Henan International Joint Laboratory of Children's Infectious Diseases, Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China.
Zhengzhou Key Laboratory of Children's Infection and Immunity, Department of Laboratory Medicine, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China.
Ann Clin Microbiol Antimicrob. 2024 Nov 7;23(1):98. doi: 10.1186/s12941-024-00757-5.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging global threat, whereas its epidemiological characteristics in children are rarely reported. This study aims to analyze clinical and epidemiological characteristics of CRKP from children in Henan, China.
CRKP strains were isolated from pediatric patients, and the antimicrobial susceptibility of CRKP was determined using broth microdilution methods. The epidemiological characteristics of CRKP, including specimen sources, clinical data, carbapenemase types, virulence factors, MLST and PBRT typing were analyzed.
In total, 108 CRKP isolates were isolated from specimens including sputum, blood and urine, mainly from preterm pediatric department and internal medical intensive care unit (ICU). Newborns and staying in the ICU were risk factors for crude mortality. 107 isolates exhibited a multi-drug resistant (MDR) phenotype, and one isolate was extensively drug-resistant (XDR). Bacterial susceptibility to colistin, tigecycline and trimethoprim/sulfamethoxazole was 98.10%, 78.50% and 91.43%, respectively. Carbapenemase bla (86.11%) was predominant, followed by bla (5.56%) and bla (2.78%). Two strains co-harbored bla-bla, one had bla-bla, whereas three isolates did not carry any of the analyzed carbapenemase genes. All strains possessed fimH, and 98% of the isolates possessed mrkD. Hypervirulent factors rmpA2 and iucA showed high positive rates (71.30% and 49.07%), with 48.15% of strains containing both genes. MLST analysis identified nine distinct sequence types (STs), with ST11 (82.41%) being the most common, followed by ST2154 (4.63%) and ST307 (3.70%). PBRT analysis revealed IncFII (85.19%) as the most prevalent plasmid.
In summary, this study reported the epidemiological features of CRKP in pediatric patients in Henan, China, highlighting the high prevalence of multi-drug-resistant and hypervirulent strains, and underscoring the significance of continuous surveillance.
耐碳青霉烯类肺炎克雷伯菌（CRKP）是一种新兴的全球威胁，但其在儿童中的流行病学特征鲜有报道。本研究旨在分析中国河南地区儿童耐碳青霉烯类肺炎克雷伯菌的临床和流行病学特征。
从儿科患者的标本中分离 CRKP 菌株，并采用肉汤微量稀释法测定 CRKP 的药敏性。分析 CRKP 的流行病学特征，包括标本来源、临床资料、碳青霉烯酶类型、毒力因子、多位点序列分型（MLST）和脉冲场凝胶电泳（PBRT）分型。
共从包括痰、血和尿在内的标本中分离出 108 株 CRKP，主要来自早产儿儿科病房和内科重症监护病房（ICU）。新生儿和入住 ICU 是粗死亡率的危险因素。107 株表现出多药耐药（MDR）表型，1 株为广泛耐药（XDR）。细菌对黏菌素、替加环素和复方磺胺甲噁唑的药敏率分别为 98.10%、78.50%和 91.43%。碳青霉烯酶 bla（86.11%）最为常见，其次是 bla（5.56%）和 bla（2.78%）。有 2 株菌同时携带 bla-bla，1 株菌携带 bla-bla，而 3 株菌均不携带分析的任何碳青霉烯酶基因。所有菌株均携带 fimH，98%的菌株携带 mrkD。高毒力因子 rmpA2 和 iucA 的阳性率较高（71.30%和 49.07%），有 48.15%的菌株同时携带这两个基因。MLST 分析发现 9 个不同的序列型（STs），其中 ST11（82.41%）最为常见，其次是 ST2154（4.63%）和 ST307（3.70%）。PBRT 分析显示 IncFII（85.19%）是最常见的质粒。
综上所述，本研究报告了中国河南地区儿童耐碳青霉烯类肺炎克雷伯菌的流行病学特征，突出了多药耐药和高毒力菌株的高流行率，强调了持续监测的重要性。
