Jiang Muxiu, Li Heng, Liu Xiao, Shen Nan, Zhou Yuanjie, Song Wenting, Wang Xing, Cao Qing, Zhou Zhemin
Department of Infectious Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Pasteurien College, Suzhou Medical College of Soochow University, Suzhou, Jiangsu, China.
Microbiol Spectr. 2023 Mar 1;11(2):e0321322. doi: 10.1128/spectrum.03213-22.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a severe threat to public health worldwide. Based on the genomic analysis of 198 CRKP isolates collected at Shanghai Children's Medical Center over the last 8 years (2013 to 2021), we reported the clinical risk, genetic diversity, and prevalence of antimicrobial resistance (AMR) of CRKP in pediatric patients at the genomic level. We found that the genes were the predominant carbapenemase genes, followed by and . All of the carbapenemases were disseminated mainly by four main types of plasmids, among which one plasmid was associated with a higher risk of bloodstream infections. Notably, we tracked disease outbreaks caused by recent introductions of ST14 CRKP from southeast Asia or western countries, and we reported frequent, repetitive introductions of ST11 from other domestic hospitals that were associated interhospital movement of the patients. The cocirculation of K. pneumoniae and AMR plasmids in hospitals highlights the importance of genome sequencing for monitoring and controlling CRKP infections. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in pediatric patients differs from that in adults patients in terms of both genetic and phenotypic features, which remain to be elucidated. We present a summary of prevalent CRKP isolates from Chinese pediatric patients over 8 years, demonstrating the prevalence and clinical importance of New Delhi metallo-β-lactamase genes in pediatric patients, mainly describing the genomic features of two predominant CRKP clones (ST11 and ST14) in Chinese children, and identifying four carbapenemase-encoding plasmids that contribute to the transmission of most carbapenemase genes in hospitals. Overall, our research provides valuable information about the international and domestic transmission of CRKP isolates that are prevalent in Chinese children and shows the urgent need for genome sequencing-based surveillance systems for monitoring the transmission of CRKP.
耐碳青霉烯类肺炎克雷伯菌（CRKP）对全球公共卫生构成严重威胁。基于过去8年（2013年至2021年）在上海儿童医学中心收集的198株CRKP分离株的基因组分析，我们在基因组水平上报告了儿科患者中CRKP的临床风险、遗传多样性和抗菌药物耐药性（AMR）流行情况。我们发现 基因是主要的碳青霉烯酶基因，其次是 和 。所有碳青霉烯酶主要通过四种主要类型的质粒传播，其中一种质粒与血流感染的较高风险相关。值得注意的是，我们追踪了近期从东南亚或西方国家引入的ST14 CRKP引起的疾病暴发，并且我们报告了来自其他国内医院的ST11的频繁、重复引入，这与患者的院际流动有关。医院中肺炎克雷伯菌和AMR质粒的共同流行凸显了基因组测序对于监测和控制CRKP感染的重要性。儿科患者的耐碳青霉烯类肺炎克雷伯菌（CRKP）感染在遗传和表型特征方面与成人患者不同，这些仍有待阐明。我们总结了8年来中国儿科患者中流行的CRKP分离株，展示了新德里金属β-内酰胺酶基因在儿科患者中的流行情况和临床重要性，主要描述了中国儿童中两个主要CRKP克隆（ST11和ST14）的基因组特征，并确定了四种编码碳青霉烯酶的质粒，它们促成了医院中大多数碳青霉烯酶基因的传播。总体而言，我们的研究提供了关于在中国儿童中流行的CRKP分离株的国际和国内传播的有价值信息，并表明迫切需要基于基因组测序的监测系统来监测CRKP的传播。
