Cao Huijun, Liang Shiwei, Zhang Chenchen, Liu Bao, Fei Ying
Centre for Clinical Laboratories, the Affiliated Hospital of Guizhou Medical University, Guiyang, 550004, People's Republic of China.
School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, 550004, People's Republic of China.
Infect Drug Resist. 2023 Mar 11;16:1367-1380. doi: 10.2147/IDR.S404202. eCollection 2023.
The rising prevalence of infections caused by carbapenem-resistant and hypervirulent (CR-hvKP) has outpaced our understanding of their evolutionary diversity. By straining the antimicrobial options and constant horizontal gene transfer of various pathogenic elements, CR-hvKP poses a global health threat.
Six isolates (KP1~KP6) from urine, sputum and groin infection secretion of a single patient were characterized phenotypically and genotypically. The antimicrobial susceptibility, carbapenemase production, hypermucoviscosity, serum resistance, virulence factors, MLST and serotypes were profiled. Genomic variations were identified by whole-genome sequencing and the phylogenetic differentiation was analyzed by Enterobacterial repetitive intergenic consensus (ERIC)-PCR.
All strains were multi-drug resistant. Four of them (KP1, KP3, KP5 and KP6) belonged to ST11-K64, with high genetic closeness (relatedness coefficient above 0.96), sharing most resistance and virulence genes. Compared with KP1, the later isolates KP3, KP5 and KP6 acquired and lost genes. KP2 and KP4 had the same clonal origin of ST35-K16 (relatedness coefficient 0.98), containing almost identical genes for resistance and virulence. They were non-mucoid and carried gene.
A co-infection with two types of CR-hvKP affiliated with different clades within a single patient amplified the treatment difficulties. In addition to source control and epidemiological surveillance, investigation of the in-host interactions between CR-hvKP variants may provide valuable treatment solutions.
耐碳青霉烯类且高毒力肺炎克雷伯菌（CR-hvKP）引起的感染患病率不断上升，这超出了我们对其进化多样性的理解。通过限制抗菌药物选择以及各种致病因素的持续水平基因转移，CR-hvKP对全球健康构成了威胁。
对来自一名患者尿液、痰液和腹股沟感染分泌物的6株分离株（KP1~KP6）进行表型和基因型特征分析。分析了抗菌药物敏感性、碳青霉烯酶产生情况、高黏液性、血清抗性、毒力因子、多位点序列分型（MLST）和血清型。通过全基因组测序鉴定基因组变异，并通过肠杆菌重复基因间共识序列（ERIC）-PCR分析系统发育分化。
所有菌株均对多种药物耐药。其中4株（KP1、KP3、KP5和KP6）属于ST11-K64，遗传亲缘关系密切（相关系数高于0.96），共享大多数耐药和毒力基因。与KP1相比，后来分离出的KP3、KP5和KP6获得和丢失了一些基因。KP2和KP4具有相同的ST35-K16克隆起源（相关系数0.98），含有几乎相同的耐药和毒力基因。它们是非黏液型的，携带特定基因。
单一患者体内两种不同进化枝的CR-hvKP共同感染增加了治疗难度。除了源头控制和流行病学监测外，研究CR-hvKP变体在宿主体内的相互作用可能会提供有价值的治疗方案。
