基于全基因组测序技术的耐碳青霉烯类肺炎克雷伯菌传播路径分析  

Research on transmission routes of carbapenem-resistant Klebsiella pneumoniae based on whole genome sequencing technology

作　　者：胡小骞 杨锡瑶[1] 李若洁[1] 王雪萍 黄凯 严翔 吴贻乐 HU Xiao-qian;YANG Xi-yao;LI Ruo-jie;WANG Xue-ping;HUANG Kai;YAN Xiang;WU Yi-le(The Second Hospital of Anhui Medical University,Hefei,Anhui 23060l,China)

机构地区：[1]安徽医科大学第二附属医院医院感染管理办公室,安徽合肥230601

出　　处：《中华医院感染学杂志》2023年第16期2405-2409,共5页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(82202572)。

摘　　要：目的 追踪重症监护病房(ICU)19例院内感染的耐碳青霉烯类肺炎克雷伯菌(CRKP)患者的传播路径,判断传播来源及媒介,为有效实施医院感染防控措施提供参考依据。方法 收集安徽医科大学第二附属医院2018年3月-7月ICU住院患者分离的19株耐碳青霉烯类肺炎克雷伯菌,全基因组测序(WGS)后进行序列拼接、核心基因比对与提取,构建院内感染传播路径图,结合流行病学调查分析,追踪传播来源与媒介。结果 19株CRKP均为ST11型;19株CRKP院内感染传播路径图显示病例AY1和AY4之间有31%的传播概率,AY4和AY5、AY8、AY9、AY14、AY19之间分别有28%、25%、23%、22%、25%的传播概率,AY14和AY17之间有25%的传播概率,AY16和AY15之间有53%的传播概率。结论 基于全基因组测序技术与生物信息学分析技术绘制的耐药菌传播路径图,为病原体院内传播的循证提供了可靠依据,有助于指导医院感染预防与控制工作的精准开展。OBJECTIVE To track the path of infection in 19 patients with nosocomial infected carbapenem-resistant Klebsiella pneumoniae(CRKP)in the intensive care unit(ICU),and to find the source and infectious agent,for providing reference for effective prevention and control of nosocomial infection.METHODS A total of 19 strains of carbapenem-resistant Klebsiella pneumoniae isolated from ICU hospitalized patients in the Second Affiliated Hos-pital of Anhui Medical University from Mar to Jul 2018 were collected.After whole genome sequencing(WGS),sequence assembly,core gene alignment and extraction were performed to construct the nosocomial transmission path map and combined with epidemiological investigation and analysis,the sources and vectors of transmission were traced.RESULTS All the 19 CRKP strains were ST1l type.The nosocomial transmission path map in 19 CRKP strains showed that the probability of transmission between AY1 and AY4 was 31%,and that between AY4 and AY5,AY8,AY9,AY14,AY19 were 28%,25%,23%,22%and 25%,respectively.And the trans-mission probability was 25%between AY14 and AY17 and that was 53%between AY16 and AY15.CONCLUSION The map of drug-resistant bacterial nosocomial transmission path based on whole genome sequen-cing and bioinformatics analysis technology provides a reliable basis for the evidence-based transmission of pathogens and helps to guide the accurate prevention and control measures for nosocomial infection.

关 键 词：全基因组测序 重症监护病房 耐碳青霉烯类肺炎克雷伯菌 院内感染传播路径图 

分 类 号：R378.996[医药卫生—病原生物学]