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中国耐碳青霉烯类肺炎克雷伯菌荚膜血清型、抗生素耐药性和毒力因子的纵向多中心研究。

Carbapenem-resistant Klebsiella pneumoniae capsular types, antibiotic resistance and virulence factors in China: a longitudinal, multi-centre study.

机构信息

Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.

Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

出版信息

Nat Microbiol. 2024 Mar;9(3):814-829. doi: 10.1038/s41564-024-01612-1. Epub 2024 Feb 29.

DOI:10.1038/s41564-024-01612-1
PMID:38424289
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10914598/
Abstract

Epidemiological knowledge of circulating carbapenem-resistant Klebsiella pneumoniae (CRKP) is needed to develop effective strategies against this public health threat. Here we present a longitudinal analysis of 1,017 CRKP isolates recovered from patients from 40 hospitals across China between 2016 and 2020. Virulence gene and capsule typing revealed expansion of CRKP capsule type KL64 (59.5%) alongside decreases in KL47 prevalence. Hypervirulent CRKP increased in prevalence from 28.2% in 2016 to 45.7% in 2020. Phylogenetic and spatiotemporal analysis revealed Beijing and Shanghai as transmission hubs accounting for differential geographical prevalence of KL47 and KL64 strains across China. Moderate frequency capsule or O-antigen loss was also detected among isolates. Non-capsular CRKP were more susceptible to phagocytosis, attenuated during mouse infections, but showed increased serum resistance and biofilm formation. These findings give insight into CRKP serotype prevalence and dynamics, revealing the importance of monitoring serotype shifts for the future development of immunological strategies against CRKP infections.

摘要

为了制定有效的策略来应对这一公共卫生威胁，我们需要了解流行的碳青霉烯类耐药肺炎克雷伯菌（CRKP）的流行病学知识。在这里，我们对 2016 年至 2020 年间中国 40 家医院的 1017 株 CRKP 分离株进行了纵向分析。毒力基因和荚膜分型显示，CRKP 荚膜型 KL64（59.5%）的扩张，同时 KL47 的流行率降低。高毒力 CRKP 的流行率从 2016 年的 28.2%增加到 2020 年的 45.7%。系统发生和时空分析显示，北京和上海是传播中心，导致中国不同地区 KL47 和 KL64 菌株的流行率存在差异。还检测到荚膜或 O-抗原的中度丢失。非荚膜 CRKP 更容易被吞噬，在小鼠感染过程中减弱，但表现出更高的血清抗性和生物膜形成。这些发现使我们深入了解了 CRKP 血清型的流行和动态，揭示了监测血清型转变对未来开发针对 CRKP 感染的免疫策略的重要性。

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