摘要
目的了解衢州市人民医院肛周感染患者来源肺炎克雷伯菌(KP)的分子及耐药性特征,为临床诊断及治疗提供依据。方法对该院2018年1月至2022年6月肛周感染患者分离的46株KP进行药敏试验;利用Illumina测序平台对KP分离株进行全基因组测序,明确其分子血清型、多位点序列分型(MLST)、毒力与耐药基因等分子特征;基于核心基因组cgMLST构建最小进化树(MST),分析菌株间亲缘关系。结果感染KP的肛周疾病患者主要为40~64岁男性(56.52%),合并糖尿病者(41.30%)易感。46株KP中筛选出2株碳青霉烯类耐药菌株(CRKP)和4株产ESBLs菌株,大多数KP对临床常用抗生素敏感。O1K1-ST23 KP是主要的分子血清型和MLST分型菌株,MST显示菌株间亲缘较远。毒力和耐药基因显示,50%KP毒力评分≥4分,Aerobactin、Yersiniabactin、Salmochelin、rmpADC及rmpA2携带率均大于50%。2株CRKP中,1株同时携带bla KPC-2和bla NDM-1,另1株携带bla NDM-1和较多的毒力基因,其他耐药基因与其表型一致性较高。结论该院肛周感染来源KP大多为高毒力菌株,且已出现高毒力合并多重耐药菌株,临床需要高度专注并进行持续性监测。
Objective To investigate the molecular and drug resistance characteristics of Klebsiella pneumoniae(KP)from the patients with perianal infection in Quzhou People′s Hospital,and provide basis for clinical diagnosis and treatment.Methods Drug susceptibility tests were performed for 46 KP strains isolated from the patients with perianal infection from January 2018 to June 2022.The whole genome of the KP isolates was sequenced using Illumina sequencing platform,and the molecular characteristics,such as molecular serotype,multilocus sequence typing(MLST),virulence and drug resistance genes,were determined.Based on core genome cgMLST,minimum spanning tree(MST)was constructed to analyze the relationship between the strains.Results The males aged 40 to 64 years(56.52%)were the most susceptible patients infected with KP from perianal disease,and 41.30%of KP-infected patients suffered from diabetes.Two carbapenem-resistant(CRKP)strains and 4 ESBLs-producing strains were screened out from the 46 KP strains.Most of the KP strains were sensitive to clinically common antibiotics.The type O1K1-ST23 was found to be the main molecular serotype and MLST subtype in the KP strains.The results of MST showed the genetic relationships were distant between the strains.The analysis for virulence and drug resistance genes showed that the virulence score of 50%in the KP strain were≥4 points,and the carrying rates of Aerobactin,Yersiniabactin,Salmochelin,rmpADC and rmpA2 were all greater than 50%.Among the two CRKP strains,1 strain carried both bla KPC-2 and bla NDM-1,while the other strain carried bla NDM-1 and much more virulence genes.The other drug-resistance genes showed high consistency with their phenotypes.Conclusion The source of perianal infection in this hospital mostly was high virulent strains of KP,and the high virulent strains combined the strains with multiple drug resistance have emerged that requires high intense clinical attention and continuous monitoring.
作者
王玉婷
白永凤
陆军
程颖
杨云飞
祝进
WANG Yuting;BAI Yongfeng;LU Jun;CHENG Ying;YANG Yunfei;ZHU Jin(The 3rd Department of Clinical Medicine,Zhejiang University School of Medicine,Hangzhou 310058,Zhejiang;Department of Clinical Laboratory,Quzhou People′s Hospital,Wenzhou Medical University,Quzhou 324000,Zhejiang,China)
出处
《临床检验杂志》
CAS
2023年第9期700-705,共6页
Chinese Journal of Clinical Laboratory Science
基金
浙江省医药卫生科技平台计划(2019ZD023)
衢州市科技计划项目(2019K36)。
关键词
肺炎克雷伯菌
肛周感染疾病
毒力基因
耐药基因
全基因组测序
Klebsiella pneumoniae
perianal infectious
virulence gene
drug resistance gene
whole genome sequencing
