广东地区耐碳青霉烯类肺炎克雷伯菌耐药性及分子流行病学特征  

Drug resistance and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae in Guangdong

作　　者：黄静敏 柯碧霞[2] 何冬梅[2] 刘哲 李振翠 刘美真[2] 柯昌文[2] HUANG Jing-min;KE Bi-xia;HE Dong-mei;LIU Zhe;LI Zhen-cui;LIU Mei-zhen;KE Chang-wen(School of Public Health,Southern Medical University,Guangzhou,Guangdong 510515,China;不详)

机构地区：[1]南方医科大学公共卫生学院,广东广州510515 [2]广东省疾病预防控制中心病原微生物所,广东广州511430 [3]广东省公共卫生研究院,广东广州510300

出　　处：《中华医院感染学杂志》2022年第6期813-818,共6页Chinese Journal of Nosocomiology

基　　金：国家科技重大专项基金资助项目(2018ZX10714002-003-006)。

摘　　要：目的分析广东地区耐碳青霉烯类肺炎克雷伯菌(CRKP)的耐药形势及分子流行病学特征。方法对广东地区2019年收集分离的41株CRKP开展抗菌药物敏感性试验鉴定耐药表型,通过全基因组测序分析确定多位点序列分型(MLST)、耐药基因及毒力因子等分子特征,基于全基因组单核苷酸多态性(wgSNPs)分析菌株同源性及遗传进化关系。结果41株CRKP均为泛耐药菌。耐药基因及可移动遗传元件(MGEs)种类多样,75.61%(31/41)菌株携带碳青霉烯酶基因,包括bla(18株)、bla(10株)、bla(2株)和bla(1株)四种类型。其中儿童CRKP主要携带bla,而成人则为bla。bla和bla分别主要通过质粒IncX3和IncFII传播。MLST分型共获得16种ST型,以ST11型(51.22%,21/41)为主,且均为非毒力株,而ST65型株则为高毒力特征。系统发育关系表明本地区CRKP流行菌群与全球广泛传播的CRKP具有密切的亲缘关系。结论广东地区CRKP的耐药形势严峻,产KPC-2型碳青霉烯酶是碳青霉烯类抗菌药物产生耐药性的主要机制。菌株的分子分型多态性较大,存在优势克隆ST11型CRKP在医院及医院间广泛流行和传播。并且由于存在多种MGEs分布,需密切关注获得性高毒力高耐药CRKP的出现,加强耐药基因监测,以识别潜在感染播散风险,提高临床预后。OBJECTIVE To investigate the drug resistance and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae(CRKP) in Guangdong. METHODS The drug susceptibility testing was performed for 41 strains of CRKP isolated from Guangdong in 2019 so as to identify the drug resistance phenotypes. The molecular characteristics of multilocus sequence typing, drug resistance genes and virulence factors were determined by means of whole genome sequencing analysis;the homology and genetic evolution relationship of the strains were observed based on whole genome single nucleotide polymorphisms(wgSNPs). RESULTS All of the 41 strains of CRKP were pandrug-resistant bacteria. The drug resistance genes and mobile genetic elements(MGEs) were diversified, 75.61%(31/41) of the strains carried with carbapenemases genes, including bla(18 strains), bla-1(10 strains) and bla(2 strain). The CRKP strains isolated from children mainly carried with bla, while the strains isolated from adults carried with bla. blaand blawere mainly transmitted by IncX3 and IncFII plasmids, respectively. Totally 16 types of ST were obtained by MLST typing, ST11(51.22%, 21/41) was dominant, all of which were non-virulent strains, while ST65 strains showed highly virulent characteristics. Phylogenetic analysis indicated that the CRKP strains prevalent in this area showed close ties of consanguinity with the CRKP strains widely spread around the globe. CONCLUSION The drug resistance situation of the CRKP strains is severe in Guangdong, KPC-2 type carbapenemase is the major mechanism for the drug resistance to carbapenems. The molecular typing polymorphism of the CRKP strains is diverse, and the ST11 type CRKP strains with dominance in clones are prevalent and spread among hospitals. There are multiple types of MGEs, it is necessary to attach great importance to the emergence of acquired hypervirulent and highly resistant strains and strengthen surveillance of drug resistance genes so as to identify the potential risk of infection and impr

关 键 词：碳青霉烯酶 肺炎克雷伯菌 耐药基因型 分子流行病学 

分 类 号：R378.996[医药卫生—病原生物学]