Chen Wei, Cai Zhao, Liu Shuangqing, Sotgiu Giovanni, Martin-Loeches Ignacio, Cao Yang
Department of Infectious Diseases, The Second Hospital of Tianjin Medical University, Tianjin, China.
Shenzhen Mindray Bio-Medical Electronics Co., Ltd., Shenzhen, China.
J Thorac Dis. 2024 Nov 30;16(11):7739-7750. doi: 10.21037/jtd-24-1148. Epub 2024 Nov 29.
( ) is an opportunistic pathogen that can cause multiple life-threatening infections. Recently, there has been an upward trend in carbapenem-resistant infections in China. This epidemiological trend needs to be examined to enable better disease control. We sought to analyze the genomic characteristics, including the prevalent sequence type (ST), resistance, virulence, and evolutionary relationship, of strains isolated from patients with different types of infections in northern China to provide theoretical support for the effective prevention and control of the evolution and transmission of .
The STs were analyzed using multi-locus sequence typing (MLST). Drug susceptibility tests were used to examine the resistance of these STs to various antibiotics. A phylogenetic tree of these isolates was constructed using the National Center for Biotechnology Information genome as the reference. Antibiotic resistance genes were identified by comparing the genomic sequences against those in the Comprehensive Antibiotic Resistance Database. Virulence genes were identified using the Virulence Factor database, while the pathogenicity of the isolates was predicted using PathogenFinder.
In total, 38 clinical isolates of were identified and sequenced by high-throughput sequencing. Multidrug-resistant ST11 and hypervirulent ST23 were found to be the prevalent strains. The distribution of the ST11 strains was strongly correlated with stays in the neurosurgery department (chi square test, P=0.02), while the ST23 strains were more frequently isolated from patients with liver abscesses and gallbladder infections. The ST23 strains were significantly more pathogenic than the other STs (Wilcox test, P<0.001). The resistance analysis showed that the genes were significantly correlated with amikacin resistance (P<2.2e-16, R=1). The ST11 strains were also found to co-harbor the KPC-2, , and TEM-1 genes. To the best of our knowledge, this is the first study to report on the dissemination of such multidrug-resistant ST11 strains in Tianjin.
The carbapenem-resistant (CRKP) ST11 may become highly virulent (CR-hvKP) due to the acquisition of virulence plasmids. Attention should be paid to the evolutionary pressure of a caused by the overuse of antibiotics, which may trigger the further development of multidrug-resistant infections.
（某病原体名称）是一种机会性病原体，可引发多种危及生命的感染。近年来，中国耐碳青霉烯类（该病原体名称）感染呈上升趋势。需要对这一流行病学趋势进行研究，以更好地控制疾病。我们试图分析从中国北方不同类型感染患者中分离出的（该病原体名称）菌株的基因组特征，包括流行的序列类型（ST）、耐药性、毒力及进化关系，为有效预防和控制（该病原体名称）的进化及传播提供理论支持。
采用多位点序列分型（MLST）分析ST类型。通过药敏试验检测这些ST类型对各种抗生素的耐药性。以美国国立生物技术信息中心的基因组为参考构建这些分离株的系统发育树。通过将基因组序列与综合抗生素抗性数据库中的序列进行比较来鉴定抗生素抗性基因。利用毒力因子数据库鉴定毒力基因，同时使用PathogenFinder预测分离株的致病性。
共鉴定出38株（该病原体名称）临床分离株，并通过高通量测序进行了测序。发现多重耐药的ST11和高毒力的ST23是主要的（该病原体名称）菌株。ST11菌株的分布与神经外科住院情况密切相关（卡方检验，P = 0.02），而ST23菌株更常见于肝脓肿和胆囊感染患者。ST23菌株的致病性明显高于其他ST类型（Wilcox检验，P < 0.001）。耐药性分析表明，（相关基因名称）基因与阿米卡星耐药性显著相关（P < 2.2e - 16，R = 1）。还发现ST11菌株同时携带KPC - 2、（相关基因名称）和TEM - 1基因。据我们所知，这是首次报道此类多重耐药的（该病原体名称）ST11菌株在天津传播的研究。
耐碳青霉烯类（该病原体名称）（CRKP）ST11可能因获得毒力质粒而成为高毒力（该病原体名称）（CR - hvKP）。应关注抗生素过度使用导致的（该病原体名称）进化压力，这可能引发多重耐药（该病原体名称）感染的进一步发展。
