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美国，携带毒力质粒的耐碳青霉烯肺炎克雷伯菌

Carbapenem-Resistant, Virulence Plasmid-Harboring Klebsiella pneumoniae, United States.

作者信息

Jiang Jianping, Long Tengfei, Porter Adeline R, Lovey Arianne, Lee Annie, Jacob Jesse Thomas, Arias Cesar A, Bonomo Robert, Kalayjian Robert, Zhao Yanan, DeLeo Frank R, van Duin David, Kreiswirth Barry N, Chen Liang

出版信息

Emerg Infect Dis. 2025 Apr;31(4):761-771. doi: 10.3201/eid3104.241396. Epub 2024 Mar 12.

DOI:10.3201/eid3104.241396
PMID:40072602
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11950267/
Abstract

Carbapenem-resistant and virulence plasmid-harboring Klebsiella pneumoniae (pVir-CRKP) has emerged and spread globally, yet clinical investigations from the United States remain limited. We conducted a genomic analysis of 884 unique carbapenem-resistant K. pneumoniae isolates from a multicenter US cohort and identified 6 pVir-CRKP isolates, including 2 sequence type (ST) 23, 2 ST893, and 2 ST11 isolates. Patients infected with pVir-CRKP experienced high Pitt bacteremia scores and a 33% 30-day mortality rate. The pVir-CRKP isolates exhibited significant sequence variation in virulence genes and plasmids, along with differences in mucoviscosity, capsule production, survival in normal human serum, resistance to killing by human polymorphonuclear neutrophils, and in vivo pathogenicity. Phylogenetic analyses showed that most pVir-CRKP isolates were genetically similar to strains reported from other global regions. The emergence of pVir-CRKP with higher virulence potential and carbapenem resistance in the United States than the predominant carbapenem-resistant K. pneumoniae clone underscores the need for active global surveillance.

摘要

携带碳青霉烯耐药性和毒力质粒的肺炎克雷伯菌（pVir-CRKP）已在全球出现并传播，但美国的临床研究仍然有限。我们对来自美国一个多中心队列的884株独特的碳青霉烯耐药肺炎克雷伯菌分离株进行了基因组分析，鉴定出6株pVir-CRKP分离株，包括2株序列类型（ST）23、2株ST893和2株ST11分离株。感染pVir-CRKP的患者具有较高的皮特菌血症评分和33%的30天死亡率。pVir-CRKP分离株在毒力基因和质粒方面表现出显著的序列变异，同时在黏液粘度、荚膜产生、在正常人血清中的存活能力、对人多形核中性粒细胞杀伤的抗性以及体内致病性方面也存在差异。系统发育分析表明，大多数pVir-CRKP分离株在基因上与其他全球区域报道的菌株相似。在美国，具有更高毒力潜力和碳青霉烯耐药性的pVir-CRKP的出现，比主要的碳青霉烯耐药肺炎克雷伯菌克隆更突出了全球积极监测的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/40bc47002689/24-1396-F5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/9c8e59b12c13/24-1396-F1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/d7999782c488/24-1396-F3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/d38a4bd9d3b3/24-1396-F4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/40bc47002689/24-1396-F5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/9c8e59b12c13/24-1396-F1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/c5871dafea82/24-1396-F2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/d7999782c488/24-1396-F3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/d38a4bd9d3b3/24-1396-F4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c12e/11950267/40bc47002689/24-1396-F5.jpg

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