■耐碳青霉烯类肺炎克雷伯菌(CRKP)的出现因其显著的抗生素耐药性而引起国际关注。值得注意的是,与成人相比,儿童表现出不同的抗性机制,需要一种不同的抗生素选择方法。对CRKP的流行病学和耐药机制进行全面的分析对于建立临床抗感染策略和精确预防控制措施的坚实基础至关重要。
■这项研究涉及在中国一家三甲医院收集31个来自儿科和成人患者的非重复菌株,从2016年7月到2022年7月,测试抗性基因,抗菌敏感性,和同源性分析。
■婴儿(0-1岁)是最大的小儿CRKP组,61.3%的病例。新生儿重症监护病房(NICU)和儿科是受影响的主要科室。患有CRKP的成年人平均年龄为67岁,神经内科和急诊ICU患病率最高。药敏试验显示成人CRKP菌株对阿米卡星具有较高的耐药性,环丙沙星,复方新诺明,和氨曲南与儿科菌株相比。相反,儿科菌株对头孢他啶/阿维巴坦的耐药率较高。确定的主要抗性基因是儿童的blaNDM-5(58.1%)和成人的blaKPC-2(87.1%),两组中超过93%的超广谱β-内酰胺酶(ESBL)基因检测呈阳性。多位点序列分型(MLST)表明ST2735和ST11是儿童和成人的主要类型,分别。脉冲场凝胶电泳(PFGE)鉴定了两个年龄组的ST11blaKPC-2和ST15blaOXA-232的克隆传播模式。值得注意的是,这项研究报告了NICU中ST1114型CRKP共同产生blaNDM-5和blaOXA-181的首例。
■这项研究揭示了儿童和成人CRKP中不同的耐药机制和流行病学。确定的克隆传播模式强调需要改善感染控制以防止抗性菌株的传播。
UNASSIGNED: The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has garnered international concern due to its significant antibiotic resistance. Notably, children exhibit distinct resistance mechanisms compared to adults, necessitating a differential approach to antibiotic selection. A thorough analysis of CRKP\'s epidemiology and drug resistance mechanisms is essential for establishing a robust foundation for clinical anti-infection strategies and precise prevention and control measures.
UNASSIGNED: This study involved the collection of 31 non-repetitive strains from pediatric and adult patients at a tertiary hospital in China, spanning from July 2016 to July 2022, testing for resistance genes, antimicrobial susceptibility, and homology analysis.
UNASSIGNED: Infants (0-1 year) were the largest pediatric CRKP group, with 61.3% of cases. The neonatal intensive care unit (NICU) and pediatrics were the main departments affected. Adults with CRKP had a mean age of 67 years, with the highest prevalence in neurology and emergency ICU. Antimicrobial susceptibility testing revealed that adult CRKP strains exhibited higher resistance to amikacin, ciprofloxacin, cotrimoxazole, and aztreonam compared to pediatric strains. Conversely, pediatric strains showed a higher rate of resistance to ceftazidime/avibactam. The predominant resistance genes identified were bla NDM-5 in children (58.1%) and bla KPC-2 in adults (87.1%), with over 93% of both groups testing positive for extended-spectrum beta-lactamase (ESBL) genes. Multilocus Sequence Typing (MLST) indicated ST2735 and ST11 as the predominant types in children and adults, respectively. Pulsed-field gel electrophoresis (PFGE) identified clonal transmission patterns of ST11 bla KPC-2 and ST15 bla OXA-232 across both age groups. Notably, this study reports the first instance of ST1114-type CRKP co-producing bla NDM-5 and bla OXA-181 in the NICU.
UNASSIGNED: This study reveals distinct resistance mechanisms and epidemiology in CRKP from children and adults. The identified clonal transmission patterns emphasize the need for improved infection control to prevent the spread of resistant strains.