耐碳青霉烯类肺炎克雷伯菌全基因组测序及黏菌素耐药分析
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R181.3+2;R378.99+6

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安徽医科大学第二附属医院临床研究培良计划项目(2021LCYB04);安徽省高校自然科学研究项目(2023AH053175);安徽省转化医学研究院科研基金项目(2023zhyx-C78);安徽省转化医学研究院科研基金项目(2021zhyx-C47)


Whole-genome sequencing and colistin resistance of carbapenem-resistant Klebsiella pneumoniae
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    摘要:

    目的 通过全基因组测序分析临床耐碳青霉烯类肺炎克雷伯菌(CRKP)的分子流行病学及黏菌素耐药基因,为临床诊疗提供参考。方法 收集2021—2023年安徽省某三级甲等综合医院住院患者临床标本分离的57株CRKP,对所有菌株进行药敏试验。采用全基因测序技术分析CRKP菌株多位点序列分型、荚膜血清型、耐药基因和毒力基因,并对所有菌株序列进行单核苷酸多态性分析,采用聚合酶链式反应(PCR)方法扩增与黏菌素耐药相关基因。结果 57株CRKP对除替加环素外的14种抗菌药物均为耐药。测序结果显示,93.0%(53/57)的CRKP携带blaKPC-2,ST11型CRKP菌株检出率最高(51/57,89.5%)。单核苷酸多态性聚类分析表明,57株CRKP分为11个克隆群,其中有4个克隆群均为ST11-KL64型CRKP。40株(70.2%)CRKP携带多种毒力基因。5株黏菌素耐药CRKP,其耐药机制是在mgrB基因70位点处插入一个ISKpn26元件。结论 CRKP菌株以产KPC-2 ST11-KL64型为主要流行型,在重症监护病房有播散性流行。ISKpn26元件插入引起mgrB基因突变与该地区CRKP黏菌素耐药有关。

    Abstract:

    Objective To analyze the molecular epidemiology and colistin-resistant genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) by whole-genome sequencing, and to provide reference for clinical diagnosis and treatment. Methods 57 CRKP strains isolated from clinical specimens of hospitalized patients in a tertiary general first-class hospital in Anhui Province from 2021 to 2023 were collected and antimicrobial susceptibility testing was performed. Multilocus sequence typing, capsule serotype, resistance genes, and virulence genes of CRKP strains were analyzed by whole-genome sequencing technique, and single nucleotide polymorphism analysis was conducted on sequences of all strains. Colistin resistance-related genes were amplified by polymerase chain reaction (PCR). Results 57 CRKP strains exhibited resistance to 14 antimicrobial agents, with the exception of tigecycline. The sequencing results showed that 93.0% (53/57) of CRKP carried blaKPC-2, and the ST11 type CRKP strain had the highest detection rate (51/57, 89.5%). Single nucleotide polymorphism clustering analysis showed that the 57 CRKP strains were divided into 11 clone groups, of which 4 clone groups were all ST11-KL64 type CRKP. 40 (70.2%) CRKP strains carried multiple virulence genes. Five strains of CRKP were colistin-resistant strains, the resistance mechanism involved the insertion of ISKpn26 element at site 70 of the mgrB gene. Conclusion The CRKP strain is primarily characterized by the production of KPC-2 ST11-KL64, with disseminated transmission in intensive care unit. The insertion of ISKpn26 element leading to mgrB gene mutation is related to resistance of CRKP to colistin in this region.

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储雯雯,刘周,李昕,等.耐碳青霉烯类肺炎克雷伯菌全基因组测序及黏菌素耐药分析[J]. 中国感染控制杂志,2025,24(1):37-44. DOI:10.12138/j. issn.1671-9638.20256485.
CHU Wenwen, LIU Zhou, LI Xin, et al. Whole-genome sequencing and colistin resistance of carbapenem-resistant Klebsiella pneumoniae[J]. Chin J Infect Control, 2025,24(1):37-44. DOI:10.12138/j. issn.1671-9638.20256485.

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  • 收稿日期:2024-05-11
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  • 在线发布日期: 2025-01-24
  • 出版日期: 2025-01-28