[1]郑 茂a,陈宗耀a,王登朝a,等.耐碳青霉烯类肺炎克雷伯菌感染的临床特征及耐药机制研究[J].现代检验医学杂志,2022,37(04):143-148.[doi:10.3969/j.issn.1671-7414.2022.04.028]
 ZHENG Maoa,CHEN Zong-yaoa,WANG Deng-chaoa,et al.Study on the Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniae Infection and Its Resistance Mechanisms[J].Journal of Modern Laboratory Medicine,2022,37(04):143-148.[doi:10.3969/j.issn.1671-7414.2022.04.028]
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耐碳青霉烯类肺炎克雷伯菌感染的临床特征及耐药机制研究()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第37卷
期数:
2022年04期
页码:
143-148
栏目:
论著
出版日期:
2022-07-15

文章信息/Info

Title:
Study on the Clinical Characteristics of Carbapenem-Resistant Klebsiella Pneumoniae Infection and Its Resistance Mechanisms
文章编号:
1671-7414(2022)04-143-06
作者:
郑 茂a陈宗耀a王登朝a邹 玉b
德阳市人民医院a. 检验科;b. 输血科,四川德阳 618000
Author(s):
ZHENG MaoaCHEN Zong-yaoaWANG Deng-chaoaZOU Yub
a. Department of Clinical Laboratory; b. Department of Blood Transfusion, People’s Hospital of Deyang City, Sichuan Deyang 618000, China
关键词:
耐碳青霉烯类肺炎克雷伯菌耐药高毒力危险因素头孢他啶-阿维巴坦
分类号:
R378.996;R446.5
DOI:
10.3969/j.issn.1671-7414.2022.04.028
文献标志码:
A
摘要:
目的 调查耐碳青霉烯类肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CR-KP)感染的临床特征及耐药机制,并分析感染CR-KP 高毒力株(carbpenem-resistant hypervirulent Klebsiella pneumoniae,CR-hvKP)的危险因素。方法 收集2016 年1 月~ 2020 年12 月从德阳市人民医院住院患者送检标本中分离的CR-KP,分析CR-KP 检出变化趋势,比较CR-KP 在不同科室及不同标本类型的分布情况,检测CR-KP 对常用抗生素的耐药性及碳青霉烯酶基因携带情况;收集CR-KP 感染患者的临床资料,比较高毒力株感染组(CR-hvKP 组)和非高毒力株感染组(CR-cKP组)的危险因素。结果 总计分离出89 株CR-KP,在肺炎克雷伯菌中占比3.47%(89/2 562),总体上呈逐年上升趋势。CR-KP 主要来源于ICU 16 株(17.98%)、感染科13 株(14.61%)和肿瘤科13 株(14.61%);标本类型主要为痰液45 株(50.56%)、尿液14 株(15.73%)和脓液11 株(12.36%)。CR-KP 对大部分常用抗生素耐药,但对头孢他啶-阿维巴坦和黏菌素耐药率较低。CR-KP 碳青霉烯酶基因检出率为78.65%(70/89),主要为blaKPC,blaNDM。年龄≥ 60 岁、糖尿病、肝胆疾病、机械通气、留置导管和入住ICU 共6 个因素,在CR-hvKP 组和CR-cKP 组之间的差异均有统计学意义(χ2 或Fisher =4.973 ~ 19.377,均P< 0.05)。经多因素logistic 回归分析,糖尿病(OR=10.947,95%CI:1.751 ~ 68.424,P =0.010)、入住ICU(OR=16.012,95%CI:2.589 ~ 99.036,P =0.003)是CR-hvKP 感染的独立危险因素。结论 该院CR-KP 检出总体上呈逐年上升趋势,携带blaKPC,blaNDM 是CR-KP 的主要耐药机制,糖尿病、入住ICU 是CR-hvKP感染的重要危险因素。
Abstract:
Objective To investigate the clinical characteristics and resistance mechanisms of Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infection, and analyze the risk factors of carbpenem-resistant hypervirulent Klebsiella pneumoniae (CRhvKP) infection. Methods CR-KP isolated from the specimens submitted by inpatients in Deyang People’s Hospital from January 2016 to December 2020 were collected, and the trend of CR-KP detection rate were analyzed. The distribution of CRKP in different departments and different specimen types were compared. At the same time, the resistance of CR-KP to common antibiotics and the carbapenem genes carryed by CR-KP were detected. The clinical data of patients with CR-KP infection were collected to compare the risk factors between carbpenem-resistant hypervirulent Klebsiella pneumoniae infection group (CR-hvKP group) and carbapenem-resistant classic Klebsiella pneumoniae (CR-cKP group). Results A total of 89 strains of CR-KP were isolated, accounting for 3.47% (89/2 562) of Klebsiella pneumoniae, and the detection rate of CR-KP generally increased year by year. CR-KP mainly included 16 strains in ICU (17.98%), 13 strains in Infection Diseases Department (14.61%), and 13 strains in Oncology Department (14.61%). The main types of specimens were 45 strains in sputum (50.56%), 14 strains in urine (15.73%), and 11 strains in pus (12.36%). CR-KP was resistant to most common antibiotics, but the resistance rate to ceftazidime-avibatan or colistin was low. The detection rate of carbapenemase genes in CR-KP was 78.65% (70/89), mainly blaKPC and blaNDM. There were six factors including age ≥ 60 years old, diabetes mellitus, hepatobiliary disease, mechanical ventilation, indwelling catheter and admission to ICU, which were statistically different between CR-hvKP group and CR-cKP group (χ2 or Fisher=4.973 ~ 19.377,all P < 0.05). Multivariate logistic regression analysis showed that diabetes mellitus (OR=10.947, 95%CI: 1.751 ~ 68.424, P=0.010) and admission to ICU (OR=16.012, 95%CI: 2.589 ~ 99.036, P=0.003) were independent risk factors for CR-hvKP infection. Conclusion The detection of CR-KP in the hospital was generally increasing year by year. Carrying blaKPC or blaNDM is the main resistance mechanisms of CR-KP. Diabetes mellitus and admission to ICU were important risk factors for CR-hvKP infection.

参考文献/References:

[1] MARTIN R M, BACHMAN M. Colonization,infection, and the accessory genome of Klebsiella pneumoniae [J]. Frontiers in Cellular and Infection Microbiology, 2018, 8: 4.
[2] ZHANG Ya w e i , WANG Qi, YIN Yuyao, et al. Epidemiology of carbapenem-resistant Enterobacteriaceae infections: report from the China CRE network[J]. Antimicrobial Agents and Chemotherapy, 2018, 62(2): e01882-17.
[3] GU Danxia, DONG Ning, ZHENG Zhiwei, et al.A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital :a molecular epidemiological study[J]. The Lancet Infectious Diseases, 2018, 18(1): 37-46.
[4] ZHAO Yajie, ZHANG Xiucai, TORRES V V L,et al. An outbreak of carbapenem-resistant and hypervirulent Klebsiella pneumoniae in an intensive care unit of a major teaching hospital in Wenzhou,China[J]. Front Public Health, 2019 , 7:229.
[5] 全国细菌耐药监测网. 全国细菌耐药监测网2014 ~ 2019 年细菌耐药性监测报告[J]. 中国感染控制杂志, 2021, 20(1):15-30. China Antimicrobial Resistance Surveillance System. Antimicrobial resistance of bacteria: surveillance report from China Antimicrobial Resistance Surveillance System in 2014 ~ 2019 [J]. Chinese Journal of Infection Control, 2021, 20(1): 15-30.
[6] MENTASTI M, PRIME K, SANDS K, et al. Rapid detection of IMP, NDM, VIM, KPC and OXA-48-like carbapenemases from Enterobacteriales and Gramnegative non-fermenter bacteria by real-time PCR and melt-curve analysis[J]. European Journal of Clinical Microbiology & Infectious Diseases, 2019, 38(11):2029-2036.
[7] ZHANG Yawei, ZHAO Chunjiang, WANG Qi, et al.High prevalence of hypervirulent Klebsiella pneumoniae infection in China: Geographic distribution, clinical characteristics, and antimicrobial resistance[J].Antimicrobial Agents and Chemotherapy, 2016, 60(10):6115-6120.
[8] RUSSO T, OLSON R, FANG Chitai, et al.Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K.pneumoniae[J]. Journal of Clinical Microbiology, 2018,56(9): e00776-18.
[9] 全国细菌耐药监测网. 全国细菌耐药监测网2014 ~ 2019 年耐碳青霉烯类肺炎克雷伯菌流行病学变迁[J]. 中国感染控制杂志, 2021, 20(2): 175-179. China Antimicrobial Resistance Surveillance System. Epidemiological change in carbapenem-resistant Klebsiella pneumoniae:surveillance report from China Antimicrobial Resistance Surveillance in 2014 ~ 2019[J]. Chinese Journal of Infection Control, 2021, 20(2):175-179.
[10] XU Liangfei, SUN Xiaoxi, MA Xiaoling. Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae[J]. Annals of Clinical Microbiology and Antimicrobials, 2017, 16(1): 18.
[11] LI Meiling, WANG Xiaoli, WANG Jiahui, et al.Infection-prevention and control interventions to reduce colonisation and infection of intensive care unitacquired carbapenem-resistant Klebsiella pneumoniae:a 4-year quasi-experimental before-and-after study[J].Antimicrobial Resistance and Infection Control, 2019,8(1): 8.
[12] 邓文喻, 陈国洋, 麦荣嘉, 等.婴幼儿肺泡灌洗液中肺炎克雷伯菌对β-内酰胺类抗生素的耐药变迁[J].现代检验医学杂志, 2020, 35(1):75-78. DENG Wenyu, CHEN Guoyang, MAI Rongjia, et al. Changes of resistance of Klebsiella pneumoniae to beta-lactam antibiotics in alveolar lavage fluid of infants [J]. Journal of Modern Laboratory Medicine,2020, 35(1):75-78.
[13] SHIELDS R K, CLANCY C J, PRESS E G, et al.Aminoglycosides for treatment of bacteremia due to carbapenem-resistant Klebsiella pneumoniae[J].Antimicrobial Agents and Chemotherapy, 2016, 60(5):3187-3192.
[14] 张敬霞, 贾天野, 张树永, 等. 头孢他啶/ 阿维巴坦对耐碳青霉烯肠杆菌科细菌的体外抗菌活性研究[J]. 中国抗生素杂志, 2018, 43(9): 1109-1116. ZHANG Jingxia, JIA Tianye, ZHANG Shuyong, et al.Study on in vitro antimicrobial activities of ceftazidime/avibactam to carbapenem-resistant Enterobacteriaceae [J].Chinese Journal of Antibiotics, 2018, 43(09): 1109-1116.
[15] KAZMIERCZAK K M, DE JONGE B, STONE G G,et al. In vitro activity of ceftazidime/avibactam against isolates of Enterobacteriaceae collected in European countries: INFORM global surveillance 2012-15[J].The Journal of Antimicrobial Chemotherapy, 2018,73(10): 2782-2788.
[16] 周琴, 杨向贵, 王丹, 等. 头孢他啶/ 阿维巴坦对耐碳青霉烯类肺炎克雷伯菌的体外抗菌活性分析[J].华西医学, 2020, 35(8): 918-923. ZHOU Qin, YANG Xianggui, WANG Dan, et al.Analysis of antibacterial activity of ceftazidime/avibactam against carbapenem resistant Klebsiella pneumoniae in vitro [J]. West China Medical Journal,2020, 35(8): 918-923.
[17] HANSEN G T. Continuous evolution: perspective on the epidemiology of carbapenemase resistance among enterobacterales and other Gram-Negative bacteria[J].Infectious Diseases and Therapy, 2021, 10(1): 75-92.
[18] ZHANG Rong, LIU Lizhang, ZHOU Hongwei, et al. Nationwide surveillance of clinical carbapenemresistant Enterobacteriaceae (CRE) strains in China[J].EBioMedicine, 2017, 19: 98-106.
[19] 王青, 李耘, 郑波.中国2017 ~ 2018 年耐碳青霉烯类肺炎克雷伯菌药物敏感性及耐药基因分析[J].中国感染控制杂志, 2021, 20(5): 437-442. WANG Qing, LI Yun, ZHENG Bo. Antimicrobial susceptibility and resistance genes of carbapenemresistant Klebsiella pneumoniae in China from 2017 to 2018 [J]. Chinese Journal of Infection Control, 2021,20(5): 437-442.
[20] VENA A, CASTALDO N, BASSETTI M. The role of new β-lactamase inhibitors in gram-negative infections[J]. Current Opinion in Infectious Diseases,2019, 32(6): 638-646.
[21] CHOBY J E, HOWARD-ANDERSON J, WEISS D S. Hypervirulent Klebsiella pneumoniae -clinical and molecular perspectives[J]. Journal of Internal Medicine,2020, 287(3): 283-300.
[22] RUSSO T A, OLSON R, MACDONALD U, et al.Aerobactin mediates virulence and accounts for increased siderophore production under Iron-Limiting conditions by hypervirulent (hypermucoviscous) Klebsiella pneumoniae[J]. Infection and Immunity,2014, 82(6): 2356-2367.
[23] RUSSO T A, OLSON R, MACDONALD U, et al.Aerobactin, but not yersiniabactin, salmochelin,or enterobactin, enables the growth/survival of hypervirulent (hypermucoviscous) Klebsiella pneumoniae Ex vivo and in vivo[J]. Infection and Immunity, 2015, 83(8): 3325-3333.
[24] LIU Chao, GUO Jun. Characteristics of ventilatorassociated pneumonia due to hypervirulent Klebsiella pneumoniae genotype in genetic background for the elderly in two tertiary hospitals in China[J].Antimicrobial Resistance and Infection Control, 2018,7(1): 95.
[25] 贾艳增, 马玉兰, 陈莹, 等. 碳青霉烯耐药高毒力肺炎克雷伯菌的实验室研究及与临床转归相关危险因素分析[J]. 现代检验医学杂志, 2021, 36(1): 112-115. JIA Yanzeng, MA Yulan, CHEN Ying, et al. Laboratory study and analysis of risk factors associated with clinical ouecomes of hypervirulent and carbapenemresistant Klebsiella pneumonia [J]. Journal of Modern Laboratory Medicine, 2021,36(1):112-115.
[26] JIN Longyang, LIU Yudong, JING Chendi, et al.Neutrophil extracellular traps (NETs)-mediated killing of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) are impaired in patients with diabetes mellitus[J]. Virulence, 2020, 11(1): 1122-1130.
[27] ZENG Lingyi, YANG Chengru, ZHANG Jisheng, et al. An outbreak of carbapenem-resistant Klebsiella pneumoniae in an intensive care unit of a major teaching hospital in chongqing, china[j]. Front Cell Infect Microbiol, 2021, 11: 656070.
[28] YU Fangyou, L? Jingnan, NIU Siqiang, et al. In vitro activity of ceftazidime-avibactam against carbapenemresistant and hypervirulent Klebsiella pneumoniae isolates[J]. Antimicrobial Agents and Chemotherapy,2018, 62(8): e01031-18.

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备注/Memo

备注/Memo:
基金项目:德阳市科技计划重点研发项目(NO.2020SZZ087):肺炎克雷伯菌高毒力株对碳青霉烯类抗生素耐药的机制及同源性研究。
作者简介:郑茂(1989-),男,硕士,主管检验师,研究方向:临床微生物与感染,E-mail:zhengmao322@163.com。
通讯作者:邹玉,E-mail:676091264@qq.com。
更新日期/Last Update: 1900-01-01