产NDM-1和产KPC-2耐碳青霉烯类肺炎克雷伯菌临床及分子流行病学特征比较
作者:
作者单位:

1.国家儿童医学中心 复旦大学附属儿科医院院内感染控制与防保科, 上海 201102;2.国家儿童医学中心 复旦大学附属儿科医院临床检验中心细菌室, 上海 201102

作者简介:

通讯作者:

武娜娜  E-mail: wum891021@163.com
王传清  E-mail: chuanqing523@163.com

中图分类号:

+2  R378.99+6]]>

基金项目:

国家重点研发计划项目(2021YFC2701800、2021YFC2701805)


Comparison in clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae
Author:
Affiliation:

1.Department of Healthcare-associated Infection Control and Health Care, National Children's Medical Center, Shanghai 201102, China;2.Laboratory of Microbiology of Center for Clinical Laboratory, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China

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    摘要:

    目的 比较产NDM-1和产KPC-2耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床及分子流行病学特征。 方法 回顾性分析2017—2020年某儿童医院非重复儿童住院患者临床分离的CRKP, 查阅菌株来源患者的病历资料获得患者的基本临床特征。对CRKP进行药敏试验及多位点序列分型(MLST)分析, 比较产NDM-1和产KPC-2的CRKP临床及分子流行病学特征。 结果 2017—2020年共收集164株CRKP菌株, 其中96株携带blaNDM-1, 68株携带blaKPC-2, 产NDM-1的CRKP主要分布在新生儿科室, 产KPC-2的CRKP以非新生儿科室居多, 两组在标本来源、患者年龄、科室分布和预后情况方面比较, 差异均有统计学意义(均P<0.05);产NDM-1的CRKP菌株以ST 17型和ST 278型为主, 分别为40.63%、18.75%;而产KPC-2的CRKP菌株以ST 11为主, 达73.53%。产KPC-2的CRKP分离株对头孢吡肟、氨曲南、亚胺培南、阿米卡星、庆大霉素、呋喃妥因和磷霉素的耐药率均高于产NDM-1的CRKP分离株, 差异均有统计学意义(均P<0.05)。 结论 产NDM-1和产KPC-2的CRKP菌株在临床及分子流行病学方面均存在差异, 产KPC-2的CRKP菌株表现出更严重的耐药性, 感染KPC-2 CRKP的患者预后较差, 应引起临床和感控的重视。

    Abstract:

    Objective To compare the clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods Clinically isolated non-repetitive CRKP strains from children in a children's hospital from 2017 to 2020 were retrospectively analyzed. Basic clinical characteristics of the patients from whom strains were detected were obtained by referring to their medical records. Antimicrobial susceptibility testing and multilocus sequence typing (MLST) analysis on CRKP were performed. Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP were compared. Results A total of 164 CRKP strains were collected from 2017 to 2020, among which 96 strains carried blaNDM-1 and 68 strains carried blaKPC-2. NDM-1-producing CRKP were mainly from neonatal department, while KPC-2-producing CRKP were mostly from non-neonatal departments. There were statistically significant differences in specimen sources, patient's age, department distribution, and prognosis between the two groups (all P < 0.05). NDM-1-producing CRKP strains were mainly ST 17 and ST 278, accounting for 40.63% and 18.75% respectively, while KPC-2-producing CRKP strains were mainly ST 11 (73.53%). Resistance rates of KPC-2-producing CRKP to cefepime, aztreonam, imipenem, amikacin, gentamicin, furanotoin and fosfomycin were higher than those of NDM-1-producing CRKP, all with statistical significance (all P < 0.05). Conclusion Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP strains are different. KPC-2-producing CRKP strains show more serious antimicrobial resistance and poor prognosis in patients, thus should be paid more attention in clinic and infection control.

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殷丽军,卢露,何磊燕,等.产NDM-1和产KPC-2耐碳青霉烯类肺炎克雷伯菌临床及分子流行病学特征比较[J]. 中国感染控制杂志,2024,23(5):556-562. DOI:10.12138/j. issn.1671-9638.20245367.
Li-jun YIN, Lu LU, Lei-yan HE, et al. Comparison in clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae[J]. Chin J Infect Control, 2024,23(5):556-562. DOI:10.12138/j. issn.1671-9638.20245367.

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  • 收稿日期:2023-12-21
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  • 在线发布日期: 2024-06-24
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