中国深圳儿科住院患者中碳青霉烯耐药肠杆菌科细菌定植的危险因素及分子流行病学

Risk factors and molecular epidemiology of colonizing carbapenem-resistant Enterobacterales in pediatric inpatient in Shenzhen, China.

作者信息

Yang Hongmei, Xiong Zhile, Cao Ke, He Yunxing, Song Songhong, Lan Fangjun, Yang Kaiyue, Liu Xiaochun, Duan Chaohui, Zhou Zhenwen

机构信息

Longgang Maternity and Child Institute of Shantou University Medical College (Longgang District Maternity & Child Healthcare Hospital of Shenzhen City), Clinical Laboratory, Shenzhen, Guangdong 518172, China; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt, Universität zu Berlin, Institute of Microbiology, Infectious Diseases and Immunology, Hindenburgdamm 30, 12203 Berlin, Germany.

出版信息

J Infect Public Health. 2025 Jan;18(1):102614. doi: 10.1016/j.jiph.2024.102614. Epub 2024 Dec 3.

DOI:10.1016/j.jiph.2024.102614

PMID:39642772

Abstract

OBJECTIVES

The spread of CRE has been rapid on a global scale and represents a significant challenge in nosocomial infections worldwide. The aim is to evaluate the risk factors for CRE colonization and to describe the molecular and clinical characteristics of CRE colonization in pediatric inpatients in Shenzhen, China.

METHODS

We collected stool specimens from 2474 randomly selected pediatric inpatient hospitalized in 2 pediatric hospitals in Shenzhen between January 2023 and December 2023 for subsequent microbiological analysis, including microbial culture, species identification, antimicrobial sensitivity testing, genetic characterization and multilocus sequence typing (MLST). In addition, we conducted a case-control study to identify potential risk factors for gastrointestinal CRE colonization.

RESULTS

Of the 2474 non-replicating pediatric stool specimens collected, 3.6 % (n = 90) test positive for CRE. The most dominant CRE species were Escherichia coli (n = 67, 74.5 %), and Klebsiella pneumoniae (n = 17, 19.0 %). Multidrug resistance and carbapenemase production were observed in most CRE isolates. In CR E. coli and CR K. pneumoniae, the bla was the predominant resistance gene, accounting for 95.5 % and 76.5 %, respectively. MLST showed considerable clonal diversity among the CR E. coli and CR K. pneumoniae isolates and the most common ST in CR E. coli was ST48 (n = 6, 9.0 %) and ST35 in CR K. pneumoniae (n = 4, 23.5 %).

CONCLUSIONS

This study once again shows that pediatric inpatients in South China were colonized by a diversity of CRE strains, increasing the likelihood of difficult-to-treat infections. Hospitals and competent authorities should take appropriate public health measures, to prevent the further spread of CRE.

摘要

目的

耐碳青霉烯类肠杆菌科细菌（CRE）在全球范围内传播迅速，是全球医院感染面临的重大挑战。本研究旨在评估深圳儿科住院患者CRE定植的危险因素，并描述CRE定植的分子和临床特征。

方法

我们收集了2023年1月至2023年12月期间在深圳两家儿科医院随机选取的2474例儿科住院患者的粪便标本，用于后续微生物学分析，包括微生物培养、菌种鉴定、药敏试验、基因特征分析和多位点序列分型（MLST）。此外，我们进行了病例对照研究，以确定胃肠道CRE定植的潜在危险因素。

结果

在收集的2474份非重复儿科粪便标本中，3.6%（n = 90）的标本CRE检测呈阳性。最主要的CRE菌种是大肠埃希菌（n = 67，74.5%）和肺炎克雷伯菌（n = 17，19.0%）。大多数CRE分离株表现出多重耐药和碳青霉烯酶产生。在耐碳青霉烯类大肠埃希菌和耐碳青霉烯类肺炎克雷伯菌中，bla是主要的耐药基因，分别占95.5%和76.5%。MLST显示耐碳青霉烯类大肠埃希菌和耐碳青霉烯类肺炎克雷伯菌分离株之间存在相当大的克隆多样性，耐碳青霉烯类大肠埃希菌中最常见的序列型是ST48（n = 6，9.0%），耐碳青霉烯类肺炎克雷伯菌中是ST35（n = 4，23.5%）。