Liao Quanfeng, Yuan Yu, Zhang Weili, Deng Jin, Kang Mei
（ 610041） Department of Experimental Medicine, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2024 Mar 20;55(2):391-396. doi: 10.12182/20240360202.
To investigate the clinical characteristics and molecular epidemiology of carbapenem-resistant (CRKP) isolated from patients with bloodstream infections in a large tertiary-care general hospital in Southwest China.
A total of 131 strains of non-repeating CRKP were collected from the blood cultures of patients who had bloodstream infections in 2015-2019. The strains were identified by VITEK-2, a fully automated microbial analyzer, and matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. The minimum inhibitory concentration (MIC) was determined by microbroth dilution method. The common carbapenemase resistant genes and virulence factors were identified by PCR. Homology analysis was performed by multilocus sequencing typing. Whole genome sequencing was performed to analyze the genomic characteristics of CRKP without carbapenemase.
The 131 strains of CRKP showed resistance to common antibiotics, except for polymyxin B (1.6% resistance rate) and tigacycline (8.0% resistance rate). A total of 105 (80.2%) CRKP strains carried the carbapenemase () resistance gene, 15 (11.4%) strains carried the New Delhi Metallo-β-lactamase () gene, and 4 (3.1%) isolates carried both and genes. Sequence typing (ST) 11 (74.0%) was the dominant sequence type. High detection rates for (96.2%), (98.5%), (100%), and other virulence genes were reported. One hypervirulent CRKP strain was detected. The seven strains of CRKP that did not produce carbapenemase were shown to carry or genes and had anomalies in membrane porins OMPK35 and OMPK36, according to whole genome sequencing.
In a large-scale tertiary-care general hospital, CRKP mainly carries the gene, has a high drug resistance rate to a variety of antibiotics, and possesses multiple virulence genes. Attention should be paid to CRKP strains with high virulence.
调查中国西南部一家大型三级综合医院血流感染患者分离出的耐碳青霉烯类肺炎克雷伯菌（CRKP）的临床特征和分子流行病学。
2015年至2019年期间，从血流感染患者的血培养物中收集了总共131株非重复CRKP菌株。这些菌株通过全自动微生物分析仪VITEK-2和基质辅助激光解吸电离飞行时间（MALDI-TOF）质谱进行鉴定。采用微量肉汤稀释法测定最低抑菌浓度（MIC）。通过PCR鉴定常见的耐碳青霉烯酶基因和毒力因子。通过多位点测序分型进行同源性分析。对无碳青霉烯酶的CRKP进行全基因组测序以分析其基因组特征。
131株CRKP对除多粘菌素B（耐药率1.6%）和替加环素（耐药率8.0%）外的常用抗生素均耐药。共有105株（80.2%）CRKP菌株携带碳青霉烯酶（）耐药基因，15株（11.4%）携带新德里金属β-内酰胺酶（）基因，4株（3.1%）分离株同时携带和基因。序列分型（ST）11型（74.0%）是主要的序列类型。报告了（96.2%）、（98.5%）、（100%）和其他毒力基因的高检出率。检测到1株高毒力CRKP菌株。根据全基因组测序，7株不产碳青霉烯酶的CRKP菌株携带或基因，且膜孔蛋白OMPK35和OMPK36存在异常。
在一家大型三级综合医院中，CRKP主要携带基因，对多种抗生素耐药率高，且拥有多个毒力基因。应关注高毒力的CRKP菌株。
