Biedrzycka Marta, Izdebski Radosław, Hryniewicz Waleria, Gniadkowski Marek, Żabicka Dorota
Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.
Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.
Infect Dis Ther. 2025 Feb;14(2):401-419. doi: 10.1007/s40121-024-01097-9. Epub 2025 Jan 5.
Despite a scarcity of data, before 2022 Ukraine was already considered a high-prevalence country for carbapenemase-producing Enterobacterales (CPE), and the situation has dramatically worsened during the full-scale war with Russia. The aim of this study was to analyse CPEs isolated in Poland from victims of war in Ukraine.
The study included 65 CPE isolates from March 2022 till February 2023, recovered in 36 Polish medical centres from 57 patients arriving from Ukraine, differing largely by age and reason for hospitalisation. All isolates were sequenced by MiSeq and ten Klebsiella pneumoniae isolates also by MinION. Taxonomy, clonality and resistomes were analysed for all CPEs, whereas phylogeny, serotypes, virulomes and plasmids were characterised for K. pneumoniae, and partially for Escherichia coli ST131, using various bioinformatic tools.
Multifactorial diversity of the isolates reflected the patients' clinical-epidemiological heterogeneity. The CPEs represented six species. Klebsiella pneumoniae was the most prevalent with 50 isolates and 15 sequence types (STs), mainly ST395, ST307, ST11, ST147 and ST23, producing NDM (-1/-5), OXA-48 (-48/-1242) or KPC (-2/-3)-like carbapenemases. Each of the STs produced groups of loosely related isolates, clusters of close relatives and/or unique isolates, correlating with K serotypes and carbapenemases. Many of these, especially NDM-1- and/or OXA-48-producing ST395 and ST307, were related to Russian organisms. Others, for example, NDM-1-producing ST11, clustered with those from Poland. Numerous K. pneumoniae isolates had specific virulence genes, including aerobactin iuc, largely due to spread of pNDM-MAR plasmids, showing both resistance and virulence. Two E. coli ST131 isolates belonged to clades B or C1 and produced KPC-3 or NDM-1, respectively.
Together with similar studies from Germany and The Netherlands, this work has documented broad dissemination of CPE in Ukraine, driven by a number of specific K. pneumoniae lineages circulating over a large territory of Eastern Europe.
尽管数据匮乏，但在2022年之前，乌克兰就已被视为产碳青霉烯酶肠杆菌科细菌（CPE）的高流行国家，而在与俄罗斯的全面战争期间，情况急剧恶化。本研究的目的是分析在波兰从乌克兰战争受害者中分离出的CPE。
该研究纳入了2022年3月至2023年2月期间分离出的65株CPE，这些菌株来自波兰的36个医疗中心，是从57名来自乌克兰的患者身上分离得到的，这些患者在年龄和住院原因上有很大差异。所有分离株均通过MiSeq进行测序，10株肺炎克雷伯菌分离株还通过MinION进行测序。使用各种生物信息学工具对所有CPE进行分类学、克隆性和耐药组分析，而对肺炎克雷伯菌以及部分大肠杆菌ST131的系统发育、血清型、毒力组和质粒进行表征。
分离株的多因素多样性反映了患者的临床流行病学异质性。CPE代表6个菌种。肺炎克雷伯菌最为常见，有50株，共15个序列型（ST），主要为ST395、ST307、ST11、ST147和ST23，产生NDM（-1/-5）、OXA-48（-48/-1242）或KPC（-2/-3）样碳青霉烯酶。每个ST都产生了一组关系松散的分离株、近亲簇和/或独特的分离株，与K血清型和碳青霉烯酶相关。其中许多，尤其是产NDM-1和/或OXA-48的ST395和ST307，与俄罗斯的菌株有关。其他的，例如产NDM-1的ST11，与来自波兰的菌株聚类。许多肺炎克雷伯菌分离株具有特定的毒力基因，包括气杆菌素iuc，这主要是由于pNDM-MAR质粒的传播，显示出耐药性和毒力。两株大肠杆菌ST131分离株分别属于B或C1分支，分别产生KPC-3或NDM-1。
与德国和荷兰的类似研究一起，这项工作记录了CPE在乌克兰的广泛传播，这是由一些在东欧大片地区传播的特定肺炎克雷伯菌谱系驱动的。
