Department of Nosocomial Infection Administration, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
Department of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong, China.
Antimicrob Resist Infect Control. 2021 Feb 25;10(1):41. doi: 10.1186/s13756-021-00910-1.
Klebsiella pneumoniae (K. pneumoniae) is a common pathogen associated with hospital and community-onset infections. This study aimed to compare the clinical and microbiological characteristics of nosocomial, healthcare-associated (HCA), and community-acquired (CA) K. pneumoniae infections.
Clinical data were extracted from electronic medical records and analyzed retrospectively. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) production were determined for all identified strains. Carbapenemase and ESBL genes were amplified by PCR. Genotyping of carbapenem-resistant K. pneumoniae (CRKP) and ESBL-producing strains was performed by pulsed-field gel electrophoresis (PFGE).
Of 379 K. pneumoniae infections, 98 (25.9%) were nosocomial, 195 (51.5%) were healthcare-associated, and 86 (22.6%) were community-acquired. Hematological malignancy (OR = 4.467), and hypertension (OR = 2.08) and cerebral vascular disease (OR = 2.486) were associated with nosocomial and HCA infections respectively, when compared to CA infections. Overall, the incidence of antimicrobial resistance for the majority of agents tested was similar between nosocomial and HCA infections (P > 0.05) and both groups had a higher incidence than CA infections (P < 0.05). Moreover, 95.1% (78/82) of CRKP strains were isolated from the nosocomial and HCA groups. The bla was the most prevalent carbapenemase gene among CRKP strains (80.5%, 66/82). ESBL-producing strains were prevalent among nosocomial (40.8%), HCA (35.9%) and CA groups (24.4%). The bla and bla genes were predominant in nosocomial (65.0%) and CA strains (66.7%), respectively. PFGE results showed ESBL-producing and CRKP strains were genetically diverse. Identical PFGE profiles were observed among HCA and nosocomial strains.
Nosocomial and HCA K. pneumoniae infections presented similar clinical features and antimicrobial resistance, and both two types of infections were different to CA infections. CRKP and ESBL-producing strains were disseminated mainly in HCA and nosocomial groups, and showed a clonal diversity. The cross transmission of CRKP was existed among HCA and nosocomial patients. This finding suggests that similar empirical therapy should be considered for patients with nosocomial and HCA K. pneumoniae infections and bacterial resistance surveillance of these infections is necessary.
肺炎克雷伯菌（K. pneumoniae）是一种常见的病原体，与医院和社区获得性感染有关。本研究旨在比较医院获得性、医疗保健相关性（HCA）和社区获得性（CA）肺炎克雷伯菌感染的临床和微生物学特征。
从电子病历中提取临床数据并进行回顾性分析。对所有鉴定的菌株进行抗生素敏感性和超广谱β-内酰胺酶（ESBL）产生的测定。通过 PCR 扩增碳青霉烯酶和 ESBL 基因。通过脉冲场凝胶电泳（PFGE）对耐碳青霉烯肺炎克雷伯菌（CRKP）和产 ESBL 株进行基因分型。
在 379 例肺炎克雷伯菌感染中，98 例（25.9%）为医院获得性，195 例（51.5%）为医疗保健相关性，86 例（22.6%）为社区获得性。与 CA 感染相比，血液恶性肿瘤（OR=4.467）、高血压（OR=2.08）和脑血管病（OR=2.486）与医院获得性和 HCA 感染相关。总体而言，大多数检测药物的抗菌药物耐药率在医院获得性和 HCA 感染之间相似（P>0.05），且两组的耐药率均高于 CA 感染（P<0.05）。此外，82 株 CRKP 菌株中有 95.1%（78/82）分离自医院获得性和 HCA 组。bla是 CRKP 菌株中最常见的碳青霉烯酶基因（80.5%，66/82）。产 ESBL 菌株在医院获得性（40.8%）、HCA（35.9%）和 CA 组（24.4%）中较为常见。bla和 bla基因分别是医院获得性（65.0%）和 CA 株（66.7%）的主要优势基因。PFGE 结果表明产 ESBL 和 CRKP 菌株具有遗传多样性。在 HCA 和医院获得性菌株中观察到相同的 PFGE 图谱。
医院获得性和 HCA 肺炎克雷伯菌感染具有相似的临床特征和抗生素耐药性，且这两种类型的感染与 CA 感染不同。CRKP 和产 ESBL 菌株主要在 HCA 和医院获得性组中传播，并表现出克隆多样性。HCA 和医院获得性患者之间存在 CRKP 的交叉传播。这一发现表明，对于医院获得性和 HCA 肺炎克雷伯菌感染的患者，应考虑类似的经验性治疗，并且有必要对这些感染进行细菌耐药性监测。
