PDF(Pubmed)
Abstract：
Extensively drug-resistant and hypervirulent Klebsiella pneumoniae (XDR-hvKp) is a new problem for patients in Intensive Care Unit (ICU) and can become an even more severe threat if resistant to tigecycline, considered one of the \'last lines of defense\' drugs. This study collected seven non-replicated tigecycline-resistant XDR-hvKp from seven patients and performed genome analysis and epidemiological investigation using whole genome equencing (WGS) and other methods. All strains in this study were identified as ST11-KL64 and showed high resistance to antibiotics such as β-lactams, aminoglycosides, quinolones, and tigecycline, and one strain was also resistant to colistin. All strains were determined to be hvKp by the results of serum resistance assay and Galleria mellonella infection models. All strains had resistance genes bla CTX-M-65,bla KPC-2,bla LAP-2,bla TEM-1B, rmtB, and qnrS1 and virulence factors such as rmpA, rmpA2, and aerobactin (iucABCD, iutA). The expression of the AcrAB-TolC efflux pump was upregulated in all strains, and the expression levels of the gene pmrK was significantly upregulated in colistin-resistant strain DP compared to colistin-sensitive strain WT in this study. In conclusion, we described an outbreak caused by tigecycline-resistant XDR-hvKp in the ICU of a teaching hospital in southwest China. The spread of these superbugs poses a great threat to patients and therefore requires us to closely monitor these XDR-hvKp and develop relevant strategies to combat them.
摘要：
广泛耐药和高毒力肺炎克雷伯菌（XDR-hvKp）是重症监护病房（ICU）患者的新问题，如果对替加环素耐药，则可能成为更严重的威胁。被认为是“最后一道防线”的药物之一。本研究从7例患者中收集了7例未复制的替加环素耐药XDR-hvKp，并使用全基因组测序（WGS）和其他方法进行了基因组分析和流行病学调查。本研究中的所有菌株均被鉴定为ST11-KL64，并对β-内酰胺等抗生素表现出高度耐药性，氨基糖苷类,喹诺酮类药物,还有替加环素,一株菌株对粘菌素也有抗性。通过血清抗性测定和GalleriaMellonella感染模型的结果确定所有菌株均为hvKp。所有菌株均具有抗性基因blaCTX-M-65，blaKPC-2，blaLAP-2，blaTEM-1B，rmtB,和qnrS1和rmpA等毒力因子，rmpA2和aerobactin(iucABCD，IutA）。AcrAB-TolC外排泵的表达在所有菌株中均上调，与粘菌素敏感菌株WT相比，粘菌素抗性菌株DP中pmrK基因的表达水平显着上调。总之,我们描述了中国西南某教学医院ICU中替加环素耐药XDR-hvKp引起的疫情.这些叠加细菌的传播对患者构成了巨大威胁，因此需要我们密切监视这些XDR-hvKp并制定相关策略来对抗它们。
