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    某三甲医院血流感染耐碳青霉烯类肺炎克雷伯菌的毒力和分子流行病学特征分析

    Analysis of virulence and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae in bloodstream infections at a tertiary hospital

    • 摘要: 目的 探究血流感染耐碳青霉烯类肺炎克雷伯菌(CRKP)的毒力和分子流行病学特征。方法 收集2022年6月—2024年3月徐州医科大学附属医院检验科首次分离的血流感染CRKP菌株,测定抗菌药物的敏感性,采用聚合酶链式反应(PCR)检测碳青霉烯酶基因(blaKPC、blaNDM),收集患者的临床信息,通过脉冲场凝胶电泳(PFGE)检测携带blaKPC基因的菌株同源性,并通过体外血清杀伤试验和大蜡螟感染模型评估菌株毒力。结果 共收集22株CRKP菌株,全部对青霉素类、头孢菌素类、碳青霉烯类药物耐药,部分对多黏菌素和替加环素耐药。所有患者均存在侵入性操作,大部分患有基础疾病。菌株经同源性分析可分为7个克隆型。KP21分离株的毒力高于高毒力对照株。结论 所有CRKP菌株对多种抗菌药物均呈现高水平耐药且存在高毒力菌株,应当加强对此类高致病性CRKP菌株的监测,以控制其在医院内的传播。

       

      Abstract: Objective To investigate the virulence and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in bloodstream infections. Methods CRKP strains initially isolated from bloodstream infections at Department of Laboratory Examination, the Affiliated Hospital of Xuzhou Medical University between June 2022 and March 2024 were collected. Antibiotic susceptibility testing was performed, and polymerase chain reaction (PCR) was used to detect carbapenemase genes (blaKPC and blaNDM). Clinical data was collected. Pulsed-field gel electrophoresis (PFGE) was conducted to assess the homology of strains carrying the blaKPC gene. Meanwhile, the virulence of the strains was evaluated by in vitro serum killing assay and Galleria mellonella infection model. Results A total of 22 CRKP strains were collected, all of which were resistant to penicillins, cephalosporins, and carbapenems, with some showing resistance to polymyxin and tigecycline. All patients had invasive procedures, and most had underlying diseases. Homology analysis of the strains revealed seven clonal types. The virulence of strain KP21 was higher than that of the high-virulence control strain. Conclusions All CRKP strains exhibit high resistance to multiple antibiotics and include highly virulent strains. Monitoring of these highly pathogenic CRKP strains should be strengthened to control their spread within hospitals.

       

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