中国重庆一家大型教学医院重症监护病房发生碳青霉烯类耐药肠杆菌科细菌感染爆发。
An Outbreak of Carbapenem-Resistant in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China.
机构信息
Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
Department of Microbiology, The First Affiliated Hospital of Jiamusi University, Jiamusi, China.
出版信息
Front Cell Infect Microbiol. 2021 Jun 2;11:656070. doi: 10.3389/fcimb.2021.656070. eCollection 2021.
BACKGROUND
Due to the critical condition and poor immunity of patients, the intensive care unit (ICU) has always been the main hospital source of multidrug-resistant bacteria. In recent years, with the large-scale use of antibiotics, the detection rate and mortality of carbapenem-resistant (CRKP) have gradually increased. This study explores the molecular characteristics and prevalence of CRKP isolated from the ICU ward of a tertiary hospital in China.
METHODS
A total of 51 non-duplicated CRKP samples isolated from the ICU were collected from July 2018-July 2020. The enzyme production of the strains was preliminarily screened by carbapenemase phenotypic test, and drug-resistant and virulence genes were detected by PCR. The transferability of plasmid was verified by conjugation test. The minimal inhibitory concentration (MIC) was determined by microbroth dilution method and genetic diversity was detected by multilocus sequence typing and pulsed-field gel electrophoresis.
RESULTS
was the only carbapenemase detected. The major virulence genes were (100%), (94.1%), (94.1%), and (72.5%), while , , and genes were not detected. One sequence type ST1373 strain, hypervirulent (hvKP), was detected. CRKP strains were highly resistant to quinolones, cephalosporins, aminoglycosides, and polymyxin, but susceptive to tigecycline and ceftazidime-avibactam. The success rate of conjugation was 12.2%, indicating the horizontal transfer of . Homology analysis showed that there was a clonal transmission of ST11 CRKP in the ICU of our hospital.
CONCLUSION
The present study showed the outbreak and dissemination in ICU were caused by ST11 CRKP, which were producers, and simultaneously, also carried some virulence genes. ST11 CRKP persisted in the ward for a long time and spread among different areas. Due to the widespread dispersal of the transferable plasmid, the hospital should promptly adopt effective surveillance and strict infection control strategies to prevent the further spread of CRKP. Ceftazidime-avibactam showed high effectiveness against CRKP and could be used for the treatment of ICU infections.
背景
由于患者病情危急且免疫功能低下，重症监护病房（ICU）一直是多药耐药菌的主要医院来源。近年来，随着抗生素的大规模使用，碳青霉烯类耐药肠杆菌科细菌（CRKP）的检出率和死亡率逐渐升高。本研究旨在探讨中国某三甲医院 ICU 病房分离的 CRKP 的分子特征和流行情况。
方法
本研究于 2018 年 7 月至 2020 年 7 月期间，共收集了 ICU 分离的 51 株非重复 CRKP 菌株。采用碳青霉烯酶表型试验初步筛选菌株的产酶情况，采用 PCR 法检测耐药基因和毒力基因，接合试验验证质粒的可转移性。采用微量肉汤稀释法测定最小抑菌浓度（MIC），多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）检测遗传多样性。
结果
仅检测到一种碳青霉烯酶，即 blaKPC-2。主要毒力基因包括（100%）、（94.1%）、（94.1%）和（72.5%），但未检测到、、和基因。检测到一株 ST1373 型序列型的超毒力（hvKP）CRKP 菌株。CRKP 菌株对喹诺酮类、头孢菌素类、氨基糖苷类和多黏菌素高度耐药，但对替加环素和头孢他啶-阿维巴坦敏感。接合成功率为 12.2%，表明 可通过水平转移。同源性分析显示，我院 ICU 中存在 ST11 CRKP 的克隆传播。
结论
本研究表明，ST11 CRKP 引起了 ICU 的暴发和流行，该菌为 blaKPC-2 产酶株，同时携带一些毒力基因。ST11 CRKP 在病房内长期存在并在不同区域传播。由于可转移质粒的广泛传播，医院应及时采取有效的监测和严格的感染控制策略，以防止 CRKP 的进一步传播。头孢他啶-阿维巴坦对 CRKP 具有较高的疗效，可用于治疗 ICU 感染。
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