产Extended-spectrum β-lactamase 的大肠杆菌 ST131 和肺炎克雷伯菌 ST11 在肺炎患者中的传播：分子流行病学研究。
Spreading of extended-spectrum β-lactamase-producing Escherichia coli ST131 and Klebsiella pneumoniae ST11 in patients with pneumonia: a molecular epidemiological study.
机构信息
Department of Emergency Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.
出版信息
Chin Med J (Engl). 2019 Aug 20;132(16):1894-1902. doi: 10.1097/CM9.0000000000000368.
BACKGROUND
Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the important pathogens causing pneumonia. This study aimed to investigate the clinical characteristics and molecular epidemiology of ESBL-producing E. coli and K. pneumoniae causing pneumonia at a large teaching hospital in China.
METHODS
We collected patient's clinical data and ESBL-producing E. coli and K. pneumoniae strains causing pneumonia (from December 2015 to June 2016) at a hospital in Wuhan. The susceptibilities, multi-locus sequence typing, homologous analysis, ESBL genes by polymerase chain reaction and sequencing were determined.
RESULTS
A total of 59 ESBL-producing strains (31 E. coli and 28 K. pneumoniae) isolated from patients with pneumonia were analyzed. The majority of strains were isolated from patients were with hospital-acquired pneumonia (37/59, 62.7%), followed by community-acquired pneumonia (13/59, 22.0%), and ventilator-related pneumonia (9/59, 15.3%). The E. coli ST131 (9 isolates, 29.0%) and K. pneumoniae ST11 (5 isolates, 17.9%) were the predominant sub-types. The most prevalent ESBL gene was CTX-M-14, followed by SHV-77, CTX-M-3, SHV-11, and CTX-M-27. At least 33 (55.9%) of the ESBL-producing strains carried two or more ESBL genes. The ISEcp1 and IS26 were found upstream of all blaCTX-M (CTX-Ms) and of most blaSHV (SHVs) (57.6%), respectively. Moreover, three ESBL-producing K. pneumoniae ST11 strains which were resistant to carbapenems carried the blaNDM-1 and blaKPC-2, two of which also bearing blaOXA-48 were resistant to all antibiotics (including Tigecycline).
CONCLUSIONS
Hospital-acquired pneumonia is more likely correlated with ESBL-producing E. coli and K. pneumoniae. ESBL-producing E. coli ST131 and multi-drug resistance ESBL-producing, as well as New Delhi metallo-β-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemases-2 (KPC-2) bearing K. pneumoniae ST11 are spreading in patients with pneumonia in hospital.
背景
产超广谱β-内酰胺酶（ESBL）的大肠埃希菌（E. coli）和肺炎克雷伯菌（K. pneumoniae）是引起肺炎的重要病原体。本研究旨在调查中国一家大型教学医院产 ESBL 的大肠埃希菌和肺炎克雷伯菌引起肺炎的临床特征和分子流行病学。
方法
我们收集了 2015 年 12 月至 2016 年 6 月在武汉一家医院住院的肺炎患者的临床资料和产 ESBL 的大肠埃希菌和肺炎克雷伯菌菌株。通过聚合酶链反应（PCR）和测序确定药敏试验、多位点序列分型、同源分析、ESBL 基因。
结果
共分析了 59 株产 ESBL 的菌株（31 株大肠埃希菌和 28 株肺炎克雷伯菌），这些菌株均从肺炎患者中分离得到。大多数分离株来自医院获得性肺炎（37/59，62.7%），其次是社区获得性肺炎（13/59，22.0%）和呼吸机相关性肺炎（9/59，15.3%）。大肠埃希菌 ST131（9 株，29.0%）和肺炎克雷伯菌 ST11（5 株，17.9%）是主要的亚型。最常见的 ESBL 基因是 CTX-M-14，其次是 SHV-77、CTX-M-3、SHV-11 和 CTX-M-27。至少有 33 株（55.9%）产 ESBL 的菌株携带两种或两种以上的 ESBL 基因。所有 blaCTX-M（CTX-Ms）和大多数 blaSHV（SHVs）（57.6%）的上游都发现了 ISEcp1 和 IS26。此外，3 株对碳青霉烯类耐药的产 ESBL 肺炎克雷伯菌 ST11 株携带 blaNDM-1 和 blaKPC-2，其中 2 株还携带 blaOXA-48，对所有抗生素（包括替加环素）均耐药。
结论
医院获得性肺炎更可能与产 ESBL 的大肠埃希菌和肺炎克雷伯菌有关。产 ESBL 的大肠埃希菌 ST131 和多药耐药，以及携带新德里金属β-内酰胺酶-1（NDM-1）和肺炎克雷伯菌碳青霉烯酶-2（KPC-2）的肺炎克雷伯菌 ST11 在医院肺炎患者中传播。
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