耐碳青霉烯类肺炎克雷伯菌(CRKP),作为威胁人类健康的最常见的耐药细菌之一,对多种抗菌药物和碳青霉烯类抗生素具有高耐药性,这只能处理有限的临床治疗选择。本研究描述了该三级医院2016-2020年CRKP的流行病学特征。标本来源包括血液,痰,肺泡灌洗液,穿刺液,烧伤伤口的分泌物,还有尿液.在87株耐碳青霉烯菌株中,ST11是主要的分离株,其次是ST15、ST273、ST340和ST626。在区分相关菌株的簇方面,这些ST与脉冲场凝胶电泳聚类分析定义的ST基本一致。大多数CRKP分离物含有blaKPC-2基因,一些分离株携带blaOXA-1,blaNDM-1和blaNDM-5基因,携带碳青霉烯类耐药基因的分离株对β-内酰胺类抗生素的耐药性更强,碳青霉烯类,大环内酯类,和氟喹诺酮.在所有CRKP菌株中均检测到OmpK35和OmpK37基因,在一些CRKP菌株中检测到Ompk36基因。所有检测到的OmpK37都有4个突变位点,OmpK36有11个突变位点,而在OmpK35中没有发现突变位点。超过一半的CRKP菌株含有OqxA和OqxB外排泵基因。毒力基因最常与尿素-wabG-fimH-entB-ybtS-uge-ycf组合。仅检测到一种CRKP分离物具有K54偶联血清型。本研究阐明了CRKP的临床流行病学特征和分子分型,掌握耐药基因型的分布情况,足细胞血清型,和CRKP的毒力基因,为CRKP感染的后续治疗提供一定的指导。
Carbapenem-resistant Klebsiella pneumoniae (CRKP), as one of the most common drug-resistant bacteria threatening human health, is hyper-resistant to multiple antimicrobial drugs and carbapenems, which can be dealt with only limited clinical treatment options. This study described the epidemiological characteristics of CRKP in this tertiary care hospital from 2016 to 2020. Specimen sources included blood, sputum, alveolar lavage fluid, puncture fluid, secretions from a burn wound, and urine. Among the 87 carbapenem-resistant strains, ST11 was the predominant isolate, followed by ST15, ST273, ST340, and ST626. These STs were in broad agreement with the STs defined by pulsed-field gel electrophoresis clustering analysis in discriminating clusters of related strains. Most CRKP isolates contained the blaKPC-2 gene, some isolates carried the blaOXA-1, blaNDM-1, and blaNDM-5 genes, and the isolates carrying carbapenem resistance genes were more resistant to the antimicrobials of β-lactams, carbapenems, macrolides, and fluoroquinolone. The OmpK35 and OmpK37 genes were detected in all CRKP strains, and the Ompk36 gene was detected in some CRKP strains. All detected OmpK37 had 4 mutant sites, and OmpK36 had 11 mutant sites, while no mutant sites were found in OmpK35. More than half of the CRKP strains contained the OqxA and OqxB efflux pump genes. The virulence genes were most commonly combined with urea-wabG-fimH-entB-ybtS-uge-ycf. Only one CRKP isolate was detected with the K54 podoconjugate serotype. This study elucidated the clinical epidemiological features and molecular typing of CRKP, and grasped the distribution of drug-resistant genotypes, podocyte serotypes, and virulence genes of CRKP, providing some guidance for the subsequent treatment of CRKP infection.