摘要
      抗微生物耐药性（AMR）是全球公共卫生的威胁。碳青霉烯类抗生素是β-内酰胺类抗生素，用作治疗抗生素耐药性感染的最后手段。可移动遗传元件（MGEs）在抗微生物耐药性基因（ARGs）的传播和表达中发挥着重要作用，包括ARGs在物种内部和物种之间的动员。在非洲的细菌分离株中，碳青霉烯水解酶（称为碳青霉烯酶）周围存在MGE，这令人担忧。本文描述了MGE和碳青霉烯酶之间的关联。在从人类、动物和环境中分离的相同和不同克隆和物种中，发现特异性质粒复制子、整合子、转座子和插入序列位于特异性和不同碳青霉烯酶的侧翼。值得注意的是，在非非洲国家也有类似的遗传背景报告，支持MGE在推动碳青霉烯酶在非洲和全球的体内、跨克隆和物种传播方面的重要性。由于全基因组测序研究相对较少，技术和预算限制仍然是非洲碳青霉烯酶流行病学分析的挑战。抗生素耐药性感染中MGE的特征可以加深我们对碳青霉烯酶流行病学的理解，并促进非洲AMR的控制。对基因组流行病学的投资将有助于加快临床干预和遏制疫情。
Abstract
Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β-lactam antibiotics used as last-resort agents for treating antibiotic-resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem-hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non-African countries, supporting the importance of MGEs in driving the intra- and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole-genome sequencing remained relatively few. Characterization of MGEs in antibiotic-resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.

https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/nyas.14703