Zhao Yajie, Zhang Siqin, Fang Renchi, Wu Qing, Li Jiahui, Zhang Yizhi, Rocker Andrea, Cao Jianming, Lithgow Trevor, Zhou Tieli
Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.
School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, People's Republic of China.
Infect Drug Resist. 2020 Mar 31;13:931-940. doi: 10.2147/IDR.S243032. eCollection 2020.
To investigate transitions in resistance mechanisms, virulence characteristics and molecular epidemiology of carbapenem-resistant (CRKP) during 2003-2016 in a major Eastern Chinese medical center.
From a total of 2299 clinical strains collected from 2003 to 2016, 214 were found to be CRKP isolates and were selected for further study. Characterization of these was conducted by molecular detection of antibiotic resistance markers and virulence determinants, modified carbapenem inactivation method and multilocus sequence typing (MLST).
In this study, the prevalence of CRKP was increasing over the 14-year period, mirroring a national trend. These CRKP strains were resistant to most of the tested, clinically relevant drugs. The majority of these CRKP strains were positive for carbapenemases, with the carbapenemase (KPC) found to be the dominant type (207/210, 98.6%). The carrier rates of virulence genes and increased in 2016, while the and showed a relatively constant trend. From MLST data, ST11 (88.8%, 190/214) was the preponderant sequence type (ST), followed by ST15 (1.9%, 4/214) and ST656 (1.4%, 3/214). Several strains with less common STs (ST690, ST895, ST1823 and ST1384) were also detected, and these too showed high levels of antimicrobial resistance.
The average national rise in CRKP across China is mirrored in this in-depth analysis of a single hospital, while the prevalence of hypervirulent CRKP (such as ST15) was relatively low as of 2016. Continuous monitoring is necessary to keep track of CRKP and should include the prospect of newly emerging strains with less common STs and the prospect of detecting carbapenem-resistant, carbapenemase-negative .
调查2003年至2016年期间，中国东部一家大型医疗中心耐碳青霉烯类肺炎克雷伯菌（CRKP）的耐药机制、毒力特征及分子流行病学的变化情况。
在2003年至2016年间收集的2299株临床菌株中，共发现214株CRKP分离株，并选取这些菌株进行进一步研究。通过对抗生素耐药标记物和毒力决定因素进行分子检测、改良碳青霉烯灭活方法及多位点序列分型（MLST）对这些菌株进行特征分析。
在本研究中，CRKP的患病率在14年期间呈上升趋势，与全国趋势一致。这些CRKP菌株对大多数经测试的临床相关药物耐药。这些CRKP菌株中的大多数碳青霉烯酶检测呈阳性，其中碳青霉烯酶（KPC）为主要类型（207/210，98.6%）。毒力基因的携带率在2016年有所增加，而[此处原文缺失部分基因名称]和[此处原文缺失部分基因名称]呈现相对稳定的趋势。根据MLST数据，ST11（88.8%，190/214）是优势序列类型（ST），其次是ST15（1.9%，4/214）和ST656（1.4%，3/214）。还检测到几株具有较少见STs（ST690、ST895、ST1823和ST1384）的菌株，这些菌株也表现出高水平的抗菌耐药性。
对一家医院的深入分析反映了全国CRKP的平均上升情况，而截至2016年，高毒力CRKP（如ST15）的患病率相对较低。有必要持续监测CRKP，监测内容应包括出现少见STs的新菌株的可能性以及检测耐碳青霉烯类、碳青霉烯酶阴性[此处原文缺失部分内容]的可能性。
