PDF(Pubmed)
Abstract：
Infections caused by multidrug-resistant gram-negative bacteria present a severe threat to global public health. The WHO defines drug-resistant Klebsiella pneumoniae as a priority pathogen for which alternative treatments are needed given the limited treatment options and the rapid acquisition of novel resistance mechanisms by this species. Longitudinal descriptions of genomic epidemiology of Klebsiella pneumoniae can inform management strategies but data from sub-Saharan Africa are lacking.
We present a longitudinal analysis of all invasive K. pneumoniae isolates from a single hospital in Blantyre, Malawi, southern Africa, from 1998 to 2020, combining clinical data with genome sequence analysis of the isolates.
We show that after a dramatic increase in the number of infections from 2016 K. pneumoniae becomes hyperendemic, driven by an increase in neonatal infections. Genomic data show repeated waves of clonal expansion of different, often ward-restricted, lineages, suggestive of hospital-associated transmission. We describe temporal trends in resistance and surface antigens, of relevance for vaccine development.
Our data highlight a clear need for new interventions to prevent rather than treat K. pneumoniae infections in our setting. Whilst one option may be a vaccine, the majority of cases could be avoided by an increased focus on and investment in infection prevention and control measures, which would reduce all healthcare-associated infections and not just one.
We present a longitudinal analysis of all invasive K. pneumoniae isolates from a single hospital in Blantyre, Malawi, southern Africa, from 1998 to 2020, combining clinical data with genome sequence analysis of the isolates.
We show that after a dramatic increase in the number of infections from 2016 K. pneumoniae becomes hyperendemic, driven by an increase in neonatal infections. Genomic data show repeated waves of clonal expansion of different, often ward-restricted, lineages, suggestive of hospital-associated transmission. We describe temporal trends in resistance and surface antigens, of relevance for vaccine development.
Our data highlight a clear need for new interventions to prevent rather than treat K. pneumoniae infections in our setting. Whilst one option may be a vaccine, the majority of cases could be avoided by an increased focus on and investment in infection prevention and control measures, which would reduce all healthcare-associated infections and not just one.
摘要：
背景：多重耐药革兰氏阴性菌引起的感染对全球公共卫生构成严重威胁。WHO将耐药肺炎克雷伯菌定义为优先病原体，鉴于该物种有限的治疗选择和快速获得新的耐药机制，需要替代治疗。肺炎克雷伯菌基因组流行病学的纵向描述可以为管理策略提供信息，但缺乏来自撒哈拉以南非洲的数据。
方法：我们对布兰太尔一家医院的所有侵袭性肺炎克雷伯菌进行了纵向分析，马拉维,南部非洲,从1998年到2020年，将临床数据与分离株的基因组序列分析相结合。
结果：我们表明，在2016年肺炎克雷伯菌感染数量急剧增加后，由于新生儿感染的增加。基因组数据显示不同的克隆扩展的重复波，通常是病房限制，血统,提示与医院相关的传播。我们描述了抗性和表面抗原的时间趋势，与疫苗开发相关。
结论：我们的数据表明，在我们的环境中，显然需要新的干预措施来预防而不是治疗肺炎克雷伯菌感染。虽然一种选择可能是疫苗，通过增加对感染预防和控制措施的关注和投资，可以避免大多数病例，这将减少所有与医疗保健相关的感染，而不仅仅是一种感染。
方法：我们对布兰太尔一家医院的所有侵袭性肺炎克雷伯菌进行了纵向分析，马拉维,南部非洲,从1998年到2020年，将临床数据与分离株的基因组序列分析相结合。
结果：我们表明，在2016年肺炎克雷伯菌感染数量急剧增加后，由于新生儿感染的增加。基因组数据显示不同的克隆扩展的重复波，通常是病房限制，血统,提示与医院相关的传播。我们描述了抗性和表面抗原的时间趋势，与疫苗开发相关。
结论：我们的数据表明，在我们的环境中，显然需要新的干预措施来预防而不是治疗肺炎克雷伯菌感染。虽然一种选择可能是疫苗，通过增加对感染预防和控制措施的关注和投资，可以避免大多数病例，这将减少所有与医疗保健相关的感染，而不仅仅是一种感染。
