中国不同地区住院患者分离株的分子流行病学和抗菌药物耐药谱特征。
Molecular epidemiology and antimicrobial resistance profiles of isolates from hospitalized patients in different regions of China.
机构信息
Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China.
Liaoning Clinical Research Center for Laboratory Medicine, Shenyang, China.
出版信息
Front Cell Infect Microbiol. 2024 May 16;14:1380678. doi: 10.3389/fcimb.2024.1380678. eCollection 2024.
INTRODUCTION
The increasing incidence of Klebsiella pneumoniae and carbapenem-resistant Klebsiella pneumoniae (CRKP) has posed great challenges for the clinical anti-infective treatment. Here, we describe the molecular epidemiology and antimicrobial resistance profiles of K. pneumoniae and CRKP isolates from hospitalized patients in different regions of China.
METHODS
A total of 219 K. pneumoniae isolates from 26 hospitals in 19 provinces of China were collected during 2019-2020. Antimicrobial susceptibility tests, multilocus sequence typing were performed, antimicrobial resistance genes were detected by polymerase chain reaction (PCR). Antimicrobial resistance profiles were compared between different groups.
RESULTS
The resistance rates of K. pneumoniae isolates to imipenem, meropenem, and ertapenem were 20.1%, 20.1%, and 22.4%, respectively. A total of 45 CRKP isolates were identified. There was a significant difference in antimicrobial resistance between 45 CRKP and 174 carbapenem-sensitive Klebsiella pneumoniae (CSKP) strains, and the CRKP isolates were characterized by the multiple-drug resistance phenotype.There were regional differences among antimicrobial resistance rates of K. pneumoniae to cefazolin, chloramphenicol, and sulfamethoxazole,which were lower in the northwest than those in north and south of China.The mostcommon sequence type (ST) was ST11 (66.7% of the strains). In addition, we detected 13 other STs. There were differences between ST11 and non-ST11 isolates in the resistance rate to amikacin, gentamicin, latamoxef, ciprofloxacin, levofloxacin, aztreonam, nitrofurantoin, fosfomycin, and ceftazidime/avibactam. In terms of molecular resistance mechanisms, the majority of the CRKP strains (71.1%, 32/45) harbored blaKPC-2, followed by blaNDM (22.2%, 10/45). Strains harboring blaKPC or blaNDM genes showed different sensitivities to some antibiotics.
CONCLUSION
Our analysis emphasizes the importance of surveilling carbapenem-resistant determinants and analyzing their molecular characteristics for better management of antimicrobial agents in clinical use.
简介
肺炎克雷伯菌和碳青霉烯类耐药肺炎克雷伯菌（CRKP）的发病率不断上升，给临床抗感染治疗带来了巨大挑战。本研究描述了来自中国不同地区住院患者的肺炎克雷伯菌和 CRKP 分离株的分子流行病学和抗菌药物耐药谱。
方法
2019-2020 年，我们从中国 19 个省的 26 家医院共收集了 219 株肺炎克雷伯菌。进行了抗菌药物敏感性试验、多位点序列分型，采用聚合酶链反应（PCR）检测抗菌药物耐药基因。比较了不同组之间的抗菌药物耐药谱。
结果
肺炎克雷伯菌对亚胺培南、美罗培南和厄他培南的耐药率分别为 20.1%、20.1%和 22.4%。共鉴定出 45 株 CRKP。45 株 CRKP 与 174 株碳青霉烯类敏感肺炎克雷伯菌（CSKP）的抗菌药物耐药性存在显著差异，CRKP 分离株表现出多重耐药表型。肺炎克雷伯菌对头孢唑林、氯霉素和磺胺甲噁唑的耐药率存在地域差异，西北地区低于北方和南方。最常见的序列型（ST）是 ST11（占菌株的 66.7%）。此外，我们还检测到了其他 13 种 ST。ST11 与非 ST11 分离株对阿米卡星、庆大霉素、拉氧头孢、环丙沙星、左氧氟沙星、氨曲南、呋喃妥因、磷霉素、头孢他啶/阿维巴坦的耐药率存在差异。在分子耐药机制方面，大多数 CRKP 株（71.1%，32/45）携带 blaKPC-2，其次是 blaNDM（22.2%，10/45）。携带 blaKPC 或 blaNDM 基因的菌株对一些抗生素的敏感性不同。
结论
我们的分析强调了监测碳青霉烯类耐药决定因素及其分子特征的重要性，以便更好地管理临床使用的抗菌药物。
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