临床分离高黏液肺炎克雷伯菌耐药性及基因组特征分析
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R181.3+2

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淮安市自然科学研究计划项目(HABZ202109);江苏省预防医学科研课题(Y2018047);淮安市社会发展计划(HAS202409)


Drug resistance and genomic characteristics of clinically isolated hypermucoviscous Klebsiella pneumoniae
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    摘要:

    目的 分析临床分离高黏液肺炎克雷伯菌(hmKp)的耐药情况及基因组特征。方法 收集2019—2023年分离自淮安市国家致病菌识别网哨点医院临床标本的肺炎克雷伯菌,使用VITEK 2 Compact对菌株进行鉴定,拉丝试验判断黏液表型,微量肉汤稀释法测定hmKp的耐药性。应用全基因组测序技术进行分子分型, 并对菌株携带的毒力和耐药基因进行注释。结果 共收集hmKp 60株,主要分离自痰标本(33.33%)和血标本 (28.33%)。60株菌株基因组平均大小为5.6 Mb,平均GC含量为57.09%。多位点序列分型(ST)显示,有28种ST型,优势ST型为ST11(11.67%)、ST15(11.67%)和ST412(10.00%)。核心基因组多位点序列分型(cgMLST)分析发现,部分菌株高度同源,未发现暴发菌株。多重耐药菌株占60.00%,耐亚胺培南菌株占28.33%。共携带64种耐药基因,其中84.38%的耐药基因位于可移动原件上,磷霉素相关耐药基因、超广谱β-内酰胺类抗生素相关耐药基因在菌株中携带率较高,分别为100%、98.33%。碳青霉烯类耐药基因blaKPC-2,21.67%由ST11、ST1和ST15菌株携带;blaNDM-5基因3.33%由ST76菌株携带。共携带101种毒力基因,其中Colibactin和Ⅵ型分泌系统相关毒力基因种类最多。所有菌株均携带荚膜合成调节相关基因(rcsA、rcsB)、外排泵相关基因(acrA、acrB)和肠杆菌素相关基因(entABCEF、fepABCDFG、fes)。结论 淮安地区临床分离的hmKp呈现多重耐药,优势ST型为ST11、ST15和ST412,携带多种能够进行水平转移的耐药基因和毒力基因,应加强防控措施。

    Abstract:

    Objective To analyze the drug resistance and genomic characteristics of clinically isolated hypermucoviscous Klebsiella pneumoniae (hmKp). Methods Klebsiella pneumoniae isolated from clinical specimens from the sentinel hospitals of National Pathogen Identification Network in Huai’an City from 2019 to 2023 were collected, strains were identified by VITEK 2 Compact, mucus phenotype was determined by string test, resistance of hmKp was determined by microbroth dilution method. Molecular typing was conducted by whole-genome sequencing technology, annotation of virulence and resistance genes carried by strains was performed. Results A total of 60 strains of hmKp were collected, mainly isolated from sputum specimens (33.33%) and blood specimens (28.33%). The average genome size of 60 strains was 5.6 Mb, with an average GC content of 57.09%. Multilocus sequence typing (MLST) showed that there were 28 ST types, with the dominant ST types being ST11 (11.67%), ST15 (11.67%), and ST412 (10.00%). Core genome MLST (cgMLST) analysis revealed that some strains were highly homologous, and no outbreak strains were found. Multidrug-resistant strains accounted for 60.00%, while imipe-nem-resistant strains accounted for 28.33%. 64 types of resistance genes were carried, 84.38% of which were located on mobile element. The carriage rates of fosfomycin-related resistance genes and extended-spectrum β-lactam antibiotic-related resistance genes were relatively high in the strains, at 100% and 98.33%, respectively. Among carbapenem-resistance gene blaKPC-2, 21.67% was carried by ST11, ST1, and ST15 strains, among blaNDM-5 gene, 3.33% was carried by ST76 strain. A total of 101 virulence genes were carried, most were Colibactin and type Ⅵ secretion system-related virulence genes. All strains carried capsule synthesis regulation-related genes (rcsA, rcsB), efflux pump-related genes (acrA, acrB), and enterobacterin-related genes (entABCEF, fepABCDFG, fes). Conclusion Clinically isolated hmKp in Huai’an exhibits multidrug resistance, with dominant ST types ST11, ST15, and ST412, carrying multiple horizontally transferable resistance and virulence genes, prevention and control measures should be strengthened.

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李兵兵,陈大伟,刘靓,等.临床分离高黏液肺炎克雷伯菌耐药性及基因组特征分析[J]. 中国感染控制杂志,2025,24(1):113-120. DOI:10.12138/j. issn.1671-9638.20256142.
LI Bingbing, CHEN Dawei, LIU Liang, et al. Drug resistance and genomic characteristics of clinically isolated hypermucoviscous Klebsiella pneumoniae[J]. Chin J Infect Control, 2025,24(1):113-120. DOI:10.12138/j. issn.1671-9638.20256142.

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  • 收稿日期:2024-02-23
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  • 在线发布日期: 2025-01-24
  • 出版日期: 2025-01-28