基于全基因组测序的耐碳青霉烯类肺炎克雷伯菌的流行病学特征与耐药及毒力基因研究
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R181.3+2 R378.99+6

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河南省医学科技攻关计划联合共建项目(LHGJ20230920)


Epidemiological characteristics, antimicrobial resistance genes, and virulence genes of carbapenem-resistant Klebsiella pneumoniae: a study based on whole genome sequencing
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    摘要:

    目的 探讨某地区耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床特点、耐药基因及毒力基因分子流行病学特征,为CRKP感染的防治及流行病学研究提供科学依据。方法 回顾性分析2023年11月—2024年9月濮阳油田总医院临床分离的非重复CRKP 60株。采用VITEK 2 Compact全自动微生物分析仪、K-B纸片扩散法及微量肉汤稀释法进行药敏试验;拉丝试验鉴定菌株的黏液表型;碳青霉烯酶抑制剂增强试验检测碳青霉烯酶;通过全基因组测序及生物信息学分析确定菌株的多位点序列分型(MLST)、荚膜血清型、耐药基因、毒力基因、质粒复制类型等分子特征及菌株的亲缘与进化关系。结果 CRKP主要分离自老年男性住院患者,标本多来源于痰(71.67%),主要分布在呼吸内科(30.00%)。所有菌株对多种常见抗菌药物均高度耐药,仅对头孢他啶/阿维巴坦、替加环素和多黏菌素B敏感率较高(>60.00%)。2株CRKP拉丝试验阳性,95.00%的菌株产A类丝氨酸碳青霉烯酶。所有菌株均携带氟喹诺酮类、磷霉素类、β-内酰胺类和氨基糖苷类耐药基因,肠杆菌素、大肠埃希菌共有菌毛(ECP)和外膜蛋白相关毒力基因,以及IncF质粒家族的质粒。碳青霉烯酶基因以blaKPC-2(95.00%)为主,荚膜血清型以KL19(43.33%)为主,MLST中ST11(51.67%)为主要优势克隆群,ST11-KL62(12株)为优势亚型。结论 该院CRKP对多种常见抗菌药物高度耐药,其对碳青霉烯类药物耐药的机制主要与携带blaKPC-2耐药基因相关。所有菌株多种耐药基因、多种毒力基因共存,呈多克隆传播现象,ST11为主要优势克隆群,ST11-KL62为主要流行的亚克隆型别。

    Abstract:

    Objective To explore the clinical characteristics as well as molecular epidemiological features of resis-tance genes and virulence genes of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in a region, and provide scientific basis for the prevention, treatment, and epidemiological study of CRKP. Methods 60 non-repetitive CRKP strains isolated clinically from Puyang Oilfield General Hospital from November 2023 to September 2024 were analyzed retrospectively. Antimicrobial susceptibility testing was performed using VITEK 2 Compact automa-tic microbial analyzer, K-B disk diffusion method, and micro-broth dilution method. Mucus phenotype of bacterial strains was identified by string test. Carbapenemase was detected by carbapenemase inhibitor enhancement assay. Molecular features, such as multi-locus sequence typing (MLST), capsule serotypes, resistance genes, virulence genes, plasmid replication types of strains, as well as the genetic and evolutionary relationships of strains were determined by whole genome sequencing and bioinformatics analysis. Results CRKP strains were mainly isolated from elderly male hospitalized patients. Specimens were mostly from sputum (71.67%), mainly distributed in department of respiratory medicine (30.00%). All strains were highly resistant to multiple commonly used antimicrobial agents, only with high susceptibility rates to cefotaxime/avibactam, tigecycline, and polymyxin B (>60.00%). Two CRKP strains were positive for string test. 95.00% of the strains produced class A serine carbapenemase. All strains carried fluoroquinolone, phosphomycin, β-lactam, and aminoglycoside resistance genes; enterobactin, Esche-richia coli common pilus (ECP), and outer membrane protein-related virulence genes; as well as plasmids from the IncF plasmid family. Carbapenemase gene was mainly blaKPC-2 (95.00%), and the major capsule serotype was KL19 (43.33%). In MLST, ST11 (51.67%) was the dominant clone group, and ST11-KL62 (n=12) was the dominant subtype. Conclusion CRKP in this hospital is highly resistant to multiple commonly used antimicrobial agents, and its mechanism of resistance to carbapenems is mainly related to the presence of blaKPC-2 resistance gene. All strains have coexisting multiple resistance genes and virulence genes, and show a phenomenon of multi-clone transmission. ST11 is the dominant clone group, and ST11-KL62 is the main prevalent subclone type.

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饶玉婷,姜蕾,葛茹,等.基于全基因组测序的耐碳青霉烯类肺炎克雷伯菌的流行病学特征与耐药及毒力基因研究[J]. 中国感染控制杂志,2025,24(10):1367-1376. DOI:10.12138/j. issn.1671-9638.20252389.
RAO Yuting, JIANG Lei, GE Ru, et al. Epidemiological characteristics, antimicrobial resistance genes, and virulence genes of carbapenem-resistant Klebsiella pneumoniae: a study based on whole genome sequencing[J]. Chin J Infect Control, 2025,24(10):1367-1376. DOI:10.12138/j. issn.1671-9638.20252389.

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  • 收稿日期:2025-04-18
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  • 在线发布日期: 2025-10-29
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