Dong Fang, Zhang Ye, Yao Kaihu, Lu Jie, Guo Lingyun, Lyu Shuang, Yang Ying, Wang Yan, Zheng Hongyan, Song Wenqi, Liu Gang
1 Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University , Beijing, People's Republic of China .
2 Department of Infectious Disease, Beijing Children's Hospital, Capital Medical University , Beijing, People's Republic of China .
Microb Drug Resist. 2018 Mar;24(2):154-160. doi: 10.1089/mdr.2017.0031. Epub 2017 Jun 8.
The spread of carbapenem-resistant Klebsiella pneumoniae (CRKp) has become a significant problem worldwide; however, relevant data in children are limited. We performed a retrospective study to better understand the epidemiology of CRKp bloodstream infections at Beijing Children's Hospital. A total of 164 K. pneumoniae strains were collected from blood cultures between January 2011 and September 2014, of which 52 (31.7%) were CRKp strains. All 52 CRKp strains were multidrug resistant; 46 (88.5%) and 49 (94.2%) isolates were resistant to meropenem and imipenem, respectively. Low rates of resistance to amikacin (5.8%), levofloxacin (7.7%), and ciprofloxacin (15.4%) were observed. All isolates were susceptible to colistin. Among the tested carbapenem resistance genes, the predominant gene was bla, detected in 28 (53.8%) isolates, followed by bla (19, 36.5%) and bla (4, 7.7%). Multilocus sequence typing identified 31 sequence types (STs), the most predominant of which was ST782 (9, 29.0%). All ST782 strains were New Delhi metallo-β-lactamase-1 (NDM-1) producing. Four novel STs (ST2010, ST2011, ST2012, and ST2013) and two novel alleles (phoE243 and tonB324) were also detected. Hematologic disease was the most common underlying disease (73.1%). All children received initial empirical therapy. A total of 59.6% (31/52) patients received inappropriate empirical therapy, and 45.2% (14/31) changed antimicrobial therapy after blood culture results were obtained. The overall mortality rate was 11.5%. In conclusion, we observed a high rate of CRKp isolates collected from blood cultures and the predominance of NDM-1-producing K. pneumoniae among children from 2011 to 2014.
耐碳青霉烯类肺炎克雷伯菌（CRKp）的传播已成为全球一个重大问题；然而，儿童中的相关数据有限。我们进行了一项回顾性研究，以更好地了解北京儿童医院CRKp血流感染的流行病学情况。2011年1月至2014年9月期间，共从血培养中收集了164株肺炎克雷伯菌菌株，其中52株（31.7%）为CRKp菌株。所有52株CRKp菌株均对多种药物耐药；46株（88.5%）和49株（94.2%）分离株分别对美罗培南和亚胺培南耐药。观察到对阿米卡星（5.8%）、左氧氟沙星（7.7%）和环丙沙星（15.4%）的耐药率较低。所有分离株对黏菌素敏感。在所检测的碳青霉烯耐药基因中，主要基因是bla，在28株（53.8%）分离株中检测到，其次是bla（19株，36.5%）和bla（4株，7.7%）。多位点序列分型鉴定出31种序列类型（STs），其中最主要的是ST782（9株，29.0%）。所有ST782菌株均产新德里金属β-内酰胺酶-1（NDM-1）。还检测到4种新的STs（ST2010、ST2011、ST2012和ST2013）和2个新的等位基因（phoE243和tonB324）。血液系统疾病是最常见的基础疾病（73.1%）。所有儿童均接受了初始经验性治疗。共有59.6%（31/52）的患者接受了不恰当的经验性治疗，45.2%（14/31）的患者在获得血培养结果后更改了抗菌治疗。总体死亡率为11.5%。总之，我们观察到2011年至2014年期间从血培养中分离出的CRKp菌株比例较高，且产NDM-1的肺炎克雷伯菌在儿童中占主导地位。
