揭示重症监护病房环境中耐碳青霉烯类肺炎克雷伯菌的克隆动态及传播机制。

Unveiling the clonal dynamics and transmission mechanism of carbapenem-resistant Klebsiella pneumoniae in the ICU environment.

作者信息

Han Xinhong, Song Meijun, Yu Qing, Zhou Junxin, Hu Huangdu, Jiang Yan, Shi Qiucheng, Chen Yongyi, Yang Qing, Du Xiaoxing, Mao Caiping, Yu Yunsong

机构信息

Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China; Chinese Academy of Sciences, Hangzhou Institute of Medicine (HIM), Hangzhou, Zhejiang, China; Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.

Department of Infectious Diseases, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China; Centre for General Practice Medicine, Department of Infectious Diseases, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang Province, China.

出版信息

Int J Antimicrob Agents. 2025 Sep;66(3):107532. doi: 10.1016/j.ijantimicag.2025.107532. Epub 2025 May 7.

Abstract

CRKP infections are a significant public health threat due to their high mortality and limited treatment options. This study aimed to investigate CRKP colonization and clonal dissemination mechanism in an ICU. From August 2019 to December 2019, 8668 samples were collected from patients and the ICU environment for CRKP screening. Positive samples underwent antimicrobial susceptibility testing, whole-genome sequencing, and molecular epidemiological analysis. Disinfectant sensitivity and ultraviolet (UV) resistance experiments were conducted to evaluate clonal persistence. The overall CRKP positive rate was 4.85% (420/8668), with higher rates in patients (14.77%, 247/1672) compared to environmental surfaces (2.47%, 173/6996). Intestinal and ventilator-related surfaces were identified as high-risk colonization sites. Molecular analysis revealed six sequence types, with ST11-KL64 (44.05%, 185/420) and ST15-KL112 (24.05%, 101/420) as dominant clones, both exhibiting elevated virulence. Notably, the emerging ST15-KL112 clone demonstrated enhanced resistance to disinfectants including chlorhexidine (MIC 8 mg/L) and benzalkonium chloride (32 mg/L). While most isolates produced KPC-2 (72.86%), OXA-232 prevalence (25.23%) exceeded prior reports. Crucially, ST11 strains survived standard UV disinfection (60-second exposure) at rates 1.3- to 5-fold higher than other clones (p < 0.01). Our findings highlight the critical role of disinfectant resistance in sustaining CRKP transmission. To mitigate outbreaks, we advocate for disinfectant rotation protocols targeting disinfectant-resistant clones and prolonged UV exposure times in ICUs. The persistence of resistant CRKP clones in the ICU environment, particularly their high tolerance to disinfectants, highlights the urgent need for enhanced infection control strategies, including tailored disinfection protocols and surveillance programs.

摘要

耐碳青霉烯类肺炎克雷伯菌(CRKP)感染因其高死亡率和有限的治疗选择而对公共卫生构成重大威胁。本研究旨在调查重症监护病房(ICU)中CRKP的定植及克隆传播机制。2019年8月至2019年12月,从患者和ICU环境中采集了8668份样本进行CRKP筛查。对阳性样本进行了药敏试验、全基因组测序和分子流行病学分析。进行了消毒剂敏感性和紫外线(UV)抗性实验以评估克隆的持久性。CRKP总体阳性率为4.85%(420/8668),患者中的阳性率(14.77%,247/1672)高于环境表面(2.47%,173/6996)。肠道和呼吸机相关表面被确定为高风险定植部位。分子分析揭示了六种序列类型,其中ST11-KL64(44.05%,185/420)和ST15-KL112(24.05%,101/420)为优势克隆,二者均表现出较高的毒力。值得注意的是,新兴的ST15-KL112克隆对包括洗必泰(MIC 8 mg/L)和苯扎氯铵(32 mg/L)在内的消毒剂的抗性增强。虽然大多数分离株产生KPC-2(72.86%),但OXA-232的流行率(25.23%)超过了先前的报道。至关重要的是,ST11菌株在标准紫外线消毒(照射60秒)后的存活几率比其他克隆高1.3至5倍(p<0.01)。我们的研究结果突出了消毒剂抗性在维持CRKP传播中的关键作用。为减轻疫情爆发,我们主张针对耐消毒剂克隆采用消毒剂轮换方案,并在ICU中延长紫外线照射时间。耐碳青霉烯类肺炎克雷伯菌抗性克隆在ICU环境中的持续存在,尤其是它们对消毒剂的高耐受性,凸显了加强感染控制策略的迫切需求,包括定制的消毒方案和监测计划。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索