Cheng Jun, Zhao Dongmei, Ma Xuejiao, Li Jiabin
Department of Infectious Disease, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Front Microbiol. 2023 Jul 27;14:1223138. doi: 10.3389/fmicb.2023.1223138. eCollection 2023.
Carbapenem-resistant (CRKP) have been extensively disseminated worldwide, resulting in increased mortality. We performed a retrospective analysis of the epidemiology and risk factors for the outcome of CRKP infection in a general teaching hospital in China.
A molecular and clinical study was conducted for 98 CRKP in a tertiary hospital from January 2013 to December 2016. Carbapenemase gene detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) were performed. Logistic regression was also used to identify the risk factors associated with 30-day mortality.
The production of KPC carbapenemase was the main resistant mechanism, and KPC carbapenemase increased annually with a significant difference. However, the molecular outcome revealed the dominance and diversity in CRKP with 24 sequence types (STs) and 59 PFGE types (PTs). The ST11 CRKP strains, which showed a significant increasing trend year by year, were documented as predominant in our study. Additionally, the predominant ST11 CRKP corresponding to PT10 and PT15 continued to exhibit their characteristic patterns. Importantly, the newly identified PT09 and PT16 strains, corresponding to the ST11 lineage, were only discovered in 2016. Meanwhile, factors affecting 30-day mortality and ST11 proportionality with CRKP infection were assessed, and ST11, appropriate empirical treatment, and hospital stays were found to be independently associated with 30-day mortality.
The ST11 CRKP strains played a dominant role in the process; however, the homology of these strains was polymorphic, and the advantage clusters were subject to changes through evolution. Furthermore, in addition to appropriate empirical treatment and hospital stays, ST11 CRKP was independently associated with 30-day mortality. To the best of our knowledge, this association was reported for the first time.
耐碳青霉烯类肺炎克雷伯菌（CRKP）已在全球广泛传播，导致死亡率上升。我们对中国一家综合教学医院中CRKP感染的流行病学及感染结局的危险因素进行了回顾性分析。
2013年1月至2016年12月在一家三级医院对98株CRKP进行了分子及临床研究。进行了碳青霉烯酶基因检测、脉冲场凝胶电泳（PFGE）及多位点序列分型（MLST）。还采用逻辑回归来确定与30天死亡率相关的危险因素。
KPC碳青霉烯酶的产生是主要耐药机制，且KPC碳青霉烯酶每年呈上升趋势，差异有统计学意义。然而，分子结果显示CRKP具有优势及多样性，有24种序列型（STs）和59种PFGE型（PTs）。ST11 CRKP菌株在我们的研究中被记录为占主导地位，且逐年呈显著上升趋势。此外，与PT10和PT15相对应的优势ST11 CRKP继续呈现其特征模式。重要的是，与ST11谱系相对应的新鉴定的PT09和PT16菌株仅在2016年被发现。同时，评估了影响30天死亡率的因素以及CRKP感染中ST11的比例，发现ST11、适当的经验性治疗及住院时间与30天死亡率独立相关。
ST11 CRKP菌株在这一过程中起主导作用；然而，这些菌株的同源性具有多态性，优势菌群会随进化而发生变化。此外，除了适当的经验性治疗和住院时间外，ST11 CRKP与30天死亡率独立相关。据我们所知，这种关联首次被报道。
