Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
Vietnam National Children's Hospital, Hanoi, Vietnam.
Antimicrob Resist Infect Control. 2021 Nov 20;10(1):162. doi: 10.1186/s13756-021-01033-3.
The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, particularly in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections.
We isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from faecal samples collected in 2017 from patients at admission and discharge at a Vietnamese neonatal intensive care unit (NICU). 126 CRKP were whole-genome sequenced. The phylogenetic relationship between the isolates and between clinical CRKP isolates collected in 2012-2018 at the same hospital were investigated.
NDM-type carbapenemase-(61%) and KPC-2-encoding genes (41%) were the most common carbapenem resistance genes observed among the admission and discharge isolates. Most isolates (56%) belonged to three distinct clonal clusters of ST15, carrying bla, bla and bla, respectively. Each cluster also comprised clinical isolates from blood collected at the study hospital. The most dominant ST15 clone was shown to be related to isolates collected from the same hospital as far back as in 2012.
Highly resistant CRKP were found colonising admission and discharge patients at a Vietnamese NICU, emphasising the importance of continued monitoring. Whole-genome sequencing revealed a population of CRKP consisting mostly of ST15 isolates in three clonally related clusters, each related to blood isolates collected from the same hospital. Furthermore, clinical isolates collected from previous years (dating back to 2012) were shown to likely be clonally descended from ST15 isolates in the largest cluster, suggesting a successful hospital strain which can colonise inpatients.
碳青霉烯类耐药肠杆菌科（CRE）的发病率不断上升，是一个全球性的日益严重的问题，尤其是在中低收入国家（LMICs）。先前的研究表明，在 LMICs 的医院中，患者中存在高比例的 CRE 定植，医院获得性感染的风险增加。
我们从 2017 年越南新生儿重症监护病房（NICU）入院和出院的患者粪便样本中分离出碳青霉烯类耐药肺炎克雷伯菌（CRKP）。对 126 株 CRKP 进行全基因组测序。调查了分离株之间以及同一医院 2012-2018 年采集的临床 CRKP 分离株之间的系统发育关系。
在入院和出院分离株中，最常见的碳青霉烯类耐药基因是 NDM 型碳青霉烯酶基因（占 61%）和 KPC-2 编码基因（占 41%）。大多数分离株（56%）属于携带 blaCTX-M-15 、blaKPC-2 和 blaNDM-1 的三个不同克隆群的 ST15 型，每个克隆群还包括来自研究医院血液采集的临床分离株。最主要的 ST15 克隆株与 2012 年以来同一医院采集的分离株有关。
在越南新生儿重症监护病房，入院和出院患者中发现了高度耐药的 CRKP 定植，这强调了持续监测的重要性。全基因组测序揭示了一个以 ST15 分离株为主的 CRKP 群体，这些分离株存在于三个密切相关的克隆群中，每个克隆群都与来自同一医院的血液分离株有关。此外，从前几年（可追溯到 2012 年）采集的临床分离株与最大克隆群中的 ST15 分离株可能具有克隆关系，表明这是一种能够定植住院患者的成功医院菌株。
