重症监护病房耐碳青霉烯类肺炎克雷伯菌定植与传播研究  

Colonization and transmission of carbapenem-resistant Klebsiella pneumoniae in intensive care unit

作　　者：陈翔 高晓东[1,4] 周春妹 黄声雷[2] 潘文彦 刘霄 梅静骅[3] 史庆丰[1,4] CHEN Xiang;GAO Xiaodong;ZHOU Chunmei;HUANG Shenglei;PAN Wenyan;LIU Xiao;MEI Jinghua;SHI Qingfeng(Department of Infection Management,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Laboratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Intensive Care Unit,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Institute of Infection and Control,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院感染管理科,上海200032 [2]复旦大学附属中山医院检验科,上海200032 [3]复旦大学附属中山医院重症监护室,上海200032 [4]复旦大学医院感染与控制研究所,上海200032

出　　处：《中国感染控制杂志》2025年第1期77-84,共8页Chinese Journal of Infection Control

基　　金：美国中华医学基金会(Grant#23-513);复旦大学附属中山医院发展基金资助项目(2021ZSFZ14);上海申康医院发展中心市级医院临床科技创新项目(SHDC22021315);上海申康医院发展中心第三批诊疗技术推广项目(SHDC22022220)。

摘　　要：目的探讨和分析重症监护病房耐碳青霉烯类肺炎克雷伯菌(CRKP)菌株特征与传播途径。方法选取2023年1—10月某院肝外科监护病房CRKP临床感染株17株(临床感染组)、主动筛查株5株(主动筛查组)、环境分离株7株(环境组)进行全基因组测序分析,并比较其耐药基因、毒力基因、ST分型差异,根据系统发育树分析其传播途径。结果29株CRKP分别携带4~18种耐药基因,52~98个毒力基因,3组CRKP的耐药基因、毒力基因的数量及基因型别分布比较,差异均无统计学意义(均P>0.05)。ST分型显示,29株CRKP主要包含ST11和ST15两大类,基于核心基因组构建的系统发育树显示,共有7组不同的CRKP高度同源,其中4组有较为明确的流行病学关联。结论重症监护病房的CRKP携带较多的耐药基因、毒力基因,部分菌株ST分型和系统发育树高度同源,存在交叉传播的可能,今后应加强防控措施以减少CRKP的传播。Objective To explore and analyze the characteristics and transmission routes of carbapenem-resistant Klebsiella pneumoniae(CRKP)strains in intensive care unit(ICU).Methods From January to October 2023,17 clinical infection isolates(clinical infection group),5 active screening isolates(active screening group),and 7 environmental isolates(environmental group)of CRKP in the liver surgery ICU of a hospital were selected and analyzed by whole-genome sequencing.The differences in resistance genes,virulence genes,and sequence typing(ST)were compared,and transmission routes were analyzed based on the phylogenetic tree.Results 29 strains of CRKP carried 4-18 resistance genes and 52-98 virulence genes,respectively.There were no statistically significant diffe-rences in genotype distribution of resistance genes,the number of virulence genes,and gene types among three groups of CRKP(all P>0.05).ST showed that 29 CRKP strains mainly consisted of two categories:ST11 and ST15.Based on the phylogenetic tree constructed from the core genome,there were 7 highly homologous groups of CRKP,among which 4 groups had clear epidemiological associations.Conclusion CRKP in ICU carries more resistance and virulence genes,and some strains are highly homologous in ST and phylogenetic tree,which may lead to cross transmission.In the future,prevention and control measures should be strengthened to reduce the transmission of CRKP.

关 键 词：重症监护病房 耐碳青霉烯类肺炎克雷伯菌 全基因组测序 传播 

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]