某教学医院耐碳青霉烯类高毒力肺炎克雷伯菌临床及分子特征
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1.蚌埠医学院第一附属医院感染性疾病科, 安徽 蚌埠 233004;2.蚌埠医学院第一附属医院检验科, 安徽 蚌埠 233004;3.蚌埠医学院第一附属医院输血科, 安徽 蚌埠 233004;4.齐齐哈尔医学院临床医学系, 黑龙江 齐齐哈尔 161006

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郭普  E-mail: 3504624902@qq.com

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安徽省高校自然科学研究项目(KJ2021A0761)


Clinical and molecular characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in a teaching hospital
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Affiliation:

1.Department of Infectious Diseases, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China;2.Department of Labotory Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China;3.Department of Blood Transfusion, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China;4.Department of Clinical Medicine, School of Basic Medicine, Qiqihar Medical University, Qiqihar 161006, China

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    摘要:

    目的 了解临床分离的耐碳青霉烯类高毒力肺炎克雷伯菌(CR-hvKP)的耐药、毒力及流行病学特征。 方法 收集安徽省某教学医院2018年1月-2020年12月临床分离的耐碳青霉烯类肺炎克雷伯菌(CRKP),并分析其临床特征。采用飞行时间质谱鉴定菌株,拉丝试验及检测毒力基因筛选出CR-hvKP,按1:1配比选取与CR-hvKP同病室或相近时间内分离的碳青霉烯耐药非高毒力肺炎克雷伯菌(CR-non-hvKP)作为对照组,采用全基因组测序检测分析CR-hvKP及对照组CR-non-hvKP的荚膜血清型、耐药、毒力基因及ST分型,比较两组菌株间的差异。 结果 共分离512株CRKP,其中CR-hvKP 30株,CR-non-hvKP 482株。CR-hvKP感染患者多为老年(20例,66.67%),存在呼吸系统疾病(29例,96.67%)、消化系统疾病(12例,40.00%)、感染性休克(10例,33.33%)、侵入性治疗(23例,76.67%)以及高病死率(20例,66.67%)。CR-hvKP对常用的大多数抗菌药物耐药率>90%,对替加环素的耐药率为3.33%,对多粘菌素B全部敏感,与CR-non-hvKP的耐药率比较,差异无统计学意义(P>0.05)。测序结果表明:CR-hvKP携带主要的碳青霉烯耐药基因为blaKPC-2(28株,93.33%),耐药基因SHV-11、mph(A)和armA检出率低于CR-non-hvKP菌株。30株CR-hvKP携带的毒力基因iucA、iutA、fimF、fimH、mrkD检出率均为100%,高于CR-non-hvKP菌株,差异均有统计学意义(均P < 0.05)。CR-hvKP菌株中ST11-K64检出率(76.67%)高于CR-non-hvKP菌株(40.00%),差异有统计学差异(P < 0.05)。 结论 该院主要流行株为ST11-K64产KPC-2酶的CR-hvKP,携带较多毒力和耐药基因,病死率高,临床应重点关注老年及重症监护病房患者。

    Abstract:

    Objective To understand the drug resistance, virulence and epidemiological characteristics of clinically isolated carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP). Methods Clinically isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from a teaching hospital in Anhui Province from January 2018 to December 2020 were collected, their clinical characteristics were analyzed. Bacterial trains were identified by time-of-flight mass spectrometry, CR-hvKP was screened out by string test and virulence gene detection, carbapenem-resistant non-hypervirulent Klebsiella pneumoniae (CR-non-hvKP)isolated in the same ward or at a similar time with CR-hvKP was as control group according to 1:1 ratio. The whole genome sequencing was used to analyze the capsule serotype, drug resistance, virulence gene and ST typing of CR-hvKP and CR-non-hvKP in control group, difference between two groups of strains was compared. Results A total of 512 CRKP strains were isolated, including 30 CR-hvKP strains and 482 CR-non-hvKP strains. Most patients with CR-hvKP infection were the elderly (n=20, 66.67%), with respiratory diseases (n=29, 96.67%), digestive system diseases (n=12, 40.00%), septic shock (n=10, 33.33%), invasive treatment (n=23, 76.67%) and high mortality (n=20, 66.67%). Resistant rates of CR-hvKP to most commonly used antimicrobial agents were>90%, to tegacyclin was 3.33%, and all were sensitive to polymyxin B. There was no statistically significant difference in resistance between CR-hvKP and CR-non-hvKP (P>0.05). Sequencing results showed that the major carbapenem-resistance gene carried by CR-hvKP was blaKPC-2 (n=28, 93.33%). Detection rate of resistant genes SHV-11, mph(A) and armA were lower than those of CR-non-hvKP strains. Detection rates of virulence genes iucA, iutA, fimF, fimH and mrkD carried by 30 CR-hvKP strains were all 100%, which was higher than those of CR-non-hvKP strains, with statistically significant difference (all P < 0.05). Detection rate of ST11-K64 in CR-hvKP strains was higher than that in CR-non-hvKP strains (76.67% vs 40.00%, P < 0.05). Conclusion KPC-2-producing ST11-K64 CR-hvKP is the main prevalent strain in the hospital, which carries more virulence and drug resistance genes and has a high mortality. The elderly and intensive care unit patients should be paid more attention in clinic.

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乔艳,孙红,李江艳,等.某教学医院耐碳青霉烯类高毒力肺炎克雷伯菌临床及分子特征[J]. 中国感染控制杂志,2022,(12):1185-1192. DOI:10.12138/j. issn.1671-9638.20223363.
Yan QIAO, Hong SUN, Jiang-yan LI, et al. Clinical and molecular characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in a teaching hospital[J]. Chin J Infect Control, 2022,(12):1185-1192. DOI:10.12138/j. issn.1671-9638.20223363.

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  • 收稿日期:2022-09-13
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  • 在线发布日期: 2024-04-28
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