Changes in the Structure of Antibiotic Resistance Genes of Enterobacterales Strains Isolated from Patients of a Perinatal Center during Long-term Monitoring

Relevance. The problem of resistance to antibacterial drugs is one of the main ones for the healthcare systems of the Russian Federation and other countries. Currently, there is an increase in the number of antibiotic-resistant strains both among pathogens of infections associated with the provision of medical care and among representatives of the normal microbiocenosis of non-sterile loci of the human body.

The purpose of the study is to analyze changes in the structure of genetic determinants of antibiotic resistance of ESBL-producing representatives of the order Enterobacterales isolated from patients of the perinatal center during six years monitoring.

Materials and methods. The genetic profile of antibiotic resistance was determined in ESBL-producing strains of Enterobacteria isolated from samples of biological material obtained from 221 women and 241 newborn children hospitalized in the departments of the Federal State Budgetary Institution "Research Institute of OMM" of the Ministry of Health of Russia in the period from 2019 to 2024. inclusive. DNA of bacterial cells was isolated from a daily culture of microorganisms using the PROBANK kit, detection of the tem, ctx-M-1, shv genes; oxa-40-like, oxa-48- like, oxa-23- like, oxa-51- like, imp, kps, ges, ndm, vim were carried out using the diagnostic kit «BakResist GLA» on the detecting amplifier DT-48 (DNA -technology, Russia ). To assess the statistical significance of differences in gene frequency of occurrence of genes, Pearson's x2 test with Yates' correction was used.

Results and discussion. The number of genovariants of antibiotic resistance of Enterobacteriaceae isolated from patients in obstetrics and gynecology departments from 2019 to 2024, as well as in children, increased from 3 to 7. However, the dynamics of increasing diversity of genetic determinants of antibiotic resistance differed. Thus, in 2019, 3 genovariants were detected, in 2020, 4 variants were recorded, and in the next year, 2021, 6 genovariants were registered. In the next three years (2022 – 2024), the spectrum of determinants of antibiotic resistance was represented by 7 genetic variants, their structure underwent changes. In 2019, the blaCTX-M and blaSHV genes predominated with the same frequency (30 %). In 2020, the blaCTX-M + blaTEM genovariant was isolated more often (37.5 %). In 2021, 2022 and 2024 strains with the blaCTX-M gene dominated, registered in 59.5 %, 37.7 %, 36.9 % of cases, respectively. In 2023, the frequency of isolation of the blaCTX-M gene (27.1 %) was comparable to the frequency of occurrence of the blaCTX-M + blaTEM genovariant (30 %) (p = 0.852). The genetic profile of antibiotic resistance of Enterobacteriaceae strains isolated from patients in obstetrics, gynecology and pediatric departments is represented by 12 genovariants, in which the dominant gene providing resistance to beta-lactam antibiotics among Enterobacteriaceae during the entire observation period is blaCTX-M. The absence of significant differences in the frequency of occurrence of the studied antibiotic resistance genes and their combinations in Escherichia coli and Klebsiella pneumoniae strains isolated from both children and women indicates the same genetic determinants that ensure the synthesis of enzymes that inactivate beta-lactam antibacterial drugs of the cephalosporin group. The dynamics of changes in the structure of antibiotic resistance genovariants and the predominance of one or another type of bacteria may differ in departments of different profiles, which requires continuous monitoring of the spectrum of species diversity of bacteria and their antibiotic sensitivity for timely recording of the deterioration of the epidemiological situation and the adoption of adequate anti-epidemic measures.

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