Abstract

Infectious complications caused by antibiotic-resistant strains in burn-injury patients account for 30–75% of all deaths. For optimal clinical control, it is important to know the susceptibility profile, the mechanisms of antimicrobial resistance, and the predominant genetic lineage. The aim of the study is to investigate the mechanisms of antibiotic resistance of the main causative agents of pyroinflammatory complications in patients with burns. In 2011–2017, 90 patients were examined with deep burns who were being treated at the Regional Clinical Hospital. Materials were investigated by a bacteriological method (MALDI-TOF). Antibiotic sensitivity was studied by disk-diffusion, PCR, E-test, and serial dilutions in Muller–Hinton broth methods. Genotyping and determination of resistance mechanisms were studied by PCR sequencing. The prevalence of a mixed flora of multi- and extremely resistant pathogens, representatives of the ESKAPE group, has been established. A total of 66.7% of P. aeruginosa strains (n = 9) had blaVIM, and 22.2% had blaCTX-M. Fifty percent of A. baumannii strains (n = 8) had blaOXA-24-like, 25% had blaOXA-23-like, and 100% had blaOXA-51-like ompA and adeR. Fifty percent of K. pneumonia strains (n = 2) had blaTEM and blaCTX-M, and 100% had blaSHV, ompK36. MRSA PVL-isolates (n = 10) belonging to the ST239, spat037, SCCmecIIIA, tst variant had the aacA-aphD and aadD resistance genes; ermA; tetM; cat (2.5-kb plasmid); mutations were revealed in GyrA-Ser84Leu and GrlA- Ser80Phe, as well as in rpoB-His481Asn and Ile527Met. The distribution of P. aeruginosa, A. baumannii, and K. pneumoniae strains with carbapenemases and other mechanisms among patients with burns was revealed. MRSA strains were due to the resistance genes and the presence of mutations in chromosomal genes.

中文翻译：

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热烧伤感染患者抗生素耐药的分子遗传学机制

摘要

烧伤患者中由抗生素耐药菌株引起的感染性并发症占所有死亡人数的 30-75%。为了获得最佳的临床控制，重要的是要了解易感性概况、抗菌素耐药性机制和主要遗传谱系。该研究的目的是调查烧伤患者炎症并发症的主要致病因子的抗生素耐药性机制。2011-2017 年，对在地区临床医院接受治疗的 90 名深度烧伤患者进行了检查。通过细菌学方法 (MALDI-TOF) 研究材料。在 Muller-Hinton 肉汤法中，通过纸片扩散、PCR、电子测试和系列稀释研究了抗生素敏感性。通过 PCR 测序研究了基因分型和耐药机制的确定。已经确定了以 ESKAPE 组为代表的多重和极端耐药病原体混合菌群的流行。总计 66.7%铜绿假单胞菌菌株 ( n = 9) 具有 blaVIM，22.2% 具有 blaCTX-M。50% 的鲍曼不动杆菌菌株 ( n = 8) 具有 blaOXA-24 样，25% 具有 blaOXA-23 样，100% 具有 blaOXA-51 样 ompA 和 adeR。50% 的肺炎克雷伯菌菌株 ( n = 2) 具有 blaTEM 和 blaCTX-M，100% 具有 blaSHV、ompK36。属于 ST239、spa t037、SCCmecIIIA、tst变体的MRSA PVL 分离株（n = 10）具有 aacA-aphD 和 aadD 抗性基因；尔玛; 四月; 猫（2.5-kb 质粒）；在 GyrA-Ser84Leu 和 GrlA-Ser80Phe 以及 rpoB-His481Asn 和 Ile527Met 中揭示了突变。铜绿假单胞菌的分布、鲍曼不动杆菌和肺炎克雷伯菌菌株在烧伤患者中具有碳青霉烯酶和其他机制。MRSA菌株是由于耐药基因和染色体基因突变的存在。