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Makiriniki uye mamorekuru maitiro e carbapenem-resistant high-virulence Klebsiella pneumoniae muchipatara chepamusoro muShanghai.
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 China;2 Shanghai Jiaotong Dhipatimendi reLabhoritari Mushonga, Shanghai Vana Hospital, Shanghai, People's Republic of China;3 Dhipatimendi reNeurology, Shanghai Fifth People's Hospital, Fudan University Anowirirana munyori: Fang Shen, Dhipatimendi reClinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, No. 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 yeChinaTel +86 180611073 Email [email yakadzivirirwa] Mhedziso: Kusanganiswa kwecarbapenem kuramba uye hypervirulence muKlebsiella pneumoniae kwakatungamira kumatambudziko makuru ehutano hweveruzhinji.Mumakore achangopfuura, kwave kune mishumo yakawanda uye yakawanda pamusoro pecarbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) inotsaura.Zvishandiso uye nzira: Ongororo yakadzokororwa yekiriniki data kuongororwa kwevarwere vane CR-hvKP kubva muna Ndira 2019 kusvika Zvita 2020 muchipatara chepamusoro.calculate the Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) uye carbapenem-resistant high-virulence mabayo yakaunganidzwa mukati memakore maviri Huwandu hwemabayo ari ega eLeberella (CR-hvKP).PCR yekuona maitiro ekupikisa, virulence-inoenderana nemajini, capsular serotype genes uye multilocus sequence typing (MLST) yeCR-hvKP inotsaura.Results: Zvose zve 1081 zvisingadzokizve Klebsiella pneumoniae strains zvakaparadzaniswa panguva yekudzidza., Kusanganisira 392 strains of Klebsiella pneumoniae (36.3%), 39 strains yeCR-hmKP (3.6%) uye 16 yeCR-hvKP (1.5%).Zvingangoita 31.2% (5/16) yeCR-hvKP ichave yega muna 2019, uye ingangoita 68.8% (11/16) yeCR-hvKP ichave yega muna 2020. Pakati pegumi nematanhatu CR-hvKP strains, gumi nematanhatu ari ST11 uye serotype K64, 1 strain inonzi ST11 neK47 serotypes, 1 strain iST23 neK1 serotypes, uye 1 strain ndeye ST86 uye K2 serotypes.Majini ane hukama nehutachiona entB, fimH, rmpA2, iutA, uye iucA aripo mune ese gumi nematanhatu CR-hvKP akasarudzika, achiteverwa nemrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).Iyo 16 CR-hvKP inotsaura yese inotakura carbapenemase gene blaKPC-2 uye yakawedzera-spectrum β-lactamase gene blaSHV.Migumisiro yeERIC-PCR DNA fingerprinting yakaratidza kuti 16 CR-hvKP strains yakanga yakanyanya polymorphic, uye mabhandi emhando imwe neimwe akanga akasiyana zvakanyanya, achiratidza mamiriro ezvishoma.Mhedziso: Kunyangwe CR-hvKP ichigoverwa zvishoma nezvishoma, iri kuwedzera gore negore.gore.Naizvozvo, kutariswa kwekiriniki kunofanirwa kumutswa, uye matanho anodiwa anofanirwa kutorwa kudzivirira kuumbwa uye kupararira kweiyo superbug CR-hvKP.Keywords: Klebsiella pneumoniae, carbapenem kuramba, high virulence, high mucus, epidemiology
Klebsiella pneumoniae chirwere chinogona kukonzera zvirwere zvakasiyana-siyana, kusanganisira mabayo, zvirwere zveurinary, bacteremia, uye meningitis.1 Mumakore makumi matatu adarika, kusiyana neKlebsiella pneumoniae (cKP), imwe itsva ine utachiona hweKlebsiella pneumoniae (hvKP) hypermucosal mucus yave utachiona hunokosha muchipatara, hunogona kuwanikwa muHurwere hunotyisa hwakadai semapundu echiropa anokonzerwa nehutano. uye vanhu vasina immunocompromised.2 Zvakakosha kuziva kuti zvirwere izvi zvinowanzoperekedzwa nezvirwere zvinoparadza zvinoparadzirwa, kusanganisira endophthalmitis uye meningitis.3 Kugadzirwa kwepamusoro mucosal mucosal phenotype hvKP inowanzokonzerwa nekuwedzera kwekugadzirwa kwe capsular polysaccharides uye kuvapo kwemajini chaiwo ehutachiona, akadai sermpA uye rmpA2.4.Iyo yakakwirira mucus phenotype inowanzogadziriswa ne "string test".MaKlebsiella pneumoniae colonies akakura kwehusiku pamahwendefa eropa agar akatambanudzwa nechishwe.Kana tambo ye viscous ine urefu hwe> 5mm inoumbwa, "tambo yekuedza" yakanaka.5 Ongororo ichangoburwa yakaratidza kuti peg-344, iroB, iucA, rmpA rmpA2 uye rmpA2 mabhaibheri anogona kunyatso ziva hvkp.6 Muchidzidzo ichi, Klebsiella pneumoniae ine hutsinye hwakanyanya yakatsanangurwa seine mucus viscous phenotype (positive string test result) uye kutakura Klebsiella pneumoniae virulence plasmid related sites (rmpA2, iutA, iucA) Mumakore ekuma1980, nyaya yeTaiwan yakatanga kutsanangurwa munharaunda. -akawana chiropa abscesses anokonzerwa nehvKP, achiperekedzwa neakakomba ekupedzisira-organ kukuvara, senge meningitis uye endophthalmitis.7,8 hvKP inotapuriranwa pano neapo munyika dzakawanda muAsia, Europe neAmerica.Kunyange zvazvo nyaya dzakawanda dzehvKP dzakashumwa muEurope nekuAmerica, kuwanda kwehvKP kwakanyanya kuitika munyika dzeAsia, kunyanya China.9
Kazhinji, hvKP inonyanya kunzwisiswa nemishonga inorwisa mabhakitiriya, nepo carbapenem-resistant Klebsiella pneumonia (CRKP) haina muchetura.Zvisinei, nekupararira kwekurwisa zvinodhaka uye virulence plasmids, CR-hvKP yakatanga kutsanangurwa naZhang et al.muna 2015, uye kune mishumo yakawanda uye yakawanda yemumba.10 Sezvo CR-hvKP ichigona kukonzera hosha dzakakomba uye dzakaoma-kurapa, kana denda rikaonekwa, rinogona kuita “superbug” rinotevera.Kusvika iye zvino, zvirwere zvakawanda zvinokonzerwa neCR-hvKP zvakaitika muzviitiko zvisingawanzoitiki, uye zvirwere zviduku zvishoma hazviwanzoitiki.11,12
Parizvino, chiyero chekuonekwa kweCR-hvKP chakaderera, uye kune zvishoma zvidzidzo zvine hukama.Iyo molecular epidemiology yeCR-hvKP yakasiyana munzvimbo dzakasiyana, saka zvakakosha kuti tidzidze kugoverwa kwekiriniki uye molecular epidemiological maitiro eCR-hvKP munharaunda ino.Chidzidzo ichi chakanyatsoongorora majini ekupikisa, majini ane chekuita nehutachiona uye MLST yeCR-hvKP.Takaedza kuferefeta kuwanda uye kupararira kwemolecular epidemiology yeCR-hvKP muchipatara chepamusoro muShanghai, kumabvazuva kweChina.Ichi chidzidzo chakakosha zvikuru pakunzwisisa molecular epidemiology yeCR-hvKP muShanghai.
Iyo isina kudzokorora Klebsiella pneumoniae inozvitsaura kubva kuShanghai Fifth People's Hospital yakabatana neFudan University kubva Ndira 2019 kusvika Zvita 2020 yakaunganidzwa zvakadzokororwa, uye zvikamu zvehmKP, CRKP, CR-hmkp uye CR-hvKP zvakaverengerwa.Zvese zvekuzvitsaura zvakaonekwa neVITEK-2 compact otomatiki microbial analyzer (Biomerieux, Marcy L'Etoile, France).Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) yakashandiswa kuongororazve kuzivikanwa kwemhando dzebhakitiriya.Iyo yakakwirira mucus phenotype inotarirwa ne "string test".Kana imipenem kana meropenem isingagadziriswi, carbapenem kuramba inotarirwa kuburikidza nekuongororwa kwezvinodhaka.Klebsiella pneumoniae ine hutachiwana zvakanyanya inotsanangurwa seine high mucus phenotype (positive string test result) uye kutakura Klebsiella pneumoniae virulence plasmid related sites (rmpA2, iutA, iucA)6.
Imwe Klebsiella pneumoniae colony yakaiswa pa5% yegwai ropa agar ndiro.Mushure mokuchengeta usiku hwose pa 37 ° C, zvinyoronyoro dhonzai colony neine inoculating loop uye dzokorora katatu.Kana mutsara we viscous wakaumbwa katatu uye kureba kwakakura kudarika 5mm, "line test" inofungidzirwa kuti yakanaka, uye mhirizhonga ine mucus phenotype yakakwirira.
MuVITEK-2 compact otomatiki microbial analyzer (Biomerieux, Marcy L'Etoile, France), kutapukira kweantimicrobial kune akati wandei anowanzo shandiswa maantibiotic akaonekwa nebroth micro-dilution.Mhedzisiro yacho inodudzirwa zvinoenderana negwaro rekutungamira rakagadzirwa neClinical and Laboratory Standards Institute (CLSI, 2019).E. coli ATCC 25922 uye Klebsiella pneumoniae ATCC 700603 zvakashandiswa sezvidzoreso zvekuongororwa kweantimicrobial susceptibility.
Genomic DNA yezvese Klebsiella pneumoniae isolate yakatorwa neTIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Yakawedzerwa-spectrum β-lactamase majini (blaCTX-M, blaSHV uye blaTEM), carbapenemase majini (blaKPC, blaNDM, blaVIM, blaIMP uye blaOXA-48) uye 9 anomiririra virulence-ane hukama, kusanganisira pLVPK Plasmid-like fimHS, yose , mrkD, entB, iutA, rmpA, rmpA2, iucA, uye aerobactin) dzakakwidziridzwa nePCR sezvakambotsanangurwa.13,14 Capsular serotype-specific genes (K1, K2, K5, K20, K54, uye K57) yakawedzerwa nePCR sezvinotsanangurwa pamusoro apa.14 Kana zvisina kunaka, wedzera uye rongedza wzi locus kuona iyo capsular serotype-chaiyo majini.15 Mapuranga akashandiswa muchidzidzo ichi akanyorwa muTebhura S1.Izvo zvakanaka PCR zvigadzirwa zvakatevedzana neNextSeq 500 sequencing chikuva (Illumina, San Diego, CA, USA).Enzanisa nucleotide sequences nekumhanyisa BLAST pawebhusaiti yeNCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Multi-saiti sequence typing (MLST) yakaitwa sekutsanangurwa kwazvinoitwa muPasteur Institute MLST webhusaiti (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Iwo majene manomwe ekuchengetedza imba gapA, infB, mdh, pgi, phoE, rpoB uye tonB akakwidziridzwa nePCR uye akateedzana.The sequence type (ST) inotarwa nekuenzanisa mibairo yekutevedzana neMLST database.
Homology yeKlebsiella pneumoniae yakaongororwa.Klebsiella pneumoniae genomic DNA yakatorwa se template, uye zvinyorwa zveERIC zvinoratidzwa muTable S1.PCR inokudza genomic DNA uye inogadzira zvigunwe zve genomic DNA.16 PCR zvigadzirwa zvakaonekwa ne2% agarose gel electrophoresis.DNA fingerprinting results yakaonekwa pachishandiswa QuantityOne software band recognition, uye genetic analysis yakaitwa pachishandiswa unweighted paired group method (UPGMA) of arithmetic mean.Izvo zvakaparadzana zvine kufanana> 75% inoonekwa seyakafanana genotype, uye avo vane kufanana <75% vanoonekwa sevakasiyana genotypes.
Shandisa statistical software package SPSS yeWindows 22.0 kuongorora iyo data.Iyo data inotsanangurwa sekureva ± yakajairwa kutsauka (SD).Categorical variables akaongororwa ne chi-square bvunzo kana bvunzo yaFisher chaiyo.Yese manhamba bvunzo ndeye 2-muswe, uye P kukosha kwe <0.05 inoonekwa seyakakosha.
Shanghai Fifth People's Hospital yakabatana neFudan University yakaunganidza 1081 Klebsiella pneumoniae yakazviparadzanisa kubva muna Ndira 1, 2019 kusvika Zvita 31, 2020, uye isingabatanidzwe zvakapetwa kaviri kubva kumurwere mumwe chete.Pakati pavo, 392 strains (36.3%) yaiva hmKP, 341 strains (31.5%) yaiva CRKP, 39 strains (3.6%) yaiva CR-hmKP, uye 16 strains (1.5%) yaiva CR-hvKP.Zvakakosha kucherechedza kuti 33.3% (13/39) yeCR-hmKP uye 31.2% (5/16) yeCR-hvKP vanobva muna 2019, 66.7% (26/39) yeCR-hmKP uye 68.8% (11/16). ) Iyo CR-hvKP yakaparadzaniswa kubva ku2020. Kubva sputum (17 strains), urini (12 strains), drainage fluid (4 strains), ropa (2 strains), pus (2 strains), bile (1 isolation) uye pleural effusion. (1 kuzviparadzanisa), zvichiteerana.Mhando gumi nenhanhatu dzeCR-hvKP dzakadzorerwa kubva kusputum (9 isolate), weti (5 isolate), ropa (1 isolate) uye pleural effusion (1 isolate).
Kuburikidza nekuzivikanwa kwekuomerwa, bvunzo yekunzwa kwezvinodhaka, tambo yekuyedza uye virulence-inoenderana nekuona gene, 16 CR-hvKP strains yakaongororwa.Makiriniki ehutano hwevarwere vane 16 vane hutachiona hweCR-hvKP vakaparadzana vanopfupikiswa muTebhu 1. 13 yevarwere ve16 (81.3%) vaiva varume, uye varwere vose vakanga vakwegura kupfuura makore 62 (kureva zera: 83.1 ± 10.5 makore).Ivo vakabva kumawadhi masere, uye vanopfuura hafu vakabva pakati peICU (9 kesi).Zvirwere zvekutanga zvinosanganisira cerebrovascular disease (75%, 12/16), hypertension (50%, 8/16), chirwere chisingaperi chemapapu (50%, 8 / 16), nezvimwewo. 16), weti catheter (37.5%, 6/16), gastric tube (18.8%, 3/16), kuvhiyiwa (12.5%, 2/16) uye intravenous catheter (6.3%, 1/16).Vapfumbamwe vevarwere gumi nevatanhatu vakafa, uye varwere vanomwe vakapora uye vakaburitswa.
Iwo 39 CR-hmKP akaparadzaniswa akakamurwa kuita mapoka maviri zvichienderana nehurefu hwetambo inonamira.Pakati pavo, 20 CR-hmKP inotsaura ine viscous tambo kureba ≤ 25 mm yakakamurwa kuva rimwe boka, uye 19 CR-hmKP inotsaura ine viscous tambo urefu> 25 mm yakakamurwa kuva rimwe boka.PCR nzira inoona chiyero chakanaka chemajini ane chekuita nehutachiona rmpA, rmpA2, iutA uye iucA.Nhamba dzakanaka dzeCR-hmKP dzine chokuita nehutachiona hwehutachiona mumapoka maviri dzinoratidzwa muTebhu 2. Pakanga pasina mutsauko wehuwandu muhuwandu hwakanaka hweCR-hmKP-ane chokuita nehutachiona hwehutachiona pakati pemapoka maviri.
Tafura 3 inonyora zvakadzama antimicrobial resistance profiles emishonga gumi nematanhatu.16 CR-hvKP yakatsaurwa yakaratidza kuwanda kwemishonga kuramba.Zvose zvakaparadzaniswa zvakarapwa neampicillin, ampicillin / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, uye meropenem inopikisa.Trimethoprim-sulfamethoxazole yakanga ine chiyero chakaderera chekudzivirira (43.8%), ichiteverwa neamikacin (62.5%), gentamicin (68.8%) uye ciprofloxacin (87.5%).
Kugoverwa kwemajini ane chokuita nehutachiona, antimicrobial resistance genes, capsular serotype genes uye MLST ye16 CR-hvKP isolates inoratidzwa muMufananidzo 1. Migumisiro yeagarose gel electrophoresis yemamwe majini ane chokuita nehutachiona, antimicrobial resistance genes uye capsular serotype genes. inoratidzwa muMufananidzo 1. Mufananidzo 2. Kuongororwa kweMLST kunoratidza huwandu hwe3 STs, ST11 ndiyo inonyanya kutonga ST (87.5%, 14/16), inoteverwa ne ST23 (6.25%, 1/16) uye ST86 (6.25%, 1 /16).Zvinoenderana nemhedzisiro yewzi typing, 4 akasiyana capsular serotypes akaonekwa (Mufananidzo 1).Pakati pe16 carbapenem-resistant hvKP isolates, K64 ndiyo inonyanya kuzivikanwa serotype (n=13), inoteverwa neK1 (n=1), K2 (n=1) uye K47 (n=1).Pamusoro pezvo, iyo capsular serotype K1 strain ndeye ST23, iyo capsular serotype K2 strain ndeye ST86, uye yasara gumi nenhatu strains yeK64 uye 1 strain yeK47 ese ST11.Nhamba dzakanaka dze9 virulence genes mu16 CR-hvKP isolates inoratidzwa muMufananidzo 1., Majeni ane chokuita nehutachiona entB, fimH, rmpA2, iutA, uye iucA iripo mu16 CR-hvKP strains, inoteverwa nemrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n=1).Iyo 16 CR-hvKP inotsaura yese inotakura carbapenemase gene blaKPC-2 uye yakawedzera-spectrum β-lactamase gene blaSHV.16 CR-hvKP isolates haina kutakura carbapenem genes blaNDM, blaVIM, blaIMP, blaOXA-48 uye yakawedzera-spectrum β-lactamase genes blaTEM, blaCTX-M-2 boka, uye blaCTX-M-8 boka.Pakati pe 16 CR-hvKP strains, 5 strains yakatakura yakawedzerwa-spectrum β-lactamase gene blaCTX-M-1 boka, uye 6 mashizha akatakura yakawedzera-spectrum β-lactamase gene blaCTX-M-9 boka.
Mufananidzo 1 Majini ane chokuita nehutachiona, antimicrobial resistance genes, capsular serotype genes uye MLST ye16 CR-hvKP inotsaura.
Mufananidzo 2 Agarose gel electrophoresis yemamwe majini ane hukama nehutachiona, antimicrobial resistance genes uye capsular serotype genes.
Cherechedza: M, DNA marker;1, blaKPC (893bp);2, entB (400bp);3, rmpA2 (609bp);4, rmpA (429bp);5, iucA (239bp);6, iutA (880bp);7, Aerobacterin (556bp);8, K1 (1283bp);9, K2 (641bp);10, ose S (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR yakashandiswa kuongorora homology ye16 CR-hvKP inotsaura.Mushure mePCR amplification uye agarose gel electrophoresis, pane 3-9 DNA zvidimbu.Mhedzisiro yeminwe yakaratidza kuti 16 CR-hvKP yakatsaurwa yaive yakanyanya polymorphic, uye pakanga paine misiyano iri pachena pakati pezvitsaurwa (Mufananidzo 3).
Mumakore achangopfuura, kwave kune mishumo yakawanda uye yakawanda pamusoro peCR-hvKP yekuzviparadzanisa nevamwe.Kuonekwa kweCR-hvKP kutsaura kunopa ngozi huru kune hutano hwevanhu nokuti inogona kukonzera zvakakomba, zvakaoma-kurapa zvirwere muvanhu vane hutano.Muchidzidzo ichi, kuwanda uye mamorekuru epidemiological maitiro eCR-hvKP muchipatara chepamusoro muShanghai kubva 2019 kusvika 2020 akaongororwa kuti aone kana paine njodzi yekubuda kweCR-hvKP uye budiriro yayo munzvimbo ino.Panguva imwecheteyo, chidzidzo ichi chinogona kupa kuongororwa kwakazara kwehutachiona hwehutachiona, izvo zvakakosha zvikuru kudzivirira kuwedzera kupararira kwezvitsaura zvakadaro.
Chidzidzo ichi chakaongorora zvekare kugoverwa kwekiriniki uye maitiro eCR-hvKP kubva 2019 kusvika 2020. Kubva 2019 kusvika 2020, CR-hvKP yakazviparadzanisa yakaratidza kuwedzera maitiro.Inenge 31.2% (5/16) yeCR-hvKP yakaparadzaniswa muna 2019, uye 68.8% (11/16) yeCR-hvKP yakaparadzaniswa muna 2020, inofambirana nemaitiro ekumusoro eCR-hvKP akataurwa mumabhuku.Kubva Zhang et al.yakatanga kurondedzerwa CR-hvKP mu2015,10 yakawanda uye yakawanda CR-hvKP zvinyorwa zvakashumwa, 17-20 kunyanya munharaunda yeAsia-Pacific, kunyanya muChina.CR-hvKP ibhakitiriya repamusoro rine super virulence uye multi-drug resistance.Inokuvadza hutano hwevanhu uye ine mwero wekufa kwakanyanya.Nokudaro, kutarisirwa kunofanira kubhadharwa uye matanho anofanirwa kutorwa kudzivirira kupararira kwayo.
Ongororo yemishonga inorwisa mabhakitiriya ye16 CR-hvKP yakatsaurwa yakaratidza mwero wepamusoro wekushomeka kwemishonga.Zvose zvakaparadzaniswa zvakarapwa neampicillin, ampicillin / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, uye meropenem inopikisa.Trimethoprim-sulfamethoxazole yakanga ine chiyero chakaderera chekudzivirira (43.8%), ichiteverwa neamikacin (62.5%), gentamicin (68.8%) uye ciprofloxacin (87.5%).Chiyero chekupikisa cheCR-hmkp chakadzidzwa naLingling Zhan nevamwe chakafanana nechidzidzo ichi [12].Varwere vanotapukirwa neCR-hvKP vane zvirwere zvakawanda, kusadzivirirwa kwakaderera, uye kushaya simba kwakazvimiririra kwesterilization.Naizvozvo, kurapwa kwenguva yakakodzera kunoenderana nemhedzisiro yeantimicrobial senitivity test kwakakosha zvikuru.Kana zvichidikanwa, nzvimbo ine hutachiona inogona kuwanikwa uye kurapwa nedhiraivha, debridement nedzimwe nzira.
Iwo 39 CR-hmKP akaparadzaniswa akakamurwa kuita mapoka maviri zvichienderana nehurefu hwetambo inonamira.Pakati pavo, 20 CR-hmKP inotsaura ine viscous tambo kureba ≤ 25 mm yakakamurwa kuva rimwe boka, uye 19 CR-hmKP inotsaura ine viscous tambo urefu> 25 mm yakakamurwa kuva rimwe boka.Kuenzanisa mazinga akanaka eCR-hmKP ane chokuita nehutachiona hwehutachiona pakati pemapoka maviri, pakanga pasina mutsauko wakakosha muhuwandu hwakanaka hwehutachiona hwehutachiona pakati pemapoka maviri.Tsvagiridzo yakaitwa naLin Ze et al.yakaratidza kuti chiyero chakanaka chehutachiona hwehutachiona hweKlebsiella pneumoniae hwakanga hwakanyanya kudarika hwekare hweKlebsiella pneumoniae.21 Zvisineyi, kana mwero wakanaka wemajini ehutachiona hunoenderana nehurefu hwecheni inonamira hazvizivikanwe.Zvimwe zvidzidzo zvakaratidza kuti yekare Klebsiella pneumoniae inogonawo kuva nehutachiona hweKlebsiella pneumoniae, ine mwero wepamusoro wehutachiona hwemajini.22 Ichi chidzidzo chakawana kuti virulence gene positive rate yeCR-hmKP haina kunyatsoenderana nehurefu hwemachu.Tambo (kana kuti haina kuwedzera nehurefu hwetambo inonamira).
Iyo ERIC PCR zvigunwe zvechidzidzo ichi ndezvepolymorphic, uye hapana kiriniki crossover pakati pevarwere, saka varwere gumi nevatanhatu vane CR-hvKP hutachiona inyaya dzenguva nenguva.Munguva yakapfuura, hutachiona huzhinji hunokonzerwa neCR-hvKP zvakataurwa sezviitiko zvega kana zvishoma nezvishoma, 23,24 uye kuputika kuduku kweCR-hvKP hazviwanzoitiki mumabhuku.11,25 ST11 ndiyo inonyanya kuzivikanwa ST11 muCRKP uye CR-hvKP yakazviparadzanisa muChina.26,27 Kunyange zvazvo ST11 CR-hvKP yakaverengera 87.5% (14/16) yegumi nematanhatu CR-hvKP yakazvitsaura muchidzidzo ichi, hazvigone kufungidzirwa kuti 14 ST11 CR-hvKP strains anobva kune imwechete clone, saka ERIC PCR zvigunwe. zvinodiwa.Homology kuongorora.
Muchidzidzo ichi, varwere vese gumi nevatanhatu vane CR-hvKP vakavhiyiwa.Sekureva kwemishumo, kubuda kunouraya kwepneumonia-inosanganisirwa nemabayo yakakonzerwa neCR-hvKP11 kunoratidza kuti maitiro ekupinda anogona kuwedzera njodzi yeCR-hvKP.Panguva imwecheteyo, varwere ve16 vane utachiona hweCR-hvKP vane zvirwere zvepasi, izvo zvirwere zvecerebrovascular zvinowanzoonekwa.Ongororo yapfuura yakaratidza kuti chirwere checerebrovascular chinhu chakakosha chakazvimiririra njodzi yeCR-hvKP hutachiona.28 Chikonzero chechiitiko ichi chinogona kunge chiri kushaya simba kwekudzivirira kwevarwere vane chirwere checerebrovascular, mabhakitiriya epathogenic haagone kubviswa akazvimirira, uye chete bhakitiriya yavo inovimbwa nayo.Mishonga inorwisa mabhakitiriya inotungamira mukusanganiswa kwemishonga yakawanda yekurwisa uye hypervirulence munguva refu.Pakati pevarwere gumi nevatanhatu, vapfumbamwe vakafa, uye huwandu hwevakafa hwaive 56.3% (9/16).Nhamba yekufa yakakwira kupfuura 10,12 mune zvidzidzo zvekare, uye yakaderera pane 11,21 yakashumwa mune zvidzidzo zvekare.Avhareji yezera revarwere gumi nevatanhatu yaive 83.1±10.5 makore, zvichiratidza kuti vakwegura vanonyanya kubatwa neCR-hvKP.Ongororo dzakapfuura dzakaratidza kuti vechidiki vari nyore kutapukirwa.Chirwere cheKlebsiella pneumoniae.29 Zvisinei, zvimwe zvidzidzo zvakaratidza kuti vakwegura vanobatwa nechirwere cheKlebsiella pneumoniae24,28.Ichi chidzidzo chinopindirana neizvi.
Pakati pemhando gumi nenhanhatu dzeCR-hvKP, kunze kweiyo ST23 CR-hvKP uye imwe ST86 CR-hvKP, mamwe gumi nemana ese ari ST11 CR-hvKP.Iyo capsular serotype inoenderana ne ST23 CR-hvKP ndeye K1, uye inoenderana capsular serotype ye ST86 CR-HVKP ndeye K2, yakafanana nezvidzidzo zvekare.30-32 Varwere vane utachiona hwe ST23 (K1) CR-hvKP kana ST86 (K2) CR-hvKP vakafa, uye nhamba yekufa (100%) yakanga yakakwirira zvikuru kupfuura yevarwere vane ST11 CR-hvKP (50%).Sezvinoratidzwa muMufananidzo 1, chiyero chakanaka che ST23 (K1) kana ST86 (K2) yemagetsi ane chokuita nehutachiona yakakwirira kupfuura ye ST11 (K64).Kufa kungave kwakabatana nehuwandu hwakanaka hwemajini ane hukama nehutachiona.Muchidzidzo ichi, 16 mhando dzeCR- hvKP dzose dzinotakura carbapenemase gene blaKPC-2 uye yakawedzerwa-spectrum β-lactamase gene blaSHV.blaKPC-2 ndiyo yakajairika carbapenemase gene muCR-hvKP kuChina.33 Muchidzidzo cheZhao et al., 25blaSHV ndiyo yakawedzerwa-spectrum β-lactamase gene ine yepamusoro-soro yakanaka.The virulence majini entB, fimH, rmpA2, iutA, uye iucA aripo mune ese gumi nematanhatu CR-hvKP akatsaga, achiteverwa nemrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), iyo yakafanana nedzidzo yapfuura.34 Zvimwe zvidzidzo zvakaratidza kuti rmpA uye rmpA2 (modulators of mucus phenotype genes) inogona kukurudzira kuvharwa kwe capsular polysaccharides, zvichiita kuti hypermucoid phenotypes uye kuwedzera virulence.35 Aerobacterins akaiswa encoded neiyo iucABCD gene, uye mahomologous receptors avo akaiswa encoded ne iutA gene, saka vane mwero wepamusoro wehutachiona muG. mellonella infection assay.allS chiratidzo cheK1-ST23, kwete mupLVPK, pLVPK iplasmid virulence kubva kuK2 super virulence type.allS imhando yeHTH transcript activator.Aya majini evirulence anozivikanwa kuti anobatsira pakuita virulence uye ane chekuita nekoloni, kupinda uye pathogenicity.36
Ichi chidzidzo chinotsanangura kuwanda uye mamorekuru epidemiology yeCR-hvKP muShanghai, China.Kunyange zvazvo hutachiona hunokonzerwa neCR-hvKP huri zvishoma nezvishoma, huri kuwedzera gore negore.Mhedzisiro inotsigira tsvakiridzo yapfuura uye inoratidza kuti ST11 CR-hvKP ndiyo inonyanya kufarirwa CR-hvKP muChina.ST23 uye ST86 CR-hvKP yakaratidza hutachiwana hwepamusoro kudarika ST11 CR-hvKP, kunyange zvazvo ose ari maviri ane hukasha hwakanyanya hweKlebsiella pneumoniae.Sezvo chikamu chechirwere cheKlebsiella pneumoniae chinowedzera, chiyero chekudzivirira kweKlebsiella pneumoniae chinogona kuderera, izvo zvinozotungamirira kutarisiro yeupofu mukudzidzira kwekliniki.Naizvozvo, zvinodikanwa kudzidza virulence uye kuramba zvinodhaka kweKlebsiella pneumoniae.
Ichi chidzidzo chakatenderwa neMedical Ethics Committee yeShanghai Fifth People's Hospital (Nhamba 104, 2020).Clinical samples chikamu chemaitiro emuchipatara marabhoritari maitiro.
Ndatenda kuvashandi vese veCentral Laboratory yeShanghai Fifth People's Hospital nekupa hutungamiri hwehunyanzvi hwechidzidzo ichi.
Iri basa rakatsigirwa ne Natural Science Foundation ye Minhang District, Shanghai (nhamba yemvumo: 2020MHZ039).
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Nguva yekutumira: Jul-15-2021