Iimpawu zeklinikhi kunye neemolekyuli ze-carbapenem-resistant Hypervi

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Iimpawu zeklinikhi kunye neemolekyuli ze-carbapenem-resistant high-virulence Klebsiella pneumoniae kwisibhedlele senqanaba eliphezulu eShanghai.
Zhou Cong, 1 Wu Qiang, 1 He Leqi, 1 Zhang Hui, 1 Xu Maosuo, 1 Bao Yuyuan, 2 Jin Zhi, 3 Fang Shen 11 iSebe leClinical Laboratory Medicine, Shanghai ISibhedlele seSihlanu sabantu, iYunivesithi yaseFudan, iShanghai, iRiphabhlikhi yabantu baseShanghai. iTshayina;2 iShanghai Jiaotong iSebe leLebhu yeLabhoratri, iSibhedlele saBantwana saseShanghai, eShanghai, kwiRiphabhlikhi yaBantu baseTshayina;I-3 yeSebe le-Neurology, i-Shanghai yeSibhedlele seSihlanu sabantu, iYunivesithi yaseFudan Umbhali ohambelanayo: uFang Shen, iSebe le-Clinical Laboratory Medicine, iSibhedlele seSihlanu sabantu baseShanghai, iYunivesithi yaseFudan, iNo. I-imeyile [i-imeyile ekhuselweyo] Imvelaphi: Ukudibanisa kwe-carbapenem ukumelana kunye ne-hypervirulence e-Klebsiella pneumoniae kukhokelele kwimingeni emikhulu yempilo yoluntu.Kwiminyaka yakutshanje, kukho iingxelo ezininzi malunga ne-carbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) yodwa.Izixhobo kunye neendlela: Uhlalutyo lokubuyela emva kovavanyo lwedatha yekliniki yezigulane ezosulelwe yi-CR-hvKP ukusuka ngoJanuwari 2019 ukuya kuDisemba 2020 kwisibhedlele senqanaba eliphezulu.Bala i-Klebsiella pneumoniae, i-Klebsiella pneumoniae (hmKP), i-carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) kunye ne-carbapenem-resistant high-virulence pneumoniae eziqokelelwe kwisithuba seminyaka emi-2 Inani leendawo ezizimeleyo ze-Leberella (CR-hvKP).Ukufunyanwa kwe-PCR yeejeni zokumelana, iijene ezinxulumene ne-virulence, i-capsular serotype genes kunye ne-multilocus sequence typing (MLST) ye-CR-hvKP isolates.Iziphumo: Iintlobo ze-1081 ezingapheliyo ze-Klebsiella pneumoniae ziye zahlukaniswa ngexesha lokufunda., Kubandakanya iintlobo ze-392 ze-Klebsiella pneumoniae (36.3%), iintlobo ze-39 ze-CR-hmKP (3.6%) kunye ne-16 ye-CR-hvKP (1.5%).Ngokumalunga ne-31.2% (5/16) ye-CR-hvKP iya kuba yodwa ngo-2019, kwaye malunga ne-68.8% (11/16) ye-CR-hvKP iya kuba yodwa ngo-2020. i-serotype K64, i-1 strain yi-ST11 kunye ne-K47 serotypes, i-1 strain yi-ST23 kunye ne-K1 serotypes, kunye ne-1 strain yi-ST86 kunye ne-K2 serotypes.Iijini ezinxulumene nokuxhatshazwa kwe-entB, i-fimH, i-rmpA2, i-iutA, kunye ne-iucA zikhona kuzo zonke ii-isotes eziyi-16 ze-CR-hvKP, zilandelwa yi-mrkD (n=14), i-rmpA (n=13), i-aerobactin (n=2) , i-AllS ( n=1).I-16 CR-hvKP ihlukanisa zonke zithwala i-carbapenemase gene blaKPC-2 kunye ne-extension-spectrum β-lactamase gene blaSHV.Iziphumo ze-ERIC-PCR DNA fingerprinting zibonise ukuba i-16 ye-CR-hvKP yayiyi-polymorphic kakhulu, kwaye iibhendi zoluhlu ngalunye zazihluke kakhulu, zibonisa imeko ye-sporadic.Isiphelo: Nangona i-CR-hvKP isasazwa manqaphanqapha, iya isanda unyaka nonyaka.unyaka.Ke ngoko, uqwalaselo lweklinikhi kufuneka luvuswe, kwaye amanyathelo ayimfuneko kufuneka athathwe ukuphepha i-cloning kunye nokusasazeka kwe-superbug CR-hvKP.Amagama angundoqo: Klebsiella pneumoniae, carbapenem resistance, high virulence, high mucus, epidemiology
I-Klebsiella pneumoniae yintsholongwane engenelelayo enokubangela izifo ezahlukeneyo, kuquka inyumoniya, usulelo lomgudu womchamo, i-bacteremia, kunye ne-meningitis.1 Kule minyaka ingamashumi amathathu idlulileyo, ngokungafaniyo neKlebsiella pneumoniae yakudala (cKP), iKlebsiella pneumoniae (hvKP) entsha eyingozi kakhulu ye-hypermucosal mucus ibe yipathogen ebaluleke kakhulu ekliniki, enokufumaneka kwizifo ezindlongo Kakhulu ezifana namathumba esibindi abangelwa impilo. kunye nabantu abane-immunocompromised.2 Kubalulekile ukuqaphela ukuba olu sulelo ludla ngokukhatshwa zizifo ezisasazwayo ezitshabalalisayo, kuquka i-endophthalmitis kunye ne-meningitis.I-3 Ukuveliswa kwe-mucosal mucosal phenotype ye-hvKP ngokuqhelekileyo ngenxa yokwanda kwemveliso ye-capsular polysaccharides kunye nobukho be-genes ye-virulence ethile, njenge-rmpA kunye ne-rmpA2.4.I-phenotype ye-mucus ephezulu idla ngokugqitywa "uvavanyo lwentambo".Iikholoni ze-Klebsiella pneumoniae ezikhule ngobusuku kwiipleyiti ze-agar yegazi zoluliwe nge-loop.Xa intambo ye-viscous enobude be> 5mm yenziwe, "uvavanyo lwentambo" lulungile.5 Uphononongo olutshanje lubonise ukuba i-peg-344, iroB, iucA, i-rmpA rmpA2 kunye ne-rmpA2 ziyi-biomarkers ezinokuchonga ngokuchanekileyo i-hvkp.6 Kolu phononongo, i-Klebsiella pneumoniae eyingozi kakhulu yachazwa njengene-mucus viscous phenotype (isiphumo sovavanyo esilungileyo) kunye nokuthwala i-Klebsiella pneumoniae virulence plasmid sites ezinxulumene (rmpA2, iutA, iucA) Ngeminyaka yoo-1980, ingxelo yemeko yaseTaiwan yaqala yachaza uluntu. -i-abscesses yesibindi efunyenweyo ebangelwa yi-hvKP, ehamba kunye nomonakalo omkhulu wokuphela kwelungu, njenge-meningitis kunye ne-endophthalmitis.I-7,8 hvKP inosulelo oluqhelekileyo kumazwe amaninzi e-Asia, eYurophu naseMelika.Nangona iimeko ezininzi ze-hvKP zixeliwe eYurophu naseMelika, ukuxhaphaka kwe-hvKP kwenzeka ikakhulu kumazwe ase-Asiya, ngakumbi i-China.9
Ngokuqhelekileyo, i-hvKP ivakalelwa ngakumbi kwii-antibiotics, ngelixa i-carbapenem-resistant Klebsiella pneumonia (CRKP) ayinayo ityhefu encinci.Nangona kunjalo, ngokusasazeka kokuxhatshazwa kweziyobisi kunye ne-virulence plasmids, i-CR-hvKP yaqala yachazwa nguZhang et al.ngo-2015, kwaye kukho iingxelo ezininzi zasekhaya.10 Njengoko i-CR-hvKP inokubangela usulelo olumandundu kwaye kunzima ukulunyanga, ukuba ubhubhane wesifo uyavela, inokuba “yi-superbug” elandelayo.Ukuza kuthi ga ngoku, uninzi losulelo olubangelwa yi-CR-hvKP lwenzekile kwiimeko ezingaqhelekanga, kwaye ukuqhambuka okuncinci kunqabile.11,12
Okwangoku, izinga lokuchongwa kwe-CR-hvKP liphantsi, kwaye kukho izifundo ezimbalwa ezinxulumeneyo.I-molecular epidemiology ye-CR-hvKP yahlukile kwimimandla eyahlukeneyo, ngoko ke kuyimfuneko ukufunda ukuhanjiswa kweklinikhi kunye neempawu ze-molecular epidemiological ze-CR-hvKP kulo mmandla.Olu phononongo luhlalutye ngokubanzi iijene zokumelana, iijene ezinxulumene ne-virulence kunye ne-MLST ye-CR-hvKP.Sazama ukuphanda ukuxhaphaka kunye ne-molecular epidemiology ye-CR-hvKP kwisibhedlele senqanaba eliphezulu e-Shanghai, empuma ye-China.Olu phononongo lubaluleke kakhulu ekuqondeni i-molecular epidemiology ye-CR-hvKP eShanghai.
I-Klebsiella pneumoniae engaphindi iphinde ihlale yodwa kwiSibhedlele seSihlanu sabantu saseShanghai esidityaniswe neYunivesithi yaseFudan ukusuka ngoJanuwari 2019 ukuya kuDisemba ka-2020 zaqokelelwa ngokuphindaphindiweyo, kwaye iipesenti ze-hmKP, CRKP, CR-hmkp kunye ne-CR-hvKP zibaliwe.Zonke ii-isolate zachongwa yi-VITEK-2 compact automatic analyzer microbial (Biomerieux, Marcy L'Etoile, France).I-Maldi-Tof mass spectrometry (i-Bruker Daltonics, iBillerica, i-MA, i-USA) yayisetyenziselwa ukujonga kwakhona ukuchongwa kweentlobo zebhaktheriya.I-phenotype ye-mucus ephezulu inqunywe "uvavanyo lwentambo".Xa i-imipenem okanye i-meropenem ixhathisa, ukuxhathisa kwe-carbapenem kuchongwa ngovavanyo lwe-advanced susceptibility test.I-Klebsiella pneumoniae eyingozi kakhulu ichazwa ngokuba ne-mucus phenotype ephezulu (isiphumo sovavanyo olulungileyo) kunye nokuthwala i-Klebsiella pneumoniae virulence plasmid sites ezinxulumene (rmpA2, iutA, iucA)6.
Ikholoni enye ye-Klebsiella pneumoniae yatofwa kwipleyiti yeagar yegazi legusha eyi-5%.Emva kokufukamela ubusuku bonke kwi-37 ° C, ngokukhawuleza ukhuphe i-colon kunye ne-inoculating loop kwaye uphinde amaxesha ama-3.Ukuba umgca we-viscous wenziwa kathathu kwaye ubude bukhulu kune-5mm, "uvavanyo lomgca" lubhekwa njengelilungileyo, kwaye ukuxhatshazwa kune-phenotype ye-mucus ephezulu.
Kwi-VITEK-2 i-compact automatic analyzer ye-microbial (i-Biomerieux, i-Marcy L'Etoile, eFransi), ukuchaphazeleka kwe-antimicrobial kwii-antibiotics ezininzi ezisetyenziswa ngokuqhelekileyo zifunyenwe yi-broth micro-dilution.Iziphumo zitolikwa ngokoxwebhu lwesikhokelo oluphuhliswe yiZiko leMigangatho yeKlinikhi kunye neLabhoratri (CLSI, 2019).I-E. coli i-ATCC 25922 kunye ne-Klebsiella pneumoniae ATCC 700603 zisetyenziswe njengolawulo lovavanyo lwe-antimicrobial susceptibility test.
I-Genomic DNA yazo zonke i-Klebsiella pneumoniae isolates zikhutshwe yi-TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Iijini ze-β-lactamase ezongeziweyo (i-blaCTX-M, i-blaSHV kunye ne-blaTEM), i-carbapenemase genes (i-blaKPC, i-blaNDM, i-blaVIM, i-blaIMP kunye ne-blaOXA-48) kunye ne-9 emele i-virulence-related genes, kuquka i-pLVPK Plasmid-like loci, i-fimHS , mrkD, entB, iutA, rmpA, rmpA2, iucA, kunye ne-aerobactin) ziye zandiswa yi-PCR njengoko kuchaziwe ngaphambili.I-13,14 i-Capsular serotype-specific genes (K1, K2, K5, K20, K54, kunye ne-K57) yandiswa yi-PCR njengoko kuchazwe ngasentla.14 Ukuba i-negative, yandisa kwaye ulandelelanise i-wzi locus ukumisela i-capsular serotype-specific genes.15 Iiprayimari ezisetyenziswe kolu phononongo zidweliswe kwiTheyibhile S1.Iimveliso ze-PCR ezintle zilandelelaniswe yi-NextSeq 500 yokulandelelana kweqonga (Illumina, San Diego, CA, USA).Thelekisa ulandelelwano lwe-nucleotide ngokusebenzisa i-BLAST kwiwebhusayithi ye-NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Ukuchwetheza ngolandelelwano lweendawo ezininzi (MLST) kwenziwa njengoko kuchaziwe kwiwebhusayithi ye-Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Iigenes ezisixhenxe zokugcina i-gapA, i-infB, i-mdh, i-pgi, i-phoE, i-rpoB kunye ne-tonB ziye zandiswa yi-PCR zaze zalandelelana.Uhlobo lolandelelwano (ST) luchongwa ngokuthelekisa iziphumo zolandelelwano nesiseko sedatha seMLST.
I-homology ye-Klebsiella pneumoniae yahlalutywa.I-Klebsiella pneumoniae genomic DNA yakhutshwa njenge template, kwaye iiprimers ze-ERIC ziboniswa kwiThebhile S1.I-PCR ikhulisa i-DNA ye-genomic kwaye yenza umnwe we-DNA ye-genomic.Iimveliso ze-PCR ezili-16 zifunyenwe yi-2% ye-agarose gel electrophoresis.Iziphumo ze-DNA zeminwe zichongiwe kusetyenziswa i-QuantityOne software band recognition, kwaye uhlalutyo lwemfuzo lwenziwa kusetyenziswa indlela yeqela elingenakulinganiswa (UPGMA) ye-arithmetic mean.I-isolates ngokufana> i-75% ithathwa njenge-genotype efanayo, kwaye abo bafana <75% babhekwa njenge-genotypes eyahlukileyo.
Sebenzisa iphakheji yesoftware yamanani iSPSS yeWindows 22.0 ukuhlalutya idatha.Idatha ichazwa njengentsingiselo ± ukutenxa okusemgangathweni (SD).Izinto eziguquguqukayo ngokweendidi ziye zavavanywa ngovavanyo lwe-chi-square okanye uvavanyo oluchanekileyo lukaFisher.Zonke iimvavanyo zeenkcukacha-manani zi-2-tailed, kwaye ixabiso le-P <0.05 lithathwa njengelibaluleke kakhulu.
ISibhedlele sesiHlanu saseShanghai saBantu esinxulumana neYunivesithi yaseFudan siqokelele ii-1081 Klebsiella pneumoniae zodwa ukusuka nge-1 kaJanuwari 2019 ukuya kuDisemba 31, 2020, kwaye asibandakanyi iindawo ezizimeleyo eziphindwe kabini kwisigulana esinye.Phakathi kwabo, i-392 strains (36.3%) yayiyi-hmKP, i-341 strains (31.5%) yayiyi-CRKP, i-39 strains (3.6%) yayiyi-CR-hmKP, kunye ne-16 strains (1.5%) yi-CR-hvKP.Kuyaphawuleka ukuba i-33.3% (13/39) ye-CR-hmKP kunye ne-31.2% (5/16) ye-CR-hvKP ivela kwi-2019, i-66.7% (26/39) ye-CR-hmKP kunye ne-68.8% (11/16). ) I-CR-hvKP yahlulwa ngo-2020. Ukususela kwi-sputum (i-17 strains), umchamo (i-12 strains), i-drainage fluid (i-4 strains), igazi (i-2 sins), i-pus (ii-2), i-bile (i-1 isolation) kunye ne-pleural effusion (i-1 yodwa), ngokulandelanayo.Iindidi ezilishumi elinesithandathu ze-CR-hvKP zafunyanwa kwisikhohlela (i-9 isolate), umchamo (5 isolate), igazi (1 isolate) kunye ne-pleural effusion (1 isolate).
Ngokuchongwa koxinzelelo, uvavanyo lokuva ubunzima beziyobisi, uvavanyo lwentambo kunye nokufunyanwa kwemfuza enxulumene ne-virulence, iintlobo ze-16 ze-CR-hvKP zahlolwa.Iimpawu zeklinikhi zezigulane ze-16 ezisuleleke kwi-CR-hvKP i-isolate zishwankathelwe kwiThebhile 1. I-13 yezigulane ze-16 (81.3%) yayingamadoda, kwaye zonke izigulane zazineminyaka engama-62 ubudala (iminyaka yobudala: i-83.1 ± 10.5 iminyaka).Bavela kwiiwadi ezi-8, kwaye ngaphezu kwesiqingatha bevela kwi-ICU ephakathi (amatyala ayi-9).Izifo ezisisiseko ziquka isifo se-cerebrovascular (75%, 12/16), uxinzelelo lwegazi (50%, 8/16), isifo esingapheliyo se-pulmonary (50%, 8/16), njl. I-16), i-catheter ye-urinary (37.5%, 6/16), ityhubhu yesisu (18.8%, 3/16), utyando (12.5%, 2/16) kunye ne-intravenous catheter (6.3%, 1/16).Abalithoba kwizigulane ezili-16 basweleka, kwaye izigulane ezisi-7 zaphucuka zaza zakhutshwa.
Ii-39 ze-CR-hmKP zodwa zahlulwa zaba ngamaqela amabini ngokobude bomtya oncangathi.Phakathi kwabo, i-20 CR-hmKP i-isolate kunye nobude bentambo ye-viscous ≤ 25 mm yahlulwe kwiqela elinye, kwaye i-19 CR-hmKP i-isolate kunye nobude bentambo ye-viscous> 25 mm yahlulwe kwelinye iqela.Indlela ye-PCR ibona izinga elilungileyo lejene enxulumene ne-virulence i-rmpA, i-rmpA2, i-iutA kunye ne-iucA.Amazinga afanelekileyo e-CR-hmKP enxulumene nofuzo olunxulumene nentsholongwane kumaqela amabini aboniswe kwiThebhile 2. Kwakungekho mmahluko wamanani kwizinga elincomekayo le-CR-hmKP yemfuza enxulumene nentsholongwane phakathi kwamaqela amabini.
Itheyibhile 3 idwelisa iinkcukacha zeprofayili yokuxhathisa amayeza ali-16.I-16 ye-CR-hvKP yodwa ibonise ukuxhathisa kumachiza amaninzi.Zonke i-isolate zaphathwa nge-ampicillin, i-ampicillin / sulbactam, i-cefoperazone / sulbactam, i-piperacillin / tazobactam, i-cefazolin, i-cefuroxime, i-ceftazidime, i-ceftriaxone, i-cefepime, i-Cefoxitin, imipenem, kunye ne-meropenem zixhathisa.I-Trimethoprim-sulfamethoxazole inezinga eliphantsi lokumelana (43.8%), ilandelwa yi-amikacin (62.5%), i-gentamicin (68.8%) kunye ne-ciprofloxacin (87.5%).
Ukusasazwa kwezakhi zofuzo ezinxulumene ne-virulence, i-antimicrobial resistance genes, i-capsular serotype genes kunye ne-MLST ye-16 CR-hvKP isolates iboniswe kuMzobo 1. Iziphumo ze-agarose gel electrophoresis yezinye iigenes ezinxulumene ne-virulence, i-antimicrobial resistance genes kunye ne-capsular serotype genes zi kuboniswe kuMfanekiso 1. Umzobo 2. Uhlalutyo lwe-MLST lubonisa i-3 STs iyonke, i-ST11 yeyona ST (87.5%, 14/16), ilandelwa yi-ST23 (6.25%, 1/16) kunye ne-ST86 (6.25%, 1). /16).Ngokweziphumo zokuchwetheza i-wzi, i-4 eyahlukeneyo ye-capsular serotypes ichongiwe (Umfanekiso 1).Phakathi kwe-hvKP eyi-16 ekwazi ukumelana ne-carbapenem, i-K64 yeyona serotype ixhaphakileyo (n=13), ilandelwa yi-K1 (n=1), i-K2 (n=1) kunye ne-K47 (n=1).Ukongezelela, i-capsular serotype K1 strain yi-ST23, i-capsular serotype K2 strain yi-ST86, kunye ne-13 eseleyo ye-K64 kunye ne-1 ye-K47 yonke i-ST11.Imilinganiselo emihle ye-9 ye-virulence genes kwi-16 i-CR-hvKP i-isolate iboniswe kuMfanekiso 1., I-genenes enxulumene ne-virulence i-entB, i-fimH, i-rmpA2, i-iutA, kunye ne-iucA ikhona kwiintlobo ze-16 ze-CR-hvKP, zilandelwa ngu-mrkD (n = 14), i-rmpA (n = 13), i-aerobacterin (n = 2), i-AllS (n = 1).I-16 CR-hvKP ihlukanisa zonke zithwala i-carbapenemase gene blaKPC-2 kunye ne-extension-spectrum β-lactamase gene blaSHV.I-16 ye-CR-hvKP i-isolate ayizange iphathe i-carbapenem genes i-blaNDM, i-blaVIM, i-blaIMP, i-blaOXA-48 kunye ne-extension-spectrum ye-β-lactamase ye-blaTEM, iqela le-blaCTX-M-2, kunye neqela le-blaCTX-M-8.Phakathi kweentlobo ze-CR-hvKP ze-16, iintlobo ze-5 zithwele i-extra-spectrum ye-β-lactamase gene blaCTX-M-1 iqela, kunye ne-6 strains ethwele i-extra-spectrum ye-β-lactamase gene blaCTX-M-9 iqela.
Umzobo we-1 Iijene ezinxulumene ne-virulence, i-antimicrobial resistance genenes, i-capsular serotype genes kunye ne-MLST ye-16 CR-hvKP i-isotes.
Umzobo we-2 i-Agarose gel electrophoresis yezinye iintlobo ezinxulumene ne-virulence, i-antimicrobial resistance genes kunye ne-capsular serotype genes.
Qaphela: M, i-DNA marker;1, blaKPC (893bp);2, i-entB (400bp);3, rmpA2 (609bp);4, i-rmpA (429bp);5, iucA (239bp);6, iutA (880bp);7 , Aerobacterin (556bp);8, K1 (1283bp);9, K2 (641bp);I-10, yonke i-S (508bp);11, mrkD (340bp);I-12, i-fimH (609bp).
I-ERIC-PCR yayisetyenziselwa ukuhlalutya i-homology ye-16 CR-hvKP isolates.Emva kokukhulisa i-PCR kunye ne-agarose gel electrophoresis, kukho i-3-9 DNA fragments.Iziphumo zeminwe zibonise ukuba i-16 CR-hvKP i-isolate yayiyipolymorphic kakhulu, kwaye kukho ukungafani okucacileyo phakathi kwe-isolates (Umfanekiso 3).
Kwiminyaka yakutshanje, kuye kwakho iingxelo ezininzi malunga ne-CR-hvKP yodwa.Ukubonakala kwe-CR-hvKP yodwa ibeka isoyikiso esikhulu kwimpilo yoluntu kuba inokubangela izifo ezinzulu, ezinzima-ukunyanga abantu abaphilileyo.Kolu phononongo, ukuxhaphaka kunye neempawu ze-molecular epidemiological ze-CR-hvKP kwisibhedlele senqanaba lesithathu eShanghai ukusuka ngo-2019 ukuya ku-2020 zaphononongwa ukuze kuhlolwe ukuba kukho umngcipheko wokuqhambuka kwe-CR-hvKP kunye nendlela yophuhliso kule ndawo.Kwangaxeshanye, olu phononongo lunokubonelela ngovandlakanyo olubanzi ngakumbi lokusuleleka kweklinikhi, nto leyo ibaluleke kakhulu ekuthinteleni ukusasazeka ngakumbi kwezo zodwa.
Olu phononongo luhlalutye ngokuphindaphindiweyo ukuhanjiswa kweklinikhi kunye nentsingiselo ye-CR-hvKP ukusuka ngo-2019 ukuya ku-2020.Malunga ne-31.2% (5/16) ye-CR-hvKP yabekwa yodwa ngo-2019, kwaye i-68.8% (11/16) ye-CR-hvKP yabekwa yodwa ngo-2020, ehambelana nokunyuka kwe-CR-hvKP echazwe kuncwadi.Ekubeni uZhang et al.ichazwe okokuqala CR-hvKP ngo-2015,10 ngakumbi nangakumbi CR-hvKP uncwadi kuye kwabikwa, 17-20 ikakhulu kummandla Asia-Pacific, ingakumbi China.I-CR-hvKP yibhaktiriya ephezulu enobungozi obukhulu kunye nokumelana namachiza amaninzi.Iyingozi kwimpilo yabantu kwaye inezinga eliphezulu lokufa.Ngoko ke, kufuneka kuhlawulwe ingqalelo kwaye amanyathelo kufuneka athathwe ukuthintela ukusasazeka kwayo.
Uhlalutyo lwe-antibiotic resistance ye-16 CR-hvKP isolate lubonise izinga eliphezulu lokuxhathisa amayeza okubulala iintsholongwane.Zonke i-isolate zaphathwa nge-ampicillin, i-ampicillin / sulbactam, i-cefoperazone / sulbactam, i-piperacillin / tazobactam, i-cefazolin, i-cefuroxime, i-ceftazidime, i-ceftriaxone, i-cefepime, i-Cefoxitin, imipenem, kunye ne-meropenem zixhathisa.I-Trimethoprim-sulfamethoxazole inezinga eliphantsi lokumelana (43.8%), ilandelwa yi-amikacin (62.5%), i-gentamicin (68.8%) kunye ne-ciprofloxacin (87.5%).Izinga lokumelana ne-CR-hmkp efundwe nguLingling Zhan kunye nabanye iyafana nale sifundo [12].Izigulana ezosulelwe yi-CR-hvKP zinezifo ezininzi ezisisiseko, ukungakhuseleki okuphantsi, kunye nobuchule obuzimeleyo bokuvala inzala obubuthathaka.Ke ngoko, unyango olusexesheni olusekwe kwiziphumo zovavanyo lwe-antimicrobial sensitivity lubaluleke kakhulu.Ukuba kuyimfuneko, indawo echaphazelekayo inokufumaneka kwaye iphathwe nge-drainage, i-debridement kunye nezinye iindlela.
Ii-39 ze-CR-hmKP zodwa zahlulwa zaba ngamaqela amabini ngokobude bomtya oncangathi.Phakathi kwabo, i-20 CR-hmKP i-isolate kunye nobude bentambo ye-viscous ≤ 25 mm yahlulwe kwiqela elinye, kwaye i-19 CR-hmKP ihlukanisa kunye nobude bentambo ye-viscous> 25 mm yahlulwe kwelinye iqela.Ukuthelekisa iireyithi ezintle ze-CR-hmKP ezinxulumene ne-virus phakathi kwamaqela amabini, akukho ntlukwano ephawulekayo kwimilinganiselo emihle ye-virus ye-virus phakathi kwamaqela amabini.Uphando nguLin Ze et al.yabonisa ukuba izinga elincomekayo lemfuza ye-virulence ye-Klebsiella pneumoniae laliphezulu kakhulu kunelo le-Klebsiella pneumoniae yakudala.21 Nangona kunjalo, ukuba izinga eliqinisekileyo lejini lentsholongwane linxulunyaniswe kakuhle nobude bekhonkco elincangathi lihlala lingacacanga.Olunye uphononongo lubonise ukuba i-Klebsiella pneumoniae yakudala isenokuba yi-Klebsiella pneumoniae eyingozi kakhulu, enezinga eliphezulu elincomekayo lemfuza yentsholongwane.22 Olu phononongo lufumene ukuba i-virulence gene positive rate ye-CR-hmKP ayihambelani kakuhle nobude be-mucus.Umtya (okanye awunyuki ngobude bomtya oncangathi).
Iminwe yeminwe ye-ERIC PCR yolu phononongo i-polymorphic, kwaye akukho crossover yeklinikhi phakathi kwezigulane, ngoko ke izigulane ze-16 ezinosulelo lwe-CR-hvKP ziimeko eziqhelekileyo.Kwixesha elidlulileyo, izifo ezininzi ezibangelwa yi-CR-hvKP ziye zaxelwa njengeemeko ezizimeleyo okanye ezinqabileyo, i-23,24 kunye nokuqhambuka okuncinci kwe-CR-hvKP kunqabile kwiincwadi.I-11,25 ST11 yeyona ST11 ixhaphake kakhulu kwi-CRKP kunye ne-CR-hvKP yodwa e-China.I-26,27 Nangona i-ST11 CR-hvKP ibalwa kwi-87.5% (14/16) ye-16 CR-hvKP yodwa kolu phononongo, ayinakucingelwa ukuba i-14 ST11 CR-hvKP strains ivela kwi-clone efanayo, ngoko ke i-ERIC PCR iminwe Iyafuneka.Uhlalutyo lweHomology.
Kolu phononongo, zonke izigulana ezili-16 ezosulelwe yi-CR-hvKP zenze utyando oluhlaselayo.Ngokweengxelo, uqhambuko olubulalayo lwenyumoniya ehambelana ne-ventilator ebangelwa yi-CR-hvKP11 ibonisa ukuba iinkqubo ezihlaselayo zinokunyusa umngcipheko wosulelo lwe-CR-hvKP.Ngelo xesha, izigulane ze-16 ezosulelwe yi-CR-hvKP zinezifo eziphantsi, apho izifo ze-cerebrovascular zixhaphake kakhulu.Uphononongo lwangaphambili lubonise ukuba isifo se-cerebrovascular singumngcipheko omkhulu ozimeleyo wosulelo lwe-CR-hvKP.28 Isizathu salesi siganeko sinokuba yi-immunity ebuthakathaka yezigulane ezine-cerebrovascular disease, ibhaktheriya ye-pathogenic ayikwazi ukukhutshwa ngokuzimeleyo, kwaye kuphela umphumo wabo we-bactericidal uxhomekeke kuyo.I-Antibiotics iya kukhokelela ekudibaneni kokumelana neziyobisi ezininzi kunye ne-hypervirulence ekuhambeni kwexesha.Phakathi kwezigulane ezili-16, i-9 yafa, kwaye izinga lokufa laliyi-56.3% (9/16).Izinga lokufa liphezulu kune-10,12 kwizifundo zangaphambili, kwaye ngaphantsi kwe-11,21 echazwe kwizifundo zangaphambili.Umyinge weminyaka yezigulane ze-16 yayiyi-83.1±10.5 iminyaka, ebonisa ukuba abantu abadala basengozini ye-CR-hvKP.Uphononongo lwangaphambili lubonise ukuba abantu abatsha ngabona basesichengeni sokosuleleka.Ukuxhatshazwa kwe-Klebsiella pneumoniae.29 Nangona kunjalo, olunye uphando lubonise ukuba abantu abadala basengozini kwi-Klebsiella pneumoniae24,28 enobundlobongela kakhulu.Olu phononongo luyangqinelana noku.
Phakathi kweentlobo ze-CR-hvKP ze-16, ngaphandle kwe-ST23 CR-hvKP enye kunye ne-ST86 CR-hvKP enye, ezinye iintlobo ze-14 zonke ziyi-ST11 CR-hvKP.I-serotype ye-capsular ehambelana ne-ST23 CR-hvKP yi-K1, kunye ne-capsular serotype ehambelanayo ye-ST86 CR-HVKP yi-K2, efana nezifundo zangaphambili.I-30-32 Izigulane ezisuleleke nge-ST23 (K1) CR-hvKP okanye i-ST86 (K2) i-CR-hvKP zafa, kwaye izinga lokufa (100%) laliphezulu kakhulu kunezigulane ezisuleleke nge-ST11 CR-hvKP (50%).Njengoko kuboniswe kwi-Figure 1, izinga elihle le-ST23 (K1) okanye i-ST86 (K2) yeentlobo ezinxulumene ne-virulence ziphezulu kunezo ze-ST11 (K64).Ukusweleka kunokunxulunyaniswa nezinga elincomekayo lemfuza enxulumene nobundlobongela.Kulo cwaningo, iintlobo ze-16 ze-CR-hvKP zonke zithwala i-carbapenemase gene blaKPC-2 kunye ne-extension-spectrum β-lactamase gene blaSHV.I-blaKPC-2 yeyona gene ye-carbapenemase eqhelekileyo kwi-CR-hvKP e-China.33 Kuphononongo lwe-Zhao et al., i-25blaSHV yimfuza ye-β-lactamase eyandisiweyo enezinga eliphezulu eliphezulu.Iijini ze-virulence entB, fimH, rmpA2, iutA, kunye ne-iucA zikhona kuzo zonke ii-isotes ze-CR-hvKP eziyi-16, zilandelwa yi-mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), efana nesifundo sangaphambili.I-34 Ezinye izifundo zibonise ukuba i-rmpA kunye ne-rmpA2 (i-modulators ye-mucus phenotype genes) inokukhuthaza ukukhutshwa kwe-capsular polysaccharides, ekhokelela kwi-hypermucoid phenotypes kunye nokwanda kwe-virulence.I-35 I-Aerobacterins ifakwe kwi-encoded yi-iucABCD gene, kunye ne-homologous receptors zabo zifakwe kwi-iutA gene, ngoko ke banezinga eliphezulu lokuxhatshazwa kwi-G. mellonella yovavanyo losulelo.I-AllS yi-marker ye-K1-ST23, kungekhona kwi-pLVPK, i-pLVPK yi-plasmid ye-virulence evela kuhlobo lwe-K2 super virulence.I-allS luhlobo lwe-HTH esebenza ngokukhutshelwayo.Ezi ntlobo ze-virulence ziyaziwa ngokuba negalelo kwi-virulence kwaye zijongene nekholoni, ukuhlasela kunye ne-pathogenicity.36
Olu pho nonongo luchaza ukuxhaphaka kunye ne-molecular epidemiology ye-CR-hvKP e-Shanghai, e-China.Nangona usulelo olubangelwa yi-CR-hvKP luxhaphakile, luyanda unyaka nonyaka.Iziphumo zixhasa uphando lwangaphambili kwaye zibonisa ukuba i-ST11 CR-hvKP yeyona CR-hvKP ethandwa kakhulu e-China.I-ST23 kunye ne-ST86 CR-hvKP ibonise i-virulence ephezulu kune-ST11 CR-hvKP, nangona zombini ziyingozi kakhulu i-Klebsiella pneumoniae.Njengoko ipesenti ye-Klebsiella pneumoniae enobundlobongela kakhulu inyuka, izinga lokuxhathisa i-Klebsiella pneumoniae lingancipha, eliya kukhokelela ekubeni nethemba elingaboniyo ekusebenzeni kwekliniki.Ngoko ke, kuyimfuneko ukufunda i-virulence kunye nokuxhatshazwa kweziyobisi kwe-Klebsiella pneumoniae.
Olu phononongo luvunywe yiKomiti yezoNyango yezoNyango yeSibhedlele seSihlanu sabantu baseShanghai (No. 104, 2020).Iisampulu zeklinikhi ziyinxalenye yenkqubo yesiqhelo yelebhu yasesibhedlele.
Enkosi kubo bonke abasebenzi beLabhoratri yeCentral yeSibhedlele seSihlanu sabantu baseShanghai ngokubonelela ngesikhokelo sobugcisa kolu phononongo.
Lo msebenzi wawuxhaswa yiSiseko seSayensi yeNdalo yeSithili saseMihang, eShanghai (inombolo yokuvunywa: 2020MHZ039).
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