Lau Min Yi, Ponnampalavanar Sasheela, Chong Chun Wie, Dwiyanto Jacky, Lee Yee Qing, Woon Jia Jie, Kong Zhi Xian, Jasni Azmiza Syawani, Lee Michelle Chin Chin, Obaidellah Unaizah Hanum, Teh Cindy Shuan Ju
Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia.
Antibiotics (Basel). 2024 Nov 20;13(11):1107. doi: 10.3390/antibiotics13111107.
: The emergence and dissemination of carbapenem-resistant organisms, particularly and , pose a significant threat to healthcare systems worldwide. This retrospective study aims to characterise carbapenem-resistant (CRAB) and carbapenem-resistant (CRKP) strains in a teaching hospital and to determine the risk factors associated with patients' in-hospital mortality. : A total of 90 CRAB and 63 CRKP were included in this study. Carbapenemase genes and MLST types of CRAB and CRKP were determined using specific primers. Risk factors associated with in-hospital mortality were analysed with collected data. All the CRAB strains consisted of OXA carbapenemase genes, with 98% of the strains co-harbouring OXA-23-like and OXA-51-like carbapenemase genes. Conversely, NDM is the predominant carbapenemase gene in CRKP, followed by OXA-48-like carbapenemase genes. ST2 and ST20 are the dominant MLST types in CRAB and CRKP, respectively. In CRAB, multivariate analysis identified age, ethnicity, the presence of a mechanical ventilator, and patients who experienced previous exposure to clindamycin in the last 90 days as associated with an increased risk of in-hospital mortality. In contrast, older age, male, ICU admission, and the presence of an indwelling urinary catheter were significantly associated with an increased risk of mortality for patients with CRKP. : Both CRAB and CRKP lead to high rates of mortality. The MLST profile showed that the genomic patterns of CRKP were highly diverse, whereas CRAB strains had low genetic diversity. To tackle these challenging pathogens, robust surveillance and an in-depth understanding of molecular epidemiology and genomics studies are needed to tailor infection control strategies and individualise treatment approaches.
耐碳青霉烯类微生物，尤其是[具体微生物1]和[具体微生物2]的出现和传播，对全球医疗系统构成了重大威胁。这项回顾性研究旨在对一家教学医院中的耐碳青霉烯类[具体微生物1]（CRAB）和耐碳青霉烯类[具体微生物2]（CRKP）菌株进行特征分析，并确定与患者院内死亡相关的危险因素。：本研究共纳入90株CRAB和63株CRKP。使用特异性引物确定CRAB和CRKP的碳青霉烯酶基因及多位点序列分型（MLST）类型。利用收集的数据分析与院内死亡相关的危险因素。所有CRAB菌株均含有OXA碳青霉烯酶基因，其中98%的菌株同时携带OXA - 23样和OXA - 51样碳青霉烯酶基因。相反，NDM是CRKP中主要的碳青霉烯酶基因，其次是OXA - 48样碳青霉烯酶基因。ST2和ST20分别是CRAB和CRKP中占主导地位的MLST类型。在CRAB中，多因素分析确定年龄、种族、使用机械通气以及在过去90天内曾接触克林霉素的患者与院内死亡风险增加相关。相比之下，年龄较大、男性、入住重症监护病房（ICU）以及留置导尿管与CRKP患者的死亡风险增加显著相关。：CRAB和CRKP均导致高死亡率。MLST图谱显示，CRKP的基因组模式高度多样，而CRAB菌株的遗传多样性较低。为应对这些具有挑战性的病原体，需要进行强有力的监测以及深入了解分子流行病学和基因组学研究，以制定感染控制策略并实现个体化治疗方法。
