coli). NDM-1 was the most frequently reported carbapenem-resistant genotype (81.0%, 17/21). Carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were resistant to many antibiotic classes with the exception of colistin and fosfomycin. Sequence type 105 (ST105) was the most commonly reported K. pneumoniae ST type (30.8%; 4/13), which was from the same hospital in Western China. ST17 and ST20 were the second and third most common K. pneumoniae ST type, 23.1% (3/13) and 15.4% (2/13) respectively. The three strains of ST17 are all from the same hospital in central China. The two strains of ST20, although not from the same hospital, belong to the eastern part of China.
CONCLUSIONS: Klebsiella pneumoniae with the NDM-1 genotype was the leading cause of neonatal carbapenem resistant sepsis in China. Hospital acquired infection is the main source of carbapenem resistant sepsis. There is currently no licenced antibiotic regimen available to treat such an infection in China. Improved surveillance, controlling nosocomial infection and the rational use of antibiotics are the key factors to prevent and reduce its spread.
摘要：
背景：碳青霉烯类是β-内酰胺类抗生素，用于治疗由多重耐药肠杆菌引起的严重感染。碳青霉烯类耐药肠杆菌科细菌的近期涌现和疾速散布是全球存眷的成绩。我们对中国新生儿耐碳青霉烯类肠杆菌科的抗生素敏感性和基因型特征进行了系统评价。
方法：进行了系统文献综述(PubMed/Medline，Embase,万方医疗在线数据库，中国国家知识基础设施（CNKI）数据库）关于耐碳青霉烯类肠杆菌科细菌在中国0-30天新生儿中引起的败血症。
结果：确定了17项研究。六项研究中有11名患者报告了感染源。10例患者（10/11，90.9%）为医院获得性感染。在11项研究中，有21个分离株的基因型数据(20个肺炎克雷伯菌，1大肠杆菌）。NDM-1是最常见的碳青霉烯类耐药基因型（81.0%，17/21).耐碳青霉烯类肺炎克雷伯菌和大肠埃希菌对粘菌素和磷霉素以外的许多抗生素类别均具有耐药性。序列类型105（ST105）是最常报告的肺炎克雷伯菌ST型（30.8%；4/13），来自中国西部的同一家医院。ST17和ST20是第二和第三最常见的肺炎克雷伯菌ST型，分别为23.1%（3/13）和15.4%（2/13）。ST17的三个菌株均来自中国中部的同一医院。这两种菌株的ST20，虽然不是来自同一家医院，属于中国东部。
结论：NDM-1基因型肺炎克雷伯菌是中国新生儿碳青霉烯类耐药脓毒症的主要原因。医院获得性感染是碳青霉烯类耐药脓毒症的主要来源。目前在中国还没有获得许可的抗生素治疗方案来治疗这种感染。改进监控,控制医院感染和合理使用抗生素是预防和减少其传播的关键因素。
方法：进行了系统文献综述(PubMed/Medline，Embase,万方医疗在线数据库，中国国家知识基础设施（CNKI）数据库）关于耐碳青霉烯类肠杆菌科细菌在中国0-30天新生儿中引起的败血症。
结果：确定了17项研究。六项研究中有11名患者报告了感染源。10例患者（10/11，90.9%）为医院获得性感染。在11项研究中，有21个分离株的基因型数据(20个肺炎克雷伯菌，1大肠杆菌）。NDM-1是最常见的碳青霉烯类耐药基因型（81.0%，17/21).耐碳青霉烯类肺炎克雷伯菌和大肠埃希菌对粘菌素和磷霉素以外的许多抗生素类别均具有耐药性。序列类型105（ST105）是最常报告的肺炎克雷伯菌ST型（30.8%；4/13），来自中国西部的同一家医院。ST17和ST20是第二和第三最常见的肺炎克雷伯菌ST型，分别为23.1%（3/13）和15.4%（2/13）。ST17的三个菌株均来自中国中部的同一医院。这两种菌株的ST20，虽然不是来自同一家医院，属于中国东部。
结论：NDM-1基因型肺炎克雷伯菌是中国新生儿碳青霉烯类耐药脓毒症的主要原因。医院获得性感染是碳青霉烯类耐药脓毒症的主要来源。目前在中国还没有获得许可的抗生素治疗方案来治疗这种感染。改进监控,控制医院感染和合理使用抗生素是预防和减少其传播的关键因素。
