Tian Xiaolang, Huang Changwu, Ye Xiaoli, Jiang Hongyan, Zhang Rufang, Hu Xiaofang, Xu Dongshuang
Department of Clinical Laboratory, University of Chinese Academy of Sciences Chongqing Renji Hospital, Fifth People's Hospital of Chongqing, Chongqing, China.
Front Pharmacol. 2019 Nov 1;10:1307. doi: 10.3389/fphar.2019.01307. eCollection 2019.
The increasing prevalence of extensively drug-resistant (XDR-KP) poses a serious threat to clinical anti-infective treatment. This retrospective study assessed the molecular epidemiology of and risk factors for infections with XDR-KP to investigate the mechanism of drug resistance and the epidemiological characteristics. A retrospective 1:2 case-control study was conducted at Chongqing Renji Affiliated Hospital of the Chinese Academy of Sciences University from January 2015 to December 2017. A total of 69 non-repetitive XDR-KP strains were collected. Patients infected with XDR-KP comprised the case group, and 138 matched patients with non-XDR-KP infection at the same site comprised the control group. The chi-square test and logistic regression were performed to evaluate the related risk factors. Molecular typing was performed by multilocus sequence typing (MLST). Potential resistance genes were detected by polymerase chain reaction (PCR) and sequencing. Predictors of 28-day mortality in patients with XDR-KP infection were also identified in our study. Only tigecycline and polymyxin B showed favorable drug sensitivity tests. These XDR-KP strains had a high prevalence rate (n = 66, 95.7%) of carbapenemase-related drug resistance genes. Among them, was the most frequently detected gene (n = 52, 75.4%). Particularly, all of the isolates harbored multiple drug resistance genes. Epidemiological analysis showed that fifty-eight XDR-KP isolates were resistant strains with the ST-11 genotype. Multivariate logistic regression analysis showed that ICU admission (OR: 3.28, 95% CI: 1.66-6.49, < 0.001), tracheal cannula (OR: 3.16, 95% CI: 1.48-6.76, = 0.003), and carbapenem exposure (OR: 3.16, 95% CI: 1.25-7.98, = 0.015) were independent risk factors for XDR-KP infection. Solid tumors (OR: 7.22, 95% CI: 1.84-28.34, = 0.005) and septic shock (OR: 9.46, 95% CI: 2.00-44.72, = 0.005) were independent risk factors for 28-day mortality from XDR-KP infection. This study showed that XDR-KP isolates were highly resistant and exhibited clonal transmission. ST11 was the predominant epidemic type of XDR-KP producing in Southwestern China. Physicians should be aware of these high-risk patients with notable predictive factors for XDR-KP infection. These findings may provide some recommendation for the diagnosis and treatment of patients infected with XDR-KP strains in Southwestern China.
广泛耐药肺炎克雷伯菌（XDR-KP）的日益流行对临床抗感染治疗构成严重威胁。本回顾性研究评估了XDR-KP感染的分子流行病学及危险因素，以探讨耐药机制和流行病学特征。2015年1月至2017年12月，在中国科学院大学重庆仁济附属医院进行了一项回顾性1:2病例对照研究。共收集了69株非重复的XDR-KP菌株。感染XDR-KP的患者组成病例组，138例在同一部位感染非XDR-KP的匹配患者组成对照组。采用卡方检验和逻辑回归评估相关危险因素。通过多位点序列分型（MLST）进行分子分型。通过聚合酶链反应（PCR）和测序检测潜在耐药基因。本研究还确定了XDR-KP感染患者28天死亡率的预测因素。只有替加环素和多粘菌素B的药敏试验结果良好。这些XDR-KP菌株中碳青霉烯酶相关耐药基因的流行率很高（n = 66，95.7%）。其中， 是最常检测到的基因（n = 52，75.4%）。特别地，所有分离株都携带多种耐药基因。流行病学分析显示，58株XDR-KP分离株为ST-11基因型的耐药菌株。多因素逻辑回归分析显示，入住重症监护病房（OR：3.28，95%CI：1.66 - 6.49，<0.001）、气管插管（OR：3.16，95%CI：1.48 - 6.76，=0.003）和碳青霉烯类药物暴露（OR：
