基于 PCR 荚膜分型的携带碳青霉烯酶编码基因的致病性肺炎克雷伯菌在乌干达 3 级医院的流行情况。
Prevalence of pathogenic Klebsiella pneumoniae based on PCR capsular typing harbouring carbapenemases encoding genes in Uganda tertiary hospitals.
机构信息
College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P. O. Box 7062, Kampala, Uganda.
Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western Campus, P. O. Box 71, Bushenyi, Uganda.
出版信息
Antimicrob Resist Infect Control. 2021 Mar 18;10(1):57. doi: 10.1186/s13756-021-00923-w.
BACKGROUND
Klebsiella pneumoniae is an opportunistic pathogen that has been implicated as one of commonest cause of hospital and community acquired infections. The K. pneumoniae infections have considerably contributed to morbidity and mortality in patients with protracted ailments. The capacity of K. pneumoniae to cause diseases depends on the presence of an array virulence factors. Coexistence and expression of virulence factors and genetic determinants of antibiotic resistance complicates treatment outcomes. Thus, emergence of pathogenic MDR K. pneumoniae poses a great threat to the healthcare system. However, the carriage of antibiotic resistance among pathogenic K. pneumoniae is yet to be investigated in Uganda. We sought to investigate the carbapenem resistance profiles and pathogenic potential based on capsular serotypes of K. pneumoniae clinical isolates.
METHODS
This was a cross sectional study involving use of archived Klebsiella pneumoniae isolates collected between January and December, 2019 at four tertiary hospitals in Uganda. All isolates were subject to antimicrobial susceptibility assays to determine phenotypic antibiotic resistance, pentaplex PCR to detect carbapenemases encoding genes and heptaplex PCR to identify capsular serotypes K1, K2, K3, K5, K20, K54 and K57.
RESULTS
The study found an overall phenotypic carbapenem resistance of 23.3% (53/227) and significantly higher genotypic resistance prevalence of 43.1% (98/227). Over all, the most prevalent gene was bla (36.4%), followed by bla (19.4%), bla (17.1%), bla (14.0%) and bla (13.2%). bla and bla conferred phenotypic resistance in all isolates and 38.3% of isolates that harbored them respectively. Capsular multiplex PCR revealed that 46.7% (106/227) isolates were pathogenic and the predominantly prevalent pathotype was K5 (18.5%) followed by K20 (15.1%), K3 (7.1%), K2 (3.1%) and K1 (2.2%). Of the 106 capsular serotypes, 37 expressed phenotypic resistance; thus, 37 of the 53 carbapenem resistant K. pneumoniae were pathogenic.
CONCLUSION
The high prevalence of virulent and antibiotic resistant K. pneumoniae among clinical isolates obtained from the four tertiary hospital as revealed by this study pose a great threat to healthcare. Our findings underline the epidemiological and public health risks and implications of this pathogen.
背景
肺炎克雷伯菌是一种机会性病原体，已被认为是医院和社区获得性感染的最常见原因之一。肺炎克雷伯菌感染在患有慢性疾病的患者中导致发病率和死亡率相当高。肺炎克雷伯菌致病的能力取决于存在一系列毒力因子。毒力因子和抗生素耐药性的遗传决定因素的共存和表达使治疗结果复杂化。因此，致病性多药耐药肺炎克雷伯菌的出现对医疗保健系统构成了巨大威胁。然而，在乌干达，尚未调查致病性肺炎克雷伯菌的抗生素耐药性。我们试图根据肺炎克雷伯菌临床分离株的荚膜血清型研究碳青霉烯类耐药性的特征和发病潜力。
方法
这是一项横断面研究，涉及使用 2019 年 1 月至 12 月在乌干达的四家三级医院收集的存档肺炎克雷伯菌分离株。对所有分离株进行抗菌药物敏感性测定，以确定表型抗生素耐药性，五重 PCR 检测碳青霉烯酶编码基因，七重 PCR 检测荚膜血清型 K1、K2、K3、K5、K20、K54 和 K57。
结果
研究发现，总表型碳青霉烯类耐药率为 23.3%（53/227），而基因型耐药率显著更高，为 43.1%（98/227）。总体而言，最常见的基因是 bla（36.4%），其次是 bla（19.4%）、bla（17.1%）、bla（14.0%）和 bla（13.2%）。bla 和 bla 在所有分离株中均表现出表型耐药性，分别在携带它们的 38.3%的分离株中表现出表型耐药性。荚膜多重 PCR 显示，46.7%（106/227）分离株为致病性，主要流行的病原型是 K5（18.5%），其次是 K20（15.1%）、K3（7.1%）、K2（3.1%）和 K1（2.2%）。在 106 种荚膜血清型中，有 37 种表达表型耐药性；因此，在 53 株碳青霉烯类耐药的肺炎克雷伯菌中，有 37 株为致病性。
结论
本研究揭示了从四家三级医院获得的临床分离株中高毒力和抗生素耐药性肺炎克雷伯菌的流行情况，这对医疗保健构成了巨大威胁。我们的研究结果强调了这种病原体的流行病学和公共卫生风险和影响。
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