Izici zomtholampilo kanye namangqamuzana we-hypervi engamelana ne-carbapenem

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Izici zomtholampilo kanye namangqamuzana e-carbapenem-resistant high-virulence Klebsiella pneumoniae esibhedlela semfundo ephakeme e-Shanghai
Zhou Cong, 1 Wu Qiang, 1 He Leqi, 1 Zhang Hui, 1 Xu Maosuo, 1 Bao Yuyuan, 2 Jin Zhi, 3 Fang Shen 11 Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, People's Republic of iShayina;2 I-Shanghai Jiaotong Department of Laboratory Medicine, Shanghai Children's Hospital, Shanghai, People's Republic of China;3 Department of Neurology, Shanghai Fifth People's Hospital, Fudan University Umbhali ohambelanayo: Fang Shen, Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, No. 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 of ChinaTel +86 180221073 I-imeyili [i-imeyili evikelwe] Isendlalelo: Ukuhlanganiswa kokumelana ne-carbapenem kanye ne-hypervirulence ku-Klebsiella pneumoniae kuholele ezinseleleni ezinkulu zezempilo zomphakathi.Eminyakeni yamuva nje, kuye kwaba nemibiko eyengeziwe mayelana ne-carbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) isolates.Izinto kanye nezindlela: Ukuhlaziywa okubuyayo kokuhlolwa kwedatha yomtholampilo yeziguli ezitheleleke nge-CR-hvKP kusukela ngoJanuwari 2019 kuya kuDisemba 2020 esibhedlela semfundo ephakeme.Bala i-Klebsiella pneumoniae, i-Klebsiella pneumoniae (hmKP), i-Klebsiella pneumoniae (CR-hmKP) engamelana ne-carbapenem kanye nenyumoniya evikela kakhulu i-carbapenem eqoqwe phakathi neminyaka emi-2 Inani lama-isolate e-Leberella (CR-hvKP).Ukutholwa kwe-PCR yezakhi zofuzo zokumelana, izakhi zofuzo ezihlobene ne-virulence, izakhi zofuzo ze-capsular serotype kanye ne-multilocus sequence typing (MLST) yama-isolates e-CR-hvKP.Imiphumela: Isamba sezinhlobo ezingu-1081 ze-Klebsiella pneumoniae ezingaphindaphindi zahlukaniswa ngesikhathi socwaningo., Kubandakanya izinhlobo ezingu-392 ze-Klebsiella pneumoniae (36.3%), izinhlobo ezingu-39 ze-CR-hmKP (3.6%) kanye nezinhlobo ezingu-16 ze-CR-hvKP (1.5%).Cishe u-31.2% (5/16) we-CR-hvKP uzohlukaniswa ngo-2019, futhi cishe u-68.8% (11/16) we-CR-hvKP uzohlukaniswa ngo-2020. Phakathi kwezinhlobo ezingu-16 ze-CR-hvKP, izinhlobo ezingu-13 ziyi-ST11 kanye ne-ST11 i-serotype K64, uhlobo olu-1 luyi-ST11 kanye ne-K47 serotypes, uhlobo olu-1 luyi-ST23 ne-K1 serotypes, kanti uhlobo olu-1 luyi-ST86 ne-K2 serotypes.Izakhi zofuzo ezihlobene ne-virulence i-entB, fimH, rmpA2, iutA, ne-iucA zikhona kuwo wonke ama-isolate angu-16 e-CR-hvKP, alandelwe yi-mrkD (n=14), i-rmpA (n=13), i-aerobactin (n=2) , AllS ( n=1).I-16 CR-hvKP ihlukanisa yonke iphethe isakhi sofuzo se-carbapenemase i-blaKPC-2 kanye nofuzo olunwetshiwe lwe-β-lactamase blaSHV.Imiphumela ye-ERIC-PCR DNA fingerprinting ibonise ukuthi i-16 CR-hvKP strains yayiyi-polymorphic kakhulu, futhi amabhande ohlobo ngalunye ayehluke kakhulu, abonisa isimo se-sporadic.Isiphetho: Nakuba i-CR-hvKP isatshalaliswa ngezikhathi ezithile, iyanda unyaka nonyaka.unyaka.Ngakho-ke, ukunakekelwa komtholampilo kufanele kuvuswe, futhi izinyathelo ezidingekayo kufanele zithathwe ukuze kugwenywe ukuhlanganisa nokusabalala kwe-superbug CR-hvKP.Amagama angukhiye: I-Klebsiella pneumoniae, ukumelana ne-carbapenem, i-virulence ephezulu, amafinyila aphezulu, i-epidemiology
I-Klebsiella pneumoniae iyigciwane elingosomathuba elingabangela izifo ezihlukahlukene, okuhlanganisa inyumoniya, izifo zomgudu womchamo, i-bacteremia, kanye ne-meningitis.1 Eminyakeni engamashumi amathathu edlule, ngokungafani ne-Klebsiella pneumoniae (cKP) yakudala, i-Klebsiella pneumoniae (hvKP) entsha ye-hypermucosal mucus isiphenduke i-pathogen ebaluleke kakhulu emtholampilo, engatholakala ezifweni ezinolaka kakhulu njengamathumba esibindi abangelwa impilo enempilo. kanye nabantu abane-immunocompromised.2 Kuyaphawuleka ukuthi lezi zifo ngokuvamile zihambisana nezifo ezisakazwayo ezibhubhisayo, kuhlanganise ne-endophthalmitis kanye ne-meningitis.3 Ukukhiqizwa kwe-mucosal mucosal phenotype hvKP ephezulu kuvame ukubangelwa ukwanda kokukhiqizwa kwe-capsular polysaccharides kanye nokuba khona kwezakhi zofuzo ezithile ze-virulence, njenge-rmpA ne-rmpA2.4.I-phenotype ye-mucus ephezulu ivame ukunqunywa "ukuhlolwa kwezintambo".Amakoloni e-Klebsiella pneumoniae akhule ngobusuku obubodwa kumapuleti e-agar yegazi anwetshwa ngeluphu.Uma kwakhiwa intambo ye-viscous enobude obungu->5mm, “ukuhlolwa kwentambo” kuba yiphozithivu.5 Ucwaningo lwakamuva lubonise ukuthi i-peg-344, iroB, iucA, rmpA rmpA2 kanye ne-rmpA2 yizimpawu zezinto eziphilayo ezingakhomba ngokunembile i-hvkp.6 Kulolu cwaningo, i-Klebsiella pneumoniae eyingozi kakhulu yachazwa njengene-mucus viscous phenotype (umphumela wokuhlolwa kwentambo eqondile) futhi ithwele i-Klebsiella pneumoniae virulence amasayithi ahlobene ne-plasmid (rmpA2, iutA, iucA) Ngeminyaka yawo-1980, udaba lwaseTaiwan lubika kuqala umphakathi. -amathumba esibindi atholwe yi-hvKP, ehambisana nokulimala okukhulu kwesitho sokugcina, njenge-meningitis ne-endophthalmitis.I-7,8 hvKP inokudluliselwa kwesikhashana emazweni amaningi e-Asia, eYurophu naseMelika.Nakuba izimo ezimbalwa ze-hvKP zibikwe e-Europe nasemazweni aseMelika, ukwanda kwe-hvKP kwenzeka kakhulu emazweni ase-Asia, ikakhulukazi i-China.9
Ngokuvamile, i-hvKP izwela kakhulu kuma-antibiotics, kuyilapho i-Klebsiella pneumonia engamelana ne-carbapenem (CRKP) ayinabo ubuthi obuncane.Kodwa-ke, ngokusabalala kokumelana nezidakamizwa kanye ne-virulence plasmids, i-CR-hvKP yachazwa okokuqala nguZhang et al.ngo-2015, futhi kunemibiko eminingi yasekhaya.10 Njengoba i-CR-hvKP ingabangela izifo ezimbi kakhulu futhi okunzima ukukwelapha, uma ubhubhane lwesifo luvela, lungaba "i-superbug" elandelayo.Kuze kube manje, izifo eziningi ezibangelwa i-CR-hvKP zenzeke ezimeni ezingavamile, futhi ukuqubuka kwezinga elincane akuvamile.11,12
Njengamanje, izinga lokutholwa kwe-CR-hvKP liphansi, futhi kunezifundo ezimbalwa ezihlobene.I-molecular epidemiology ye-CR-hvKP ihlukile ezifundeni ezahlukene, ngakho-ke kuyadingeka ukufunda ukusatshalaliswa komtholampilo nezici ze-molecular epidemiological ze-CR-hvKP kulesi sifunda.Lolu cwaningo luhlaziye kabanzi izakhi zofuzo, izakhi zofuzo ezihlobene ne-virulence kanye ne-MLST ye-CR-hvKP.Sizamile ukuphenya ukusabalala kanye ne-molecular epidemiology ye-CR-hvKP esibhedlela semfundo ephakeme e-Shanghai, empumalanga ye-China.Lolu cwaningo lubaluleke kakhulu ekuqondeni i-molecular epidemiology ye-CR-hvKP e-Shanghai.
I-Klebsiella pneumoniae engaphindaphindi ihlukaniswa ne-Shanghai Fifth People's Hospital exhumene ne-Fudan University kusukela ngoJanuwari 2019 kuya ku-December 2020 yaqoqwa ngokuphindaphindiwe, kanti amaphesenti e-hmKP, CRKP, CR-hmkp kanye ne-CR-hvKP abaliwe.Wonke ama-isolate atholwe yi-VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France).I-Maldi-Tof mass spectrometry (i-Bruker Daltonics, i-Billerica, i-MA, i-USA) yasetshenziselwa ukuphinda kuhlolwe ukuhlonzwa kwezinhlobo zebhaktheriya.I-phenotype ye-mucus ephezulu inqunywa "ukuhlolwa kwezintambo".Uma imipenem noma i-meropenem imelana, ukumelana ne-carbapenem kunqunywa ngokuhlolwa kokuba sengozini kwezidakamizwa.I-Klebsiella pneumoniae eyingozi kakhulu ichazwa ngokuba ne-phenotype yamafinyila aphezulu (umphumela wokuhlolwa kwezintambo ezinhle) nokuthwala amasayithi ahlobene ne-Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA)6.
Ikholoni eyodwa ye-Klebsiella pneumoniae yagonyelwa kupuleti le-agar legazi lezimvu elingu-5%.Ngemva kokufukamela ubusuku bonke ku-37°C, donsa ngobumnene ikholoni nge-loop yokujova bese uphinda izikhathi ezi-3.Uma umugqa we-viscous ukhiwa izikhathi ezintathu futhi ubude bukhulu kuno-5mm, "ukuhlolwa komugqa" kuthathwa njenge-positive, futhi ukucindezeleka kune-phenotype ye-mucus ephezulu.
Ku-VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France), ukuba sengozini kwemithi elwa namagciwane kuma-antibiotic amaningana asetshenziswa ngokuvamile kutholwe ngokuhlanjululwa komhluzi omncane.Imiphumela ihunyushwa ngokuvumelana nedokhumenti yokuqondisa eyakhiwe yi-Clinical and Laboratory Standards Institute (CLSI, 2019).I-E. coli i-ATCC 25922 ne-Klebsiella pneumoniae ATCC 700603 zisetshenziswe njengezilawuli zokuhlola ukuthambekela kokulwa namagciwane.
I-Genomic DNA yawo wonke ama-Klebsiella pneumoniae isolate akhishwe yi-TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Izakhi zofuzo ezinwetshiwe ze-β-lactamase (i-blaCTX-M, i-blaSHV ne-blaTEM), izakhi zofuzo ze-carbapenemase (i-blaKPC, i-blaNDM, i-blaVIM, i-blaIMP ne-blaOXA-48) kanye nezakhi zofuzo ezimele i-virulence eziyi-9, okuhlanganisa i-pLVPK Plasmid-like fimHS (yonke , mrkD, entB, iutA, rmpA, rmpA2, iucA, kanye ne-aerobactin) zikhuliswe yi-PCR njengoba kuchazwe ngaphambilini.13,14 Izakhi zofuzo ze-Capsular serotype-specific (K1, K2, K5, K20, K54, ne-K57) zikhuliswe nge-PCR njengoba kuchazwe ngenhla.14 Uma unegethivu, khulisa bese ulandelanisa i-wzi locus ukuze unqume izakhi zofuzo ze-capsular serotype-specific.15 Iziqalo ezisetshenziswe kulolu cwaningo zibalwe kuThebula S1.Imikhiqizo ye-PCR enhle ilandelwe yi-NextSeq 500 yesikhulumi sokulandelana (Illumina, San Diego, CA, USA).Qhathanisa ukulandelana kwe-nucleotide ngokusebenzisa i-BLAST kuwebhusayithi ye-NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Ukuthayipha okulandelanayo kwezindawo eziningi (MLST) kwenziwe njengoba kuchazwe kuwebhusayithi ye-Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Izakhi zofuzo eziyisikhombisa ze-gapA, i-infB, i-mdh, i-pgi, i-phoE, i-rpoB ne-tonB zandiswa yi-PCR futhi zalandelana.Uhlobo lokulandelana (ST) lunqunywa ngokuqhathanisa imiphumela yokulandelana nesizindalwazi se-MLST.
I-homology ye-Klebsiella pneumoniae yahlaziywa.I-Klebsiella pneumoniae genomic DNA yakhishwa njengesifanekiso, futhi iziqalo ze-ERIC ziboniswa kuThebula S1.I-PCR ikhulisa i-genomic DNA futhi yakhe izigxivizo zeminwe ze-genomic DNA.Imikhiqizo ye-PCR eyi-16 itholwe ngu-2% we-agarose gel electrophoresis.Imiphumela ye-DNA yezigxivizo zeminwe ikhonjwe kusetshenziswa ukuqashelwa kwebhendi yesofthiwe ye-QuantityOne, futhi ukuhlaziywa kofuzo kwenziwa kusetshenziswa indlela yeqembu elibhanqiwe elingenasisindo (UPGMA) ye-arithmetic mean.Ama-isolate afanayo> 75% athathwa njenge-genotype efanayo, futhi lawo afanayo <75% abhekwa njengezinhlobo ezahlukene ze-genotype.
Sebenzisa iphakheji yesofthiwe yezibalo i-SPSS ye-Windows 22.0 ukuze uhlaziye idatha.Idatha ichazwa ngokuthi ± ukuchezuka okujwayelekile (SD).Okuguquguqukayo kwezigaba kwahlaziywa ngokuhlolwa kwe-chi-square noma ukuhlolwa okuqondile kukaFisher.Konke ukuhlola kwezibalo kunomsila ongu-2, futhi inani elingu-P elingu-<0.05 libhekwa njengelibalulekile ngokwezibalo.
Isibhedlela i-Shanghai Fifth People's Hospital esixhumene ne-Fudan University siqoqe i-1081 Klebsiella pneumoniae isolate kusukela ngoJanuwari 1, 2019 kuya ku-December 31, 2020, futhi asibandakanyi izimpinda ezihlala zodwa esigulini esifanayo.Phakathi kwazo, izinhlobo ezingama-392 (36.3%) bekuyi-hmKP, izinhlobo ezingama-341 (31.5%) bekuyi-CRKP, izinhlobo ezingama-39 (3.6%) bekuyi-CR-hmKP, kanti izinhlobo eziyi-16 (1.5%) bekuyi-CR-hvKP.Kuyaphawuleka ukuthi u-33.3% (13/39) we-CR-hmKP kanye no-31.2% (5/16) we-CR-hvKP asuka ku-2019, 66.7% (26/39) we-CR-hmKP kanye no-68.8% (11/16). ) I-CR-hvKP yahlukaniswa kusukela ku-2020. Kusuka kusikhwehlela (izinhlobo eziyi-17), umchamo (izinhlobo eziyi-12), uketshezi lwe-drainage (izinhlobo ezi-4), igazi (izinhlobo ezi-2), ubomvu (izinhlobo ezi-2), i-bile (i-isolation engu-1) kanye nokuphuma kwe-pleural (1 ukuhlukaniswa), ngokulandelana.Izinhlobo eziyishumi nesithupha ze-CR-hvKP zatholwa esikhwehlela (9 isolate), umchamo (5 isolate), igazi (1 isolate) kanye ne-pleural effusion (1 isolate).
Ngokuhlonza uhlobo, ukuhlolwa kokuzwela kwezidakamizwa, ukuhlolwa kwentambo nokutholwa kwezakhi zofuzo ezihlobene ne-virulence, izinhlobo eziyi-16 ze-CR-hvKP zahlolwa.Izici zomtholampilo zeziguli ze-16 ezingenwe yi-CR-hvKP isolate zifingqiwe kuThebula 1. I-13 yeziguli ze-16 (81.3%) zazingamadoda, futhi zonke iziguli zazingaphezu kweminyaka engama-62 (iminyaka yobudala: iminyaka engu-83.1 ± 10.5).Baqhamuka ezigcemeni eziyi-8, kanti abangaphezu kwesigamu baqhamuka enkabeni ye-ICU (amacala ayi-9).Izifo eziyisisekelo zihlanganisa isifo se-cerebrovascular (75%, 12/16), umfutho wegazi ophezulu (50%, 8/16), isifo se-chronic obstructive pulmonary (50%, 8/16), njll. 16), i-catheter yomchamo (37.5%, 6/16), i-gastric tube (18.8%, 3/16), ukuhlinzwa (12.5%, 2/16) kanye ne-intravenous catheter (6.3%, 1/16).Iziguli eziyisishiyagalolunye kwezingu-16 zashona, kwathi iziguli eziyisi-7 zaba ngcono zadedelwa.
Ama-isolate angama-39 e-CR-hmKP ahlukaniswe ngamaqembu amabili ngokuya ngobude bentambo enamathelayo.Phakathi kwazo, ama-20 CR-hmKP ahlukanisayo anobude bentambo ye-viscous ≤ 25 mm ahlukaniswe abe iqembu elilodwa, futhi i-19 CR-hmKP ihlukanisa enobude bentambo ye-viscous> 25 mm yahlukaniswa yaba elinye iqembu.Indlela ye-PCR ithola izinga elihle lezakhi zofuzo ezihlobene ne-virulence i-rmpA, i-rmpA2, i-iutA ne-iucA.Amazinga amahle ezakhi zofuzo ezihlobene ne-CR-hmKP eziphathelene nodlame emaqenjini amabili aboniswa kuThebula 2. Kwakungekho mehluko wezibalo ngenani elihle lezakhi zofuzo ezihlobene ne-CR-hmKP phakathi kwamaqembu amabili.
Ithebula lesi-3 libala imininingwane enemininingwane yokumelana ne-antimicrobial yemithi eyi-16.I-16 CR-hvKP isolate ibonise ukumelana nezidakamizwa eziningi.Zonke i-isolate zalashwa nge-ampicillin, i-ampicillin/sulbactam, i-cefoperazone/sulbactam, i-piperacillin/tazobactam, i-cefazolin, i-cefuroxime, i-ceftazidime, i-ceftriaxone, i-cefepime, i-Cefoxitin, imipenem, ne-meropenem imelana.I-Trimethoprim-sulfamethoxazole inezinga lokumelana eliphansi kakhulu (43.8%), lilandelwa i-amikacin (62.5%), i-gentamicin (68.8%) ne-ciprofloxacin (87.5%).
Ukusatshalaliswa kwezakhi zofuzo ezihlobene ne-virulence, izakhi zokumelana ne-antimicrobial, izakhi zofuzo ze-capsular serotype kanye ne-MLST ye-16 CR-hvKP isolates kukhonjiswe kuMfanekiso 1. Imiphumela ye-agarose gel electrophoresis yezakhi zofuzo ezihlobene ne-virulence, izakhi zofuzo zokumelana ne-antimicrobial kanye nezakhi zofuzo ze-capsular serotype kukhona kuboniswe kuMfanekiso 1. Umfanekiso 2. Ukuhlaziywa kwe-MLST kubonisa ingqikithi yama-ST angu-3, ​​i-ST11 iyona ehamba phambili kunazo zonke i-ST (87.5%, 14/16), ilandelwa i-ST23 (6.25%, 1/16) kanye ne-ST86 (6.25%, 1 /16).Ngokwemiphumela yokuthayipha kwe-wzi, kuhlonzwe ama-serotype angu-4 ahlukene e-capsular (Umfanekiso 1).Phakathi kwe-hvKP ekwazi ukumelana ne-carbapenem eyi-16, i-K64 iyi-serotype evame kakhulu (n=13), ilandelwa i-K1 (n=1), i-K2 (n=1) ne-K47 (n=1).Ngaphezu kwalokho, uhlobo lwe-capsular serotype K1 luyi-ST23, uhlobo lwe-capsular serotype K2 luyi-ST86, kanye nezinhlobo ezingu-13 ezisele ze-K64 kanye ne-1 strain ye-K47 zonke ziyi-ST11.Amazinga amahle wezakhi zofuzo eziyi-9 ze-virulence kuma-isolate angu-16 e-CR-hvKP aboniswa kuMfanekiso 1. , Izakhi zofuzo ezihlobene ne-virulence i-entB, fimH, rmpA2, iutA, ne-iucA zikhona ku-16 CR-hvKP izinhlobo, zilandelwa yi-mrkD (n = 14), i-rmpA (n = 13), i-aerobacterin (n = 2) , i-AllS (n=1).I-16 CR-hvKP ihlukanisa yonke iphethe isakhi sofuzo se-carbapenemase i-blaKPC-2 kanye nofuzo olunwetshiwe lwe-β-lactamase blaSHV.I-16 CR-hvKP isolate ayizange iphathe izakhi zofuzo ze-carbapenem i-blaNDM, i-blaVIM, i-blaIMP, i-blaOXA-48 kanye nezakhi zofuzo ze-β-lactamase ezinwetshiwe ze-blaTEM, iqembu le-blaCTX-M-2, neqembu le-blaCTX-M-8.Phakathi kwezinhlobo ezingu-16 ze-CR-hvKP, izinhlobo ezingu-5 zithwele i-extended-spectrum β-lactamase gene blaCTX-M-1 iqembu, kanye nezinhlobo ezingu-6 zithwele i-extended-spectrum β-lactamase gene blaCTX-M-9 iqembu.
Umfanekiso 1 Izakhi zofuzo ezihlobene ne-virulence, izakhi zokumelana ne-antimicrobial, izakhi zofuzo ze-capsular serotype kanye ne-MLST ye-16 CR-hvKP isolates.
Umfanekiso 2 I-Agarose gel electrophoresis yezinhlobo ezithile zofuzo ezihlobene ne-virulence, izakhi zofuzo zokumelana ne-antimicrobial kanye nezakhi zofuzo ze-capsular serotype.
Qaphela: M, umaka we-DNA;1, blaKPC (893bp);2, i-entB (400bp);3, i-rmpA2 (609bp);4, i-rmpA (429bp);5, iucA (239bp);6, iutA (880bp);I-7, i-Aerobacterin (556bp);8, K1 (1283bp);9, K2 (641bp);10, yonke i-S (508bp);11, mrkD (340bp);12, fimH (609bp).
I-ERIC-PCR isetshenziselwe ukuhlaziya i-homology ye-16 CR-hvKP isolate.Ngemuva kokukhulisa i-PCR kanye ne-agarose gel electrophoresis, kunezingcezu ze-DNA ezingu-3-9.Imiphumela yeminwe ibonise ukuthi i-16 CR-hvKP isolate yayiyi-polymorphic kakhulu, futhi kwakukhona umehluko osobala phakathi kwama-isolate (Umfanekiso 3).
Eminyakeni yamuva nje, kuye kwaba nemibiko eyengeziwe mayelana nokuhlukaniswa kwe-CR-hvKP.Ukubukeka kwe-CR-hvKP isolate kubangela usongo olukhulu empilweni yomphakathi ngoba kungabangela izifo ezinzima, okunzima ukwelapha kubantu abanempilo.Kulolu cwaningo, ukusabalala kanye nezici ze-molecular epidemiological ze-CR-hvKP esibhedlela semfundo ephakeme e-Shanghai kusuka ngo-2019 kuya ku-2020 zacwaningwa ukuze kuhlolwe ukuthi ingabe ikhona yini ingozi yokuqubuka kwe-CR-hvKP kanye nokuthuthuka kwayo kule ndawo.Ngesikhathi esifanayo, lolu cwaningo lungahlinzeka ngokuhlolwa okuphelele kakhulu kokungenwa yizifo emtholampilo, okubaluleke kakhulu ekuvimbeleni ukusakazeka okuqhubekayo kwalezi zindawo zodwa.
Lolu cwaningo luhlaziye kabusha ukusatshalaliswa komtholampilo kanye nokuthambekela kwe-CR-hvKP kusuka ngo-2019 kuya ku-2020. Kusukela ngo-2019 kuya ku-2020, ukuhlukaniswa kwe-CR-hvKP kubonise ukuthambekela okukhulayo.Cishe u-31.2% (5/16) we-CR-hvKP wahlukaniswa ngo-2019, futhi u-68.8% (11/16) we-CR-hvKP wahlukaniswa ngo-2020, ohambisana nokukhula kwe-CR-hvKP okubikwe ezincwadini.Kusukela uZhang et al.okokuqala kuchazwe i-CR-hvKP ngo-2015,10 kuye kwabikwa izincwadi eziningi ze-CR-hvKP, i-17-20 ikakhulukazi esifundeni sase-Asia-Pacific, ikakhulukazi e-China.I-CR-hvKP igciwane elikhulu elinamandla amakhulu futhi limelana nezidakamizwa eziningi.Iyingozi empilweni yabantu futhi inezinga eliphezulu lokufa.Ngakho-ke, kufanele kuqashelwe futhi kuthathwe izinyathelo zokuvimbela ukusabalala kwayo.
Ukuhlaziywa kokumelana nama-antibiotic kwe-16 CR-hvKP isolate kubonise izinga eliphezulu lokumelana nama-antibiotic.Zonke i-isolate zalashwa nge-ampicillin, i-ampicillin/sulbactam, i-cefoperazone/sulbactam, i-piperacillin/tazobactam, i-cefazolin, i-cefuroxime, i-ceftazidime, i-ceftriaxone, i-cefepime, i-Cefoxitin, imipenem, ne-meropenem imelana.I-Trimethoprim-sulfamethoxazole inezinga lokumelana eliphansi kakhulu (43.8%), lilandelwa i-amikacin (62.5%), i-gentamicin (68.8%) ne-ciprofloxacin (87.5%).Izinga lokumelana ne-CR-hmkp elifundwe ngu-Lingling Zhan nabanye lifana nalolu cwaningo [12].Iziguli ezitheleleke nge-CR-hvKP zinezifo eziningi eziyisisekelo, ukungatheleleki komzimba okuphansi, kanye nekhono elizimele lokuvala inzalo elibuthakathaka.Ngakho-ke, ukwelashwa okufika ngesikhathi okusekelwe emiphumeleni yokuhlolwa kokuzwela kwe-antimicrobial kubaluleke kakhulu.Uma kunesidingo, indawo enegciwane ingatholakala futhi ilashwe ngamanzi, ukuchithwa nezinye izindlela.
Ama-isolate angama-39 e-CR-hmKP ahlukaniswe ngamaqembu amabili ngokuya ngobude bentambo enamathelayo.Phakathi kwazo, ama-20 CR-hmKP ahlukanisayo anobude bentambo ye-viscous ≤ 25 mm ahlukaniswe abe iqembu elilodwa, futhi i-19 CR-hmKP ihlukanisa enobude bentambo ye-viscous> 25 mm yahlukaniswa yaba elinye iqembu.Uma kuqhathaniswa namazinga amahle ezakhi zofuzo ezihlobene negciwane le-CR-hmKP phakathi kwamaqembu amabili, akuzange kube khona umehluko ophawulekayo wezibalo ezilinganisweni ezinhle zezakhi zofuzo phakathi kwamaqembu amabili.Ucwaningo luka-Lin Ze et al.yabonisa ukuthi izinga elihle lezakhi zofuzo ze-Klebsiella pneumoniae laliphakeme kakhulu kune-Klebsiella pneumoniae yakudala.21 Kodwa-ke, noma izinga elihle lezakhi zofuzo ze-virulence lihlotshaniswa kahle nobude beketango elinamathelayo kuhlala kungacacile.Olunye ucwaningo luye lwabonisa ukuthi i-Klebsiella pneumoniae yakudala ingase futhi ibe i-Klebsiella pneumoniae eyingozi kakhulu, enezinga eliphezulu elihle lezakhi zofuzo eziyingozi.22 Lolu cwaningo luthole ukuthi izinga le-virtulence gene positive rate ye-CR-hmKP alihlotshaniswa kahle nobude befinci.Intambo (noma ayinyuki ngobude bentambo enamathelayo).
Izigxivizo zeminwe ze-ERIC PCR zalolu cwaningo ziyi-polymorphic, futhi akukho ukuphambana komtholampilo phakathi kweziguli, ngakho-ke iziguli eziyi-16 ezinokutheleleka nge-CR-hvKP ziyizimo ezingavamile.Esikhathini esidlule, izifo eziningi ezibangelwa i-CR-hvKP ziye zabikwa njengezimo ezizimele noma ezingavamile, i-23,24 kanye nokuqubuka kwezinga elincane kwe-CR-hvKP akuvamile ezincwadini.I-11,25 ST11 iyona i-ST11 evame kakhulu ezindaweni zodwa ze-CRKP kanye ne-CR-hvKP e-China.26,27 Nakuba i-ST11 CR-hvKP ibala u-87.5% (14/16) we-16 CR-hvKP ehlukanisayo kulolu cwaningo, ngeke kucatshangwe ukuthi izinhlobo ezingu-14 ST11 CR-hvKP ziphuma ku-clone efanayo, ngakho-ke izigxivizo zeminwe ze-ERIC PCR iyadingeka.Ukuhlaziywa kwe-Homology.
Kulolu cwaningo, zonke iziguli eziyi-16 ezingenwe yi-CR-hvKP zahlinzwa ngendlela ehlaselayo.Ngokwemibiko, ukuqubuka okubulalayo kwenyumoniya ehambisana nama-ventilators okubangelwa i-CR-hvKP11 kubonisa ukuthi izinqubo ezihlaselayo zingase zandise ingozi yokutheleleka nge-CR-hvKP.Ngasikhathi sinye, iziguli eziyi-16 ezingenwe yi-CR-hvKP zinezifo ezingaphansi, lapho izifo ze-cerebrovascular zivame kakhulu.Ucwaningo lwangaphambilini lubonise ukuthi isifo se-cerebrovascular siyisici esibalulekile esizimele sengozi yokutheleleka nge-CR-hvKP.28 Isizathu salokhu kungase kube ukungatheleleki okubuthakathaka kweziguli ezine-cerebrovascular disease, amagciwane e-pathogenic awakwazi ukukhishwa ngokuzimela, futhi umphumela wabo we-bactericidal kuphela kuthembele kuwo.Ama-antibiotics azoholela ekuhlanganisweni kokumelana nezidakamizwa eziningi kanye ne-hypervirulence ngokuhamba kwesikhathi.Phakathi kweziguli ezingu-16, ezingu-9 zashona, kanti izinga lokushona lalingu-56.3% (9/16).Izinga lokufa liphakeme kune-10,12 ezifundweni zangaphambilini, futhi liphansi kune-11,21 ebikwe ezifundweni zangaphambilini.Isilinganiso seminyaka yobudala yeziguli eziyi-16 sasiyiminyaka engama-83.1±10.5, okubonisa ukuthi abantu asebekhulile bangenwa kalula yi-CR-hvKP.Ucwaningo lwangaphambilini luveze ukuthi abantu abasha bangenwa kalula yizifo.I-Virulence ye-Klebsiella pneumoniae.29 Nokho, olunye ucwaningo luye lwabonisa ukuthi asebekhulile basengozini yokuthola i-Klebsiella pneumoniae24,28 eyingozi kakhulu.Lolu cwaningo luyahambisana nalokhu.
Phakathi kwezinhlobo ezingu-16 ze-CR-hvKP, ngaphandle kwe-ST23 CR-hvKP eyodwa kanye ne-ST86 CR-hvKP eyodwa, ezinye izinhlobo ezingu-14 zonke ziyi-ST11 CR-hvKP.I-serotype ye-capsular ehambisana ne-ST23 CR-hvKP i-K1, futhi i-serotype ye-capsular ehambisanayo ye-ST86 CR-HVKP i-K2, efana nezifundo zangaphambilini.I-30-32 Iziguli ezingenwe yi-ST23 (K1) CR-hvKP noma i-ST86 (K2) CR-hvKP zafa, futhi izinga lokufa (100%) laliphezulu kakhulu kuneleziguli ezine-ST11 CR-hvKP (50%).Njengoba kuboniswe kuMfanekiso 1, izinga elihle lezinhlobo ze-ST23 (K1) noma i-ST86 (K2) zezakhi zofuzo ezihlobene ne-virulence liphezulu kunalelo lezinhlobo ze-ST11 (K64).Ukufa kungase kuhlotshaniswe nezinga elihle lezakhi zofuzo ezihlobene negciwane.Kulolu cwaningo, izinhlobo eziyi-16 ze-CR- hvKP zonke ziphethe isakhi sofuzo se-carbapenemase i-blaKPC-2 kanye ne-extended-spectrum β-lactamase blaSHV.I-blaKPC-2 iwufuzo oluvame kakhulu lwe-carbapenemase ku-CR-hvKP e-China.33 Ocwaningweni lwe-Zhao et al., i-25blaSHV iwufuzo olunwetshiwe lwe-β-lactamase olunenani eliphakeme kakhulu eliphozithivu.Izakhi zofuzo ze-virulence i-entB, i-fimH, i-rmpA2, i-iutA, ne-iucA zikhona kuwo wonke ama-isolate angu-16 e-CR-hvKP, alandelwe yi-mrkD (n=14), i-rmpA (n=13), i-anaerobicin (n=2), allS (n = 1), okufana nocwaningo lwangaphambilini.34 Ezinye izifundo zibonise ukuthi i-rmpA ne-rmpA2 (ama-modulators we-mucus phenotype gene) angakhuthaza ukukhishwa kwe-capsular polysaccharides, okuholela kuma-phenotypes e-hypermucoid kanye nokwanda kwe-virulence.35 Ama-Aerobacterin afakwe ngekhodi isakhi sofuzo se-iucABCD, futhi ama-homologous receptors awo afakwe ngekhodi isakhi sofuzo se-iutA, ngakho anezinga eliphakeme lobungozi ekuhlolweni kokutheleleka kwe-G. mellonella.I-AllS iwumaka we-K1-ST23, hhayi ku-pLVPK, i-pLVPK iyi-plasmid ye-virulence evela kuhlobo lwe-K2 super virulence.I-allS iyi-activator yohlobo lwe-HTH.Lezi zakhi zofuzo ze-virulence zaziwa ngokufaka isandla ku-virulence futhi zinesibopho sokwenza amakholoni, ukuhlasela kanye ne-pathogenicity.36
Lolu cwaningo luchaza ukusabalala kanye ne-molecular epidemiology ye-CR-hvKP e-Shanghai, e-China.Nakuba ukutheleleka okubangelwa i-CR-hvKP kwenzeka ngezikhathi ezithile, kuyanda unyaka nonyaka.Imiphumela isekela ucwaningo lwangaphambilini futhi ibonisa ukuthi i-ST11 CR-hvKP iyi-CR-hvKP edume kakhulu e-China.I-ST23 kanye ne-ST86 CR-hvKP ibonise ubungozi obuphezulu kune-ST11 CR-hvKP, nakuba zombili ziyi-Klebsiella pneumoniae eyingozi kakhulu.Njengoba iphesenti le-Klebsiella pneumoniae eliyingozi kakhulu likhula, izinga lokumelana ne-Klebsiella pneumoniae lingase lehle, okuzoholela ekwethembeni kwempumputhe ekusebenzeni komtholampilo.Ngakho-ke, kuyadingeka ukutadisha i-virulence kanye nokuphikiswa kwezidakamizwa kwe-Klebsiella pneumoniae.
Lolu cwaningo lugunyazwe iKomidi Lokuziphatha Lezokwelapha lase-Shanghai Fifth People's Hospital (No. 104, 2020).Amasampula omtholampilo ayingxenye yezinqubo zaselabhorethri zasesibhedlela ezivamile.
Siyabonga kubo bonke abasebenzi Belabhorethri Emaphakathi yase-Shanghai Fifth People's Hospital ngokunikeza isiqondiso sobuchwepheshe salolu cwaningo.
Lo msebenzi usekelwe yi-Natural Science Foundation yase-Mihanging District, e-Shanghai (inombolo yokugunyazwa: 2020MHZ039).
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