Xue Yu E, Zhang Dongmei, Du Shuaixian, Chen Du, Liu Shihan, Peng Tianfeng, Li Chong, Zhang Jianchu, Wang Xiaorong
Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
Infect Drug Resist. 2025 Jan 8;18:171-184. doi: 10.2147/IDR.S482713. eCollection 2025.
To investigate the molecular epidemiology and risk factors of carbapenem-resistant (CRKP) infection.
Patient's clinical data and CRKP strains were collected from November 2017 to December 2018 at a tertiary hospital in Wuhan, China. The antimicrobial susceptibilities, carbapenem-resistant genes, multi-locus sequence typing (MLST), homologous analysis, and risk factors for CRKP were determined.
A total of 203 CRKP strains were isolated, and 98.5% (200/203) of patients were nosocomially infected. The mortality rate was 17.7% (36/203). All 203 strains were confirmed as carbapenemases -producing strains. The most predominant carbapenemase gene was (81.3%, 165/203), followed by (25.1%, 51/203) and (23.2%, 47/205). Of the 203 strains, 28 (13.8%) had both and genes, 23 (11.3%) had both and genes, 20 (9.9%) had , and three genes. MLST analysis showed that there were 48 ST typologies (including 7 new STs), of which ST-11 was the most prevalent (59.6%, 121/203). Phylogenetic analysis showed that 203 CRKP isolates came from 7 clusters and exhibited a strong correlation with the isolation source. eBURST analyses indicated that CRKP isolates have undergone different evolutionary processes. Patients with ST-11 CRKP underwent more mechanical ventilation (50% vs 32.9%, =0.020) and gastric catheterization (15.7% vs 6.1%, =0.042) within 3 months before sample collection, and also had higher drug-resistance rate than non-ST-11 CRKP. Comparing with CSKP (carbapenem-sensitive ), gastrointestinal disease (odds ratio [OR]=6.168, =0.003), nosocomial infection (OR=5.573, =0.012), antibiotic exposure (OR=4.131, =0.004), urinary catheterization (OR=3.960, =0.031) and venous/arterial catheterization (OR=2.738, =0.026) within the preceding 3 months were independent risk factors for CRKP infection.
The IMP-4 was the most predominant carbapenemase and bearing ST-11 was spreading in the hospital. Nosocomial infections, antibiotic exposure, and urinary and venous/arterial catheterization within 3 months were the risk factors for developing CRKP infection.
探讨耐碳青霉烯类肺炎克雷伯菌（CRKP）感染的分子流行病学及危险因素。
于2017年11月至2018年12月在中国武汉一家三级医院收集患者的临床资料及CRKP菌株。测定抗菌药物敏感性、耐碳青霉烯类基因、多位点序列分型（MLST）、同源性分析及CRKP的危险因素。
共分离出203株CRKP菌株，98.5%（200/203）的患者为医院感染。死亡率为17.7%（36/203）。所有203株菌株均被确认为产碳青霉烯酶菌株。最主要的碳青霉烯酶基因是IMP-4（81.3%，165/203），其次是NDM-1（25.1%，51/203）和OXA-48（23.2%，47/205）。203株菌株中，28株（13.8%）同时具有IMP-4和NDM-1基因，23株（11.3%）同时具有IMP-4和OXA-48基因，20株（9.9%）具有IMP-4、NDM-1和OXA-48三种基因。MLST分析显示有48种ST型别（包括7种新的ST型），其中ST-11最为常见（59.6%，121/203）。系统发育分析表明203株CRKP分离株来自7个簇，且与分离来源呈强相关性。eBURST分析表明CRKP分离株经历了不同的进化过程。ST-11型CRKP患者在样本采集前3个月内接受机械通气（50%对32.9%，P=0.020）和胃管插管（15.7%对6.1%，P=0.042）的比例更高，且耐药率也高于非ST-11型CRKP。与碳青霉烯类敏感肺炎克雷伯菌（CSKP）相比，胃肠道疾病（比值比[OR]=6.168，P=0.003）、医院感染（OR=5.573，P=0.012）、抗生素暴露（OR=4.131，P=0.004）、留置尿管（OR=3.960，P=0.031）及动静脉置管（OR=2.738，P=0.026）是CRKP感染的独立危险因素。
IMP-4是最主要的碳青霉烯酶，携带ST-11型的菌株在医院内传播。医院感染、抗生素暴露以及3个月内的留置尿管和动静脉置管是发生CRKP感染的危险因素。
