江西地区某综合医院ST11型耐碳青霉烯类高毒力肺炎克雷伯菌的分子流行病学研究  

Molecular epidemiological study on ST11 carbepenem-resistant hypervirulent Klebsiella pneumoniae in a general hospital in Jiangxi Province

作　　者：黄珊珊 施博文 魏丹丹[1] 霍炳慧 洪涵旭 江昕竹 刘洋[1,4] HUANG Shanshan;SHI Bowen;WEI Dandan;HUO Binghui;HONG Hanxu;JIANG Xinzhu;LIU Yang(Department of Laboratory Medicine,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China;The First Clinical Medical College of Nanchang University,Nanchang 330008,China;School of Public Health,Nanchang University,Nanchang 330008,China;China-Japan Friendship Hospital,Jiangxi Hospital,Nanchang 330038,China)

机构地区：[1]南昌大学第一附属医院检验科,江西南昌330006 [2]南昌大学第一临床医学院,江西南昌330008 [3]南昌大学公共卫生学院,江西南昌330008 [4]中日友好医院江西医院,江西南昌330038

出　　处：《中国感染控制杂志》2025年第1期30-36,共7页Chinese Journal of Infection Control

基　　金：国家自然科学基金项目(32370195,82102411,82260403);2022年南昌大学第一附属医院临床研究培育项目(YFYLCYJPY202201)。

摘　　要：目的探究ST11型耐碳青霉烯类高毒力肺炎克雷伯菌(CR-hvKP)菌株的临床特征、耐药现状、毒力特征及分子流行病学特征。方法收集某三级甲等教学医院2018—2021年临床标本分离的耐碳青霉烯类肺炎克雷伯菌(CRKP)菌株,通过耐药基因、毒力基因检测,以及多位点序列分型(MLST)筛选出ST11型CR-hvKP,分析其基本临床信息、耐药基因、毒力基因;随机选取其中23株ST11型CR-hvKP菌株进行毒力表型分析;随机选取其中45株CR-hvKP,采用脉冲场凝胶电泳(PFGE)分析其同源性。结果2018—2021年临床分离ST11型CR-hvKP菌株共124株,主要来自神经外科(33.87%),标本以痰为主(56.45%),感染患者平均年龄为(55.2±16.4)岁,男性为主(77.42%)。药敏试验结果显示其对大部分临床常用抗菌药物耐药;毒力试验结果显示菌株毒力存在差异,但多为高毒力毒株;PFGE分析结果显示菌株以A1亚型为主(63.4%)。结论ST11型CR-hvKP表现出多重耐药性和高毒力特征,部分菌株在该院存在克隆性传播现象,给临床抗感染治疗及防控带来巨大挑战,需加强医院感染的防控和管理。Objective To explore the clinical characteristics,antimicrobial resistance,virulence and molecular epidemiology characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae(CR-hvKP).Methods Carbapenem-resistant Klebsiella pneumoniae(CRKP)strains isolated from clinical specimens in a tertiary first-class teaching hospital from 2018 to 2021 were collected.ST11 CR-hvKP strains were screened through the detection of antimicrobial resistance genes and virulence genes as well as multilocus sequence typing(MLST).Basic clinical information,antimicrobial resistance genes and virulence genes were analyzed.Twenty-three strains of ST11 CR-hvKP were randomly selected for virulence phenotype analysis;45 strains of CR-hvKP were randomly selected for homology analysis by pulsed-field gel electrophoresis(PFGE).Results There were a total of 124 clinically isolated strains of ST11 CR-hvKP from 2018 to 2021,mainly from the department of neurosurgery(33.87%).The major specimen source was sputum(56.45%),the average age of infected patients were(55.2±16.4)years old,and the majority were male patients(77.42%).Antimicrobial susceptibility testing results showed these strains were resis-tant to most clinically commonly used antimicrobial agents.Virulence detection showed that virulence varied among these strains,but most of them were hypervirulence strains.PFGE analysis results showed that the strains were mainly subtype A1(63.4%).Conclusion ST11 CR-hvKP presents multidrug resistance and hypervirulence.Clonal transmission of some strains exists in this hospital,which poses great challenges for clinical anti-infection treatment as well as prevention and control.It is necessary to strengthen the prevention and control of healthcare-associated infection.

关 键 词：耐碳青霉烯类高毒力肺炎克雷伯菌 ST11型CR-hvKP CRKP hvKP 耐碳青霉烯酶 肺炎克雷伯菌 

分 类 号：R181.32[医药卫生—流行病学] R378.996[医药卫生—公共卫生与预防医学]