Hou Bailong, Zhou Ying, Wang Wei, Shen Weifeng, Yu Qinlong, Mao Minjie, Wang Siheng, Ai Wenxiu, Yu Fangyou, Shao Pingyang
Department of Clinical Laboratory Medicine, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, 314000, People's Republic of China.
Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200000, People's Republic of China.
Infect Drug Resist. 2024 Jul 2;17:2719-2732. doi: 10.2147/IDR.S462158. eCollection 2024.
This study aimed to investigate the emergence and characteristics of carbapenem-resistant (CRKP) strains that demonstrate resistance to multiple antibiotics, including aminoglycosides and tigecycline, in a Chinese hospital.
A group of ten CRKP strains were collected from the nine patients in a Chinese hospital. Antimicrobial Susceptibility Testing (AST) and phenotypic inhibition assays precisely assess bacterial antibiotic resistance. Real-time quantitative PCR (RT-qPCR) was used to analyze the mRNA levels of efflux pump genes ( and ) and the regulatory gene (). The core-genome tree and PFGE patterns were analyzed to assess the clonal and horizontal transfer expansion of the strains. Whole-genome sequencing was performed on a clinical isolate of named Kpn20 to identify key resistance genes and antimicrobial resistance islands (ARI).
The CRKP strains showed high resistance to carbapenems, aminoglycosides (CLSI, 2024), and tigecycline (EUCAST, 2024). The mRNA expression levels of efflux pump genes and regulatory genes were detected by RT-qPCR. All 10 isolates had significant differences compared to the control group of ATCC13883. The core-genome tree and PFGE patterns revealed five clusters, indicating clonal and horizontal transfer expansion. Three key resistance genes ( , and ) were observed in the clinical isolate Kpn20. Mobile antibiotic resistance islands were identified containing and , with multiple insertion sequences and transposons present. The coexistence of and in a high-risk strain was reported. Conjugation assay was utilized to investigate the transferability of -encoding plasmids horizontally.
The study highlights the emergence of ST15-KL112 high-risk strains with multidrug resistance, including to aminoglycosides and tigecycline. The presence of mobile ARI and clonal and horizontal transfer expansion of strains indicate the threat of transmission of these strains. Future research is needed to assess the prevalence of such isolates and develop effective control measures.
本研究旨在调查一家中国医院中对包括氨基糖苷类和替加环素在内的多种抗生素具有耐药性的耐碳青霉烯类肺炎克雷伯菌（CRKP）菌株的出现情况和特征。
从一家中国医院的9名患者中收集了一组10株CRKP菌株。抗菌药物敏感性试验（AST）和表型抑制试验精确评估细菌的抗生素耐药性。采用实时定量PCR（RT-qPCR）分析外排泵基因（和）及调节基因（）的mRNA水平。分析核心基因组树和脉冲场凝胶电泳（PFGE）图谱，以评估菌株的克隆和水平转移扩展情况。对一株名为Kpn20的临床分离株进行全基因组测序，以鉴定关键耐药基因和抗菌耐药岛（ARI）。
CRKP菌株对碳青霉烯类、氨基糖苷类（CLSI，2024）和替加环素（EUCAST，2024）表现出高度耐药性。通过RT-qPCR检测外排泵基因和调节基因的mRNA表达水平。与ATCC13883对照组相比，所有10株分离株均有显著差异。核心基因组树和PFGE图谱显示有五个簇，表明存在克隆和水平转移扩展。在临床分离株Kpn20中观察到三个关键耐药基因（、和）。鉴定出含有和的移动性抗生素耐药岛，存在多个插入序列和转座子。报道了高危菌株中与的共存情况。利用接合试验研究编码质粒水平转移的可能性。
该研究突出了具有多重耐药性，包括对氨基糖苷类和替加环素耐药的ST15-KL112高危菌株的出现。移动性ARI的存在以及菌株的克隆和水平转移扩展表明了这些菌株传播的威胁。需要进一步研究评估此类分离株的流行情况并制定有效的控制措施。
