ʻO nā hiʻohiʻona maʻi a me ka molecular o ka Hypervi kū'ē i ka carbapenem

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ʻO nā hiʻohiʻona maʻi a me ka molecular o ka carbapenem-resistant high-virulence Klebsiella pneumoniae i loko o kahi haukapila kiʻekiʻe ma 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 Keʻena o ka Lapaʻau Lapaʻau Clinical, Shanghai Fifth People's Hospital, Fudan University, Shanghai, People's Republic of Kina;2 Shanghai Jiaotong Department of Laboratory Medicine, Shanghai Children's Hospital, Shanghai, People's Republic of China;3 Ke Keʻena Neurology, Shanghai Fifth People's Hospital, Fudan University Corresponding author: Fang Shen, Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, No. 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 o ChinaTel +86 18021073261 Email [email protected] Background: ʻO ka hui ʻana o ka pale ʻana o ka carbapenem a me ka hypervirulence i Klebsiella pneumoniae ua alakaʻi i nā pilikia olakino nui.I nā makahiki i hala iho nei, ua nui aʻe nā hōʻike e pili ana i ka carbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) isolates.Nā mea a me nā ʻano hana: ʻO kahi loiloi retrospective o ka loiloi ʻikepili lapaʻau o nā maʻi i loaʻa i ka maʻi CR-hvKP mai Ianuali 2019 a i Dekemaba 2020 i loko o kahi haukapila tertiary.E helu i ka Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) a me ka carbapenem-resistant high-virulence pneumoniae i ohiia iloko o 2 makahiki Ka heluna o na kaawale o Leberella (CR-hvKP).ʻIke PCR o nā genes kū'ē, nā genes pili i ka virulence, nā genes serotype capsular a me ka hoʻopaʻa ʻana i ka helu multilocus (MLST) o nā kaʻawale CR-hvKP.Nā hualoaʻa: Ua hoʻokaʻawale ʻia ka huina o 1081 mau ʻano Klebsiella pneumoniae i ka wā o ke aʻo ʻana., Me 392 mau kaha o Klebsiella pneumoniae (36.3%), 39 mau kaha o CR-hmKP (3.6%) a me 16 mau kaha o CR-hvKP (1.5%).Ma kahi o 31.2% (5/16) o CR-hvKP e hoʻokaʻawale ʻia i 2019, a ma kahi o 68.8% (11/16) o CR-hvKP e hoʻokaʻawale ʻia i 2020. Ma waena o nā 16 CR-hvKP strains, he 13 mau ʻano ST11 a serotype K64, 1 strain he ST11 a me K47 serotypes, 1 strain he ST23 a me K1 serotypes, a he 1 strain he ST86 a me K2 serotypes.Aia nā genes pili i ka virulence entB, fimH, rmpA2, iutA, a me iucA i nā 16 CR-hvKP isolates, a ukali ʻia e mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).ʻO ka 16 CR-hvKP hoʻokaʻawale i nā mea a pau e lawe i ka carbapenemase gene blaKPC-2 a me ka extended-spectrum β-lactamase gene blaSHV.Ua hōʻike ʻia nā hopena o ka manamana lima ERIC-PCR DNA he 16 CR-hvKP strains he polymorphic loa, a he ʻokoʻa loa nā kaula o kēlā me kēia kānana, e hōʻike ana i kahi kūlana sporadic.Panina Manaʻo: ʻOiai ua puʻunaue ʻia ka CR-hvKP i kēlā me kēia makahiki.makahiki.No laila, pono e hoʻāla ʻia ka nānā ʻana i ke kino, a pono e lawe ʻia nā mea e pono ai e pale aku i ka cloning a me ka hoʻolaha ʻana o ka superbug CR-hvKP.Hua'ōlelo: Klebsiella pneumoniae, carbapenem resistance, virulence kiʻekiʻe, mucus kiʻekiʻe, epidemiology
ʻO Klebsiella pneumoniae kahi pathogen kūpono e hiki ai ke hoʻoulu i nā maʻi like ʻole, e like me ka maʻi pneumonia, nā maʻi urinary tract, bacteremia, a me ka maningitis.1 I nā makahiki he kanakolu i hala iho nei, ʻaʻole e like me ka Klebsiella pneumoniae (cKP), he Klebsiella pneumoniae (hvKP) hypermucosal mucus hou i lilo i mea maʻi koʻikoʻi nui, hiki ke loaʻa i nā maʻi koʻikoʻi loa e like me nā abscesses o ke akepaʻa ke kumu i ke olakino. a me na kanaka immunocompromised.2 Pono e hoʻomaopopo ʻia ʻo kēia mau maʻi maʻamau e hui pū ʻia me nā maʻi hoʻolaha luku, e like me ka endophthalmitis a me ka maningitis.3 ʻO ka hana ʻana o ka mucosal mucosal phenotype hvKP ma muli o ka hoʻonui ʻia ʻana o nā polysaccharides capsular a me ka loaʻa ʻana o nā genes virulence kikoʻī, e like me rmpA a me rmpA2.4.Hoʻoholo pinepine ʻia ka phenotype mucus kiʻekiʻe e ka "string test".ʻO nā kolo Klebsiella pneumoniae i ulu ʻia i ka pō ma nā pā koko koko e hohola ʻia me kahi loop.Ke hoʻokumu ʻia kahi kaula viscous me ka lōʻihi o >5mm, maikaʻi ka "hoʻāʻo kaula".5 Ua hōʻike ʻia kahi noiʻi hou ʻana ʻo ka peg-344, iroB, iucA, rmpA rmpA2 a me rmpA2 he mau biomarkers hiki ke hoʻomaopopo pololei i ka hvkp.6 I loko o kēia noiʻi ʻana, ua wehewehe ʻia ka Klebsiella pneumoniae ʻino loa me ka loaʻa ʻana o ka mucus viscous phenotype (hopena hōʻike string maikaʻi) a me ka lawe ʻana i nā pūnaewele pili plasmid Klebsiella pneumoniae virulence (rmpA2, iutA, iucA) I nā makahiki 1980, hōʻike mua ka hihia o Taiwan i ke kaiāulu. - loaʻa nā ʻōpū o ka ate i hoʻokumu ʻia e ka hvKP, i hui pū ʻia me ka pōʻino hope loa, e like me ka maningitis a me ka endophthalmitis.Loaʻa ka 7,8 hvKP i ka hoʻouna ʻana i nā ʻāina he nui ma Asia, ʻEulopa a me ʻAmelika.ʻOiai ua hōʻike ʻia kekahi mau hihia o ka hvKP ma ʻEulopa a me ʻAmelika, ʻo ka nui o ka hvKP i loaʻa ma nā ʻāina ʻĀsia, ʻo Kina.9
Ma keʻano laulā, ʻoi aku ka maʻalahi o ka hvKP i nā lāʻau lapaʻau, ʻoiai ʻo Klebsiella pneumonia (CRKP) kūʻē i ka carbapenem ʻaʻole i ʻona.Eia naʻe, me ka hoʻolahaʻana o ka lāʻau kū'ē a me nā plasmids virulence, ua wehewehe muaʻiaʻo CR-hvKP e Zhang et al.i ka makahiki 2015, a ua nui aʻe nā hōʻike kūloko.10 No ka mea hiki i ka CR-hvKP ke hoʻoulu i nā maʻi koʻikoʻi a paʻakikī hoʻi e mālama ʻia, inā ʻike ʻia kahi clone maʻi maʻi, lilo ia i "superbug" hou.I kēia lā, ʻo ka hapa nui o nā maʻi i hoʻokumu ʻia e CR-hvKP ua loaʻa i nā hihia sporadic, a he kakaikahi nā maʻi maʻi liʻiliʻi.11,12
I kēia manawa, haʻahaʻa ka helu ʻike o CR-hvKP, a he liʻiliʻi nā haʻawina pili.ʻOkoʻa ka molecular epidemiology o CR-hvKP ma nā ʻāpana like ʻole, no laila pono e aʻo i ka hoʻolaha lāʻau lapaʻau a me nā ʻano epidemiological molecular o CR-hvKP ma kēia wahi.Hoʻopili piha kēia haʻawina i nā genes kū'ē, nā genes pili i ka virulence a me MLST o CR-hvKP.Ua hoʻāʻo mākou e noiʻi i ka maʻi maʻi a me ka molecular epidemiology o CR-hvKP i loko o kahi haukapila kula kiʻekiʻe ma Shanghai, hikina Kina.He mea koʻikoʻi kēia haʻawina no ka hoʻomaopopo ʻana i ka epidemiology molecular o CR-hvKP ma Shanghai.
ʻO ka Klebsiella pneumoniae i hoʻokaʻawale ʻole ʻia mai Shanghai Fifth People's Hospital i hui pū ʻia me Fudan University mai Ianuali 2019 a hiki i Dekemaba 2020 i hōʻiliʻili hou ʻia, a ua helu ʻia nā pākēneka o hmKP, CRKP, CR-hmkp a me CR-hvKP.Ua ʻike ʻia nā mea kaʻawale a pau e ka VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Farani).Ua hoʻohana ʻia ʻo Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) e nānā hou i ka ʻike ʻana o nā maʻi bacterial.Hoʻoholo ʻia ka phenotype mucus kiʻekiʻe e ka "string test".Ke kū'ē ka imipenem a i ʻole meropenem, hoʻoholo ʻia ke kūʻē ʻana o ka carbapenem ma o ka hoʻāʻo ʻana i ka lāʻau lapaʻau.Ua wehewehe ʻia ʻo Klebsiella pneumoniae koʻikoʻi ma ke ʻano he mucus phenotype kiʻekiʻe (ka hopena hōʻoia string maikaʻi) a me ka lawe ʻana iā Klebsiella pneumoniae virulence plasmid pūnaewele pili (rmpA2, iutA, iucA)6.
Hoʻokahi ʻāpana Klebsiella pneumoniae i hoʻopaʻa ʻia ma kahi pā 5% koko hipa.Ma hope o ka hoʻoulu ʻana i ka pō ma 37 ° C, e huki mālie i ke kolo me kahi loop inoculating a hana hou i 3 mau manawa.Inā hoʻokumu ʻia kahi laina viscous ʻekolu mau manawa a ʻoi aku ka lōʻihi ma mua o 5mm, ua manaʻo ʻia ka "hōʻoia laina" i ka maikaʻi, a he kiʻekiʻe ka mucus phenotype o ke kānana.
I loko o ka VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Palani), ua ʻike ʻia ka maʻalahi o ka antimicrobial i kekahi mau lāʻau antibiotic maʻamau e ka broth micro-dilution.Ua unuhi ʻia nā hopena e like me ka palapala alakaʻi i kūkulu ʻia e ka Clinical and Laboratory Standards Institute (CLSI, 2019).Ua hoʻohana ʻia ʻo E. coli ATCC 25922 a me Klebsiella pneumoniae ATCC 700603 ma ke ʻano he mau mana no ka hoʻāʻo ʻana i ka antimicrobial susceptibility testing.
Ua unuhi ʻia ka DNA Genomic o nā Klebsiella pneumoniae isolates e TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, Kina).Nā genes β-lactamase lōʻihi (blaCTX-M, blaSHV a me blaTEM), nā genes carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP a me blaOXA-48) a me 9 mau genes pili i ka virulence, me ka pLVPK Plasmid-like loci (allS, fimH , mrkD, entB, iutA, rmpA, rmpA2, iucA, a me aerobactin) i hoʻonui ʻia e PCR e like me ka mea i hōʻike mua ʻia.13,14 Capsular serotype-specific genes (K1, K2, K5, K20, K54, a me K57) i hoʻonui ʻia e PCR e like me ka mea i hōʻike ʻia ma luna.14 Inā maikaʻi ʻole, e hoʻonui a hoʻonohonoho i ka wzi locus e hoʻoholo ai i nā genes serotype-specific capsular.15 Ua helu ʻia nā kumu mua i hoʻohana ʻia ma kēia haʻawina ma ka Papa S1.Ua hoʻonohonoho ʻia nā huahana PCR maikaʻi e ka NextSeq 500 sequencing platform (Illumina, San Diego, CA, USA).Hoʻohālikelike i nā kaʻina nucleotide ma ka holo ʻana i ka BLAST ma ka pūnaewele NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Ua hoʻokō ʻia ka paʻi ʻana i nā pae he nui (MLST) e like me ka wehewehe ʻana ma ka pūnaewele Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).ʻO nā genes mālama hale ʻehiku gapA, infB, mdh, pgi, phoE, rpoB a me tonB i hoʻonui ʻia e PCR a hoʻonohonoho ʻia.Hoʻoholo ʻia ke ʻano o ke kaʻina (ST) ma ka hoʻohālikelike ʻana i nā hopena sequencing me ka waihona MLST.
Ua nānā ʻia ka homology o Klebsiella pneumoniae.Ua unuhi ʻia ʻo Klebsiella pneumoniae genomic DNA ma ke ʻano he laʻana, a ua hōʻike ʻia nā kumu mua ERIC ma ka Papa S1.Hoʻonui ka PCR i ka DNA genomic a kūkulu i kahi manamana lima o ka DNA genomic.Ua ʻike ʻia nā huahana 16 PCR e 2% agarose gel electrophoresis.Ua ʻike ʻia nā hopena paʻi manamana lima DNA me ka hoʻohana ʻana i ka ʻike pūʻulu lako polokalamu QuantityOne, a ua hana ʻia ka loiloi genetic me ka hoʻohana ʻana i ke ʻano hui hui paʻa ʻole (UPGMA) o ka helu helu.ʻO nā mea hoʻokaʻawale me ke ʻano like> 75% ua manaʻo ʻia he genotype like, a ʻo nā mea like <75% ua manaʻo ʻia he genotypes ʻokoʻa.
E hoʻohana i ka pūʻolo lako polokalamu helu SPSS no Windows 22.0 e kālailai i ka ʻikepili.Ua wehewehe ʻia ka ʻikepili ma ke ʻano he mean ± standard deviation (SD).Ua loiloi ʻia nā ʻano ʻano like ʻole e ka hōʻike chi-square a i ʻole ka hoʻāʻo pololei a Fisher.ʻO nā hoʻokolohua helu helu he 2-huelo, a he waiwai P <0.05 i manaʻo ʻia he koʻikoʻi.
Ua hōʻiliʻili ʻo Shanghai Fifth People's Hospital i hui pū ʻia me ke Kulanui ʻo Fudan i 1081 Klebsiella pneumoniae isolates mai Ianuali 1, 2019 a hiki i Dekemaba 31, 2020, a ua kāpae ʻia nā mea hoʻokaʻawale ʻelua mai ka mea maʻi like.Ma waena o lākou, ʻo 392 mau kaha (36,3%) he hmKP, 341 mau kaha (31,5%) he CRKP, 39 mau kaha (3,6%) he CR-hmKP, a he 16 mau kaha (1,5%) he CR-hvKP.Pono e ʻike ʻia ʻo 33.3% (13/39) o CR-hmKP a me 31.2% (5/16) o CR-hvKP mai 2019, 66.7% (26/39) o CR-hmKP a me 68.8% (11/16). ) Ua hoʻokaʻawale ʻia ka CR-hvKP mai 2020. Mai ka sputum (17 strains), mimi (12 strains), wai hoʻokahe (4 strains), koko (2 strains), pus (2 strains), bile (1 isolation) a me ka pleural effusion (1 kaʻawale), kēlā me kēia.He ʻumikūmāono ʻano CR-hvKP i loaʻa mai ka sputum (9 isolates), mimi (5 isolates), koko (1 kaʻawale) a me ka pleural effusion (1 kaʻawale).
Ma o ka hōʻike ʻana i nā kānana, ka hoʻāʻo ʻana i ka lāʻau naʻau, ka hoʻāʻo ʻana i ke kaula a me ka ʻike ʻana i nā gene pili i ka virulence, 16 mau kānana CR-hvKP i nānā ʻia.Hōʻuluʻulu ʻia nā hiʻohiʻona o nā maʻi 16 i loaʻa i ka CR-hvKP isolates ma ka Papa 1. 13 o nā maʻi 16 (81.3%) he mau kāne, a ʻo nā mea maʻi āpau i ʻoi aku ma mua o 62 mau makahiki (mean makahiki: 83.1±10.5 makahiki).Ua hele mai lākou mai 8 mau papa, a ʻoi aku ma mua o ka hapalua mai ka ICU waena (9 mau hihia).ʻO nā maʻi maʻamau ka maʻi cerebrovascular (75%, 12/16), hypertension (50%, 8/16), ka maʻi obstructive pulmonary maʻi (50%, 8/16), a me nā mea ʻē aʻe. 16), mimi catheter (37.5%, 6/16), ʻōpū ʻōpū (18.8%, 3/16), ʻoki (12.5%, 2/16) a me ka catheter intravenous (6.3%, 1/16).ʻEiwa o nā maʻi 16 i make, a ua hoʻomaikaʻi ʻia nā maʻi 7 a ua hoʻokuʻu ʻia.
Ua māhele ʻia nā ʻāpana 39 CR-hmKP i ʻelua pūʻulu e like me ka lōʻihi o ke kaula paʻa.Ma waena o lākou, 20 CR-hmKP isolates me viscous kaula lōʻihi ≤ 25 mm ua māhele ʻia i hoʻokahi hui, a me 19 CR-hmKP isolates me viscous kaula lōʻihi> 25 mm ua māhele ʻia i kekahi hui.ʻIke ʻia ke ʻano PCR i ka helu kūpono o nā genes pili i ka virulence rmpA, rmpA2, iutA a me iucA.Hōʻike ʻia nā helu maikaʻi o nā genes pili i ka virulence CR-hmKP i nā pūʻulu ʻelua ma ka Papa 2. ʻAʻohe ʻokoʻa helu helu i ka helu kūpono o nā genes pili i ka virulence CR-hmKP ma waena o nā hui ʻelua.
Papa 3 ka papa kuhikuhi kiko'ī kū'ē antimicrobial o nā lāʻau 16.16 CR-hvKP hoʻokaʻawale i hōʻike i ka nui-lāʻau kū'ē.Ua mālama ʻia nā mea hoʻokaʻawale a pau me ka ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, a me meropenem.ʻO Trimethoprim-sulfamethoxazole ka haʻahaʻa haʻahaʻa loa (43.8%), a ma hope o ka amikacin (62.5%), gentamicin (68.8%) a me ciprofloxacin (87.5%).
ʻO ka māheleʻana o nā genes pili i ka virulence, nā genes resistance antimicrobial, capsular serotype genes a me MLST o 16 CR-hvKP isolates i hōʻikeʻia ma ka Figure 1. hōʻike ʻia ma ka Figure 1. Figure 2. Hōʻike ka hōʻike MLST i ka huina o 3 ST, ʻo ST11 ka ST nui loa (87.5%, 14/16), a ukali ʻia e ST23 (6.25%, 1/16) a me ST86 (6.25%, 1). /16).Wahi a nā hopena o ka wzi type, ua ʻike ʻia nā 4 capsular serotypes (Figure 1).Ma waena o nā 16 carbapenem-resistant hvKP isolates, K64 ka serotype maʻamau (n=13), a ukali ʻia e K1 (n=1), K2 (n=1) a me K47 (n=1).Eia kekahi, he ST23 ka serotype K1 strain, he ST86 ka serotype K2 strain, a ʻo ke koena 13 strains o K64 a me 1 strain o K47 he ST11 a pau.Hōʻike ʻia nā helu maikaʻi o 9 virulence genes ma 16 CR-hvKP isolates ma ke Kiʻi 1. ʻO nā genes pili i ka virulence entB, fimH, rmpA2, iutA, a me iucA aia i loko o 16 CR-hvKP strains, ukali ʻia e mrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n=1).ʻO ka 16 CR-hvKP hoʻokaʻawale i nā mea a pau e lawe i ka carbapenemase gene blaKPC-2 a me ka extended-spectrum β-lactamase gene blaSHV.16 CR-hvKP kaawale 'aʻole i lawe carbapenem genes blaNDM, blaVIM, blaIMP, blaOXA-48 a extended-spectrum β-lactamase genes blaTEM, blaCTX-M-2 pūʻulu, a me blaCTX-M-8 pūʻulu.Ma waena o nā kānana CR-hvKP he 16, ua lawe ʻia nā kānana 5 i ka pūʻulu β-lactamase gene blaCTX-M-1 lōʻihi, a ʻo 6 mau kānana i lawe i ka pūʻulu β-lactamase gene blaCTX-M-9 lōʻihi.
Kiʻi 1 ʻO nā genes pili i ka virulence, nā genes resistance antimicrobial, capsular serotype genes a me MLST o 16 CR-hvKP kaʻawale.
Kiʻi 2 Agarose gel electrophoresis o kekahi mau genes pili i ka virulence, nā genes resistance antimicrobial a me nā genes serotype capsular.
Nānā: M, hōʻailona DNA;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, S a pau (508bp);11, mrkD (340bp);12, fimH (609bp).
Ua hoʻohana ʻia ʻo ERIC-PCR e kālailai i ka homology o 16 CR-hvKP kaawale.Ma hope o ka hoʻonui ʻana o PCR a me ka electrophoresis gel agarose, aia nā ʻāpana DNA 3-9.Ua hōʻike ʻia nā hopena paʻi manamana lima he 16 CR-hvKP kaawale he polymorphic loa, a aia nā ʻokoʻa ʻokoʻa ma waena o nā kaʻawale (Figure 3).
I nā makahiki i hala iho nei, ua nui aʻe nā hōʻike e pili ana i nā kaʻawale CR-hvKP.ʻO ke ʻano o nā mea hoʻokaʻawale CR-hvKP he mea weliweli nui i ke olakino lehulehu no ka mea hiki iā lākou ke hoʻoulu i nā maʻi koʻikoʻi a paʻakikī i ka mālama ʻana i nā kānaka olakino.Ma kēia noiʻi ʻana, ua aʻo ʻia ka prevalence a me ka molecular epidemiological hiʻohiʻona o CR-hvKP i kahi haukapila tertiary ma Shanghai mai 2019 a 2020 e loiloi ai inā aia ka pilikia o ka CR-hvKP outbreak a me kona ulu ulu ʻana ma kēia wahi.I ka manawa like, hiki i kēia haʻawina ke hāʻawi i kahi loiloi ʻoi aku ka nui o ka maʻi maʻi maʻi, he mea koʻikoʻi ia no ka pale ʻana i ka hoʻolaha ʻana o ia mau mea kaʻawale.
Ua nānā hou kēia haʻawina i ka hāʻawi ʻana a me ke ʻano o CR-hvKP mai 2019 a i 2020. Mai 2019 a i 2020, ua hōʻike ʻia nā mea hoʻokaʻawale CR-hvKP i ka piʻi nui ʻana.Ma kahi o 31.2% (5/16) o CR-hvKP i hoʻokaʻawale ʻia i ka makahiki 2019, a ʻo 68.8% (11/16) o CR-hvKP i hoʻokaʻawale ʻia ma 2020, i kūlike me ka piʻi ʻana o ka CR-hvKP i hōʻike ʻia ma ka palapala.ʻOiai ʻo Zhang et al.Ua hōʻike mua ʻia ka CR-hvKP i ka makahiki 2015, ua hōʻike ʻia ka nui a me ka nui o nā palapala CR-hvKP, 17-20 ma ka ʻāina ʻo Asia-Pacific, ʻoi aku ma Kina.ʻO ka CR-hvKP he hua bacteria nui loa me ka ikaika nui a me ka pale ʻana i nā lāʻau he nui.He mea pōʻino i ke olakino o kānaka a he kiʻekiʻe ka nui o ka make.No laila, pono e nānā a pono e hana i nā mea e pale ai i ka laha ʻana.
Ua hōʻike ʻia ka loiloi kūʻē antibiotic o 16 CR-hvKP isolates i kahi kiʻekiʻe o ke kūʻē antibiotic.Ua mālama ʻia nā mea hoʻokaʻawale a pau me ka ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, a me meropenem.ʻO Trimethoprim-sulfamethoxazole ka haʻahaʻa haʻahaʻa loa (43.8%), a ma hope o ka amikacin (62.5%), gentamicin (68.8%) a me ciprofloxacin (87.5%).ʻO ka helu kū'ē o CR-hmkp i aʻo ʻia e Lingling Zhan a me nā mea ʻē aʻe e like me kēia haʻawina [12].ʻO nā maʻi i loaʻa i ka maʻi CR-hvKP he nui nā maʻi maʻamau, haʻahaʻa haʻahaʻa, a nāwaliwali ka hiki ke sterilization kūʻokoʻa.No laila, he mea koʻikoʻi ka mālama ʻana i ka manawa e pili ana i nā hopena o ka hoʻāʻo antimicrobial sensitivity.Inā pono, hiki ke loaʻa a mālama ʻia ka wahi i hoʻopili ʻia e ka wai, debridement a me nā ʻano hana ʻē aʻe.
Ua māhele ʻia nā ʻāpana 39 CR-hmKP i ʻelua pūʻulu e like me ka lōʻihi o ke kaula paʻa.Ma waena o lākou, 20 CR-hmKP isolates me viscous kaula lōʻihi ≤ 25 mm ua māhele ʻia i hoʻokahi hui, a me 19 CR-hmKP isolates me viscous kaula lōʻihi> 25 mm ua māhele ʻia i kekahi hui.Ke hoʻohālikelike nei i nā kumukūʻai maikaʻi o nā genes pili i ka virulence CR-hmKP ma waena o nā pūʻulu ʻelua, ʻaʻohe ʻokoʻa koʻikoʻi i ka helu ʻana i nā helu kūpono o nā genes virulence ma waena o nā hui ʻelua.Noiʻi na Lin Ze et al.ua hōʻike ʻia ʻoi aku ka kiʻekiʻe o ka nui o nā genes virulence o Klebsiella pneumoniae ma mua o ka Klebsiella pneumoniae maʻamau.21 Eia nō naʻe, ʻaʻole maopopo loa inā pili maikaʻi ka nui o nā genes virulence me ka lōʻihi o ke kaulahao paʻa.Ua hōʻike ʻia nā haʻawina ʻē aʻe ʻo Klebsiella pneumoniae maʻamau paha he Klebsiella pneumoniae ʻino loa, me ka nui o ka maikaʻi o nā genes virulence.22 Ua ʻike ʻia kēia haʻawina ʻaʻole pili maikaʻi ka gene virulence gene positive rate o CR-hmKP me ka lōʻihi o ka mucus.ʻO ke kaula (a ʻaʻole e hoʻonui me ka lōʻihi o ke kaula paʻa).
ʻO nā manamana lima ERIC PCR o kēia haʻawina he polymorphic, a ʻaʻohe hoʻopaʻapaʻa lapaʻau ma waena o nā maʻi, no laila he 16 mau maʻi me ka maʻi CR-hvKP he mau hihia sporadic.I ka wā ma mua, ua hōʻike ʻia ka hapa nui o nā maʻi i hoʻokumu ʻia e CR-hvKP ma ke ʻano he hihia kaʻawale a sporadic paha, 23,24 a me nā maʻi liʻiliʻi liʻiliʻi o CR-hvKP he kakaikahi ma ka palapala.ʻO 11,25 ST11 ka ST11 maʻamau ma CRKP a me CR-hvKP kaʻawale ma Kina.26,27 ʻOiai ʻo ST11 CR-hvKP he 87.5% (14/16) o nā 16 CR-hvKP hoʻokaʻawale i kēia haʻawina, ʻaʻole hiki ke manaʻo ʻia ʻo nā kānana 14 ST11 CR-hvKP mai ka clone hoʻokahi, no laila ʻo ERIC PCR manamana lima. koi ʻia.Homology analysis.
I loko o kēia noiʻi ʻana, ʻo nā mea maʻi āpau he 16 i loaʻa i ka maʻi CR-hvKP i hana ʻia i ke kaʻina invasive.Wahi a nā hōʻike, ʻo ka maʻi maʻi o ka maʻi pneumonia pili i ka ventilator i hana ʻia e CR-hvKP11 e hōʻike ana i nā kaʻina hana invasive hiki ke hoʻonui i ka pilikia o ka maʻi CR-hvKP.I ka manawa like, he 16 mau maʻi i loaʻa i ka maʻi CR-hvKP he mau maʻi lalo, ʻo ia ka maʻi cerebrovascular ka mea maʻamau.Ua hōʻike ʻia kahi haʻawina mua i ka maʻi cerebrovascular he kumu kūʻokoʻa kūʻokoʻa koʻikoʻi no ka maʻi CR-hvKP.28 ʻO ke kumu o kēia ʻano, ʻo ia ka nāwaliwali nāwaliwali o nā maʻi me ka maʻi cerebrovascular, ʻaʻole hiki ke hoʻokaʻawale ʻia ka bacteria pathogenic, a ʻo kā lākou hopena bactericidal wale nō ke hilinaʻi ʻia.ʻO nā lāʻau'alopelo e alakaʻi i ka hui pūʻana o ka nui o nā lāʻau kū'ē a me ka hypervirulence i ka holo lōʻihi.Ma waena o nā maʻi 16, 9 i make, a ʻo ka nui o ka make he 56.3% (9/16).ʻOi aku ka nui o ka make ma mua o 10,12 i nā haʻawina mua, a haʻahaʻa ma mua o 11,21 i hōʻike ʻia ma nā haʻawina mua.ʻO ka makahiki awelika o nā maʻi he 16 he 83.1 ± 10.5 mau makahiki, e hōʻike ana ua maʻalahi ka poʻe ʻelemakule i ka CR-hvKP.Ua hōʻike ʻia nā haʻawina mua e ʻoi aku ka maʻalahi o ka poʻe ʻōpio i ka maʻi.ʻO ke kino o Klebsiella pneumoniae.29 Eia nō naʻe, ua hōʻike ʻia nā haʻawina ʻē aʻe e maʻalahi ka poʻe ʻelemakule i ka maʻi Klebsiella pneumoniae24,28.Kūlike kēia haʻawina me kēia.
Ma waena o nā kaha 16 CR-hvKP, koe wale no hoʻokahi ST23 CR-hvKP a me hoʻokahi ST86 CR-hvKP, ʻo nā kaha 14 ʻē aʻe he ST11 CR-hvKP a pau.ʻO ka serotype capsular e pili ana me ST23 CR-hvKP ʻo ia ka K1, a ʻo ka serotype capsular e pili ana i ST86 CR-HVKP ʻo K2, e like me nā haʻawina mua.30-32 Ua make nā maʻi i loaʻa i ka maʻi ST23 (K1) CR-hvKP a i ʻole ST86 (K2) CR-hvKP, a ʻoi aku ka kiʻekiʻe o ka make (100%) ma mua o nā maʻi i loaʻa i ka ST11 CR-hvKP (50%).E like me ka mea i hōʻike ʻia ma ke Kiʻi 1, ʻoi aku ka kiʻekiʻe o ka helu maikaʻi o ST23 (K1) a i ʻole ST86 (K2) o nā genes pili i ka virulence ma mua o ka ST11 (K64).Hiki ke pili ka make i ka helu maikaʻi o nā genes pili i ka virulence.I loko o kēia noiʻi ʻana, lawe nā 16 strains o CR-hvKP i ka carbapenemase gene blaKPC-2 a me ka extended-spectrum β-lactamase gene blaSHV.ʻO blaKPC-2 ka gene carbapenemase maʻamau ma CR-hvKP ma Kina.33 Ma ke aʻo ʻana iā Zhao et al., ʻo 25blaSHV ka huaʻano β-lactamase lōʻihi me ka helu maikaʻi loa.Aia nā genes virulence entB, fimH, rmpA2, iutA, a me iucA i nā 16 CR-hvKP isolates, a ukali ʻia e mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), e like me ka haʻawina mua.34 Ua hōʻike kekahi mau haʻawina e hiki i ka rmpA a me ka rmpA2 (modulators of mucus phenotype genes) ke hoʻoikaika i ka huna ʻana o nā polysaccharides capsular, e alakaʻi ana i nā phenotypes hypermucoid a me ka piʻi ʻana o ka virulence.35 Hoʻopili ʻia nā Aerobacterins e ka gene iucABCD, a ua hoʻopaʻa ʻia ko lākou mau mea homologous e ka gene iutA, no laila, ʻoi aku ka kiʻekiʻe o ka virulence i ka hoʻāʻo ʻana i ka maʻi G. mellonella.He hōʻailona ʻo allS o K1-ST23, ʻaʻole i ka pLVPK, he plasmid virulence ka pLVPK mai ke ʻano super virulence K2.ʻO allS kahi mea hana transcription ʻano HTH.Ua ʻike ʻia kēia mau genes virulence e hāʻawi i ka virulence a nona ke kuleana no ka colonization, invasion a me ka pathogenicity.36
Hōʻike kēia haʻawina i ka prevalence a me ka molecular epidemiology o CR-hvKP ma Shanghai, Kina.ʻOiai ʻo ka maʻi maʻi i hoʻokumu ʻia e CR-hvKP he mea maʻamau, ke hoʻonui nei ia i kēlā me kēia makahiki.Kākoʻo nā hopena i ka noiʻi mua a hōʻike ʻia ʻo ST11 CR-hvKP ka CR-hvKP kaulana loa ma Kina.Ua hōʻike ʻo ST23 a me ST86 CR-hvKP i ka maʻi ʻoi aʻe ma mua o ST11 CR-hvKP, ʻoiai ʻo lāua ʻelua he Klebsiella pneumoniae.Ke piʻi aʻe ka pākēneka o Klebsiella pneumoniae koʻikoʻi, hiki ke emi ke kūʻē ʻana o Klebsiella pneumoniae, kahi e alakaʻi ai i ka manaʻolana makapō i ka hana lapaʻau.No laila, pono e aʻo i ka virulence a me ke kū'ē i ka lāʻau o Klebsiella pneumoniae.
Ua ʻae ʻia kēia noiʻi ʻana e ke Kōmike Kauka Lapaʻau o Shanghai Fifth People's Hospital (No. 104, 2020).ʻO nā laʻana lāʻau lapaʻau kekahi ʻāpana o nā kaʻina hana halemai maʻamau.
Mahalo i nā limahana a pau o ka Central Laboratory o Shanghai Fifth People's Hospital no ka hāʻawi ʻana i ke alakaʻi ʻenehana no kēia haʻawina.
Ua kākoʻo ʻia kēia hana e ka Natural Science Foundation o Minhang District, Shanghai (helu ʻae ʻia: 2020MHZ039).
1. Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: ke kumu honua nui a me ke kaʻa no ka pale ʻana i ka lāʻau antibiotic.FEMS Microbiology Revised Edition 2017;41(3): 252–275.doi:10.1093/femsre/fux013
2. Prokesch BC, TeKippe M, Kim J.Ua maʻi ʻia ka Lancet me Dis.2016;16(9):e190–e195.doi:10.1016/S1473-3099(16)30021-4
3. Shon AS, Bajwa RPS, Russo TA.ʻO ka virulence kiʻekiʻe (super mucus).ʻO Klebsiella pneumoniae ʻino.2014;4(2): 107–118.doi:10.4161/viru.22718
4. Paczosa MK, Mecsas J. Klebsiella pneumoniae: E hoʻomau i ka hewa me ka pale ikaika.Microbiol Mol Biol Rev. 2016;80(3):629–661.doi:10.1128/MMBR.00078-15
5. Fang C, Chuang Y, Shun C, et al.ʻO nā genes virulence hou o Klebsiella pneumoniae e kumu ana i ka abscess ate mua a me nā hoʻopiʻi metastatic o sepsis.J Exp Med.2004;199(5):697–705.doi:10.1084/jem.20030857
6. Russo TA, Olson R, Fang CT, etc. Identification of J Clin Microbiol, he biomarker i hoʻohana ʻia no ka hoʻokaʻawale ʻana i ka Klebsiella pneumoniae mai ka Klebsiella pneumoniae maʻamau.2018;56(9):e00776.
7. YCL, Cheng DL, Lin CL.ʻO Klebsiella pneumoniae ka ʻōpū o ka ate e pili ana me ka endophthalmitis infectious.Kauka intern Arch.1986;146(10):1913-1916.doi:10.1001/archinte.1986.00360220057011
8. Chiu C, Lin D, Liaw Y. Metastatic septic endophthalmitis i loko o ka purulent ate abscess.J Hoʻomaʻamaʻa maʻi maʻi.1988;10(5):524–527.doi:10.1097/00004836-198810000-00009
9. ʻO Guo Yan, Wang Shun, Zhan Li, a me nā mea ʻē aʻe. Nā hiʻohiʻona microbiological a me ke kino o nā mucinous Klebsiella pneumoniae mucinous kiʻekiʻe e pili ana i nā maʻi invasive ma Kina.Hoʻopili ʻia nā mea mua i nā microorganisms.2017;7.
10. Zhang Yi, Zeng Jie, Liu Wei, etc. ʻO ka puka ʻana mai o kahi maʻi ʻino loa o ka carbapenem-resistant Klebsiella pneumoniae i nā maʻi maʻi ma Kina [J].J ma'i ma'i.2015;71(5): 553–560.doi:10.1016/j.jinf.2015.07.010
11. Gu De, Dong Nan, Zheng Zhong, etc. He ma'i make o ST11 carbapenem-resistant high-virulence Klebsiella pneumonia i loko o ka halemai Kina: he molecular epidemiological study.Ua ma'i ka Lancet me Dis.2018;18(1):37–46.doi:10.1016/S1473-3099(17)30489-9
12. Zhan Li, Wang S, Guo Yan, et al.ʻO kahi maʻi o ka carbapenem-resistant strain ST11 hypermucoid Klebsiella pneumoniae i loko o kahi haukapila kiʻekiʻe ma Kina.Hoʻopili ʻia nā mea mua i nā microorganisms.2017;7.
13. FRE, Messai Y, Alouache S, etc. Klebsiella pneumoniae virulence spectrum and drug sensitivity model i hoʻokaʻawale ʻia mai nā ʻano lāʻau lapaʻau like ʻole [J].ʻO ka maʻi kino.2013;61(5):209-216.doi:10.1016/j.patbio.2012.10.004
14. Turton JF, Perry C, Elgohari S.J Med Microbiology.2010;59 (Mokuna 5): 541–547.doi:10.1099/jmm.0.015198-0
15. Brisse S, Passet V, Haugaard AB, etc. Wzi gene sequencing, he ala wikiwiki no ka hoʻoholo ʻana i ke ʻano o Klebsiella capsule[J].J Keʻano Microbiology.2013;51(12):4073-4078.doi:10.1128/JCM.01924-13
16. Ranjbar R, Tabatabaee A, Behzadi P, etc. E. coli strains i hoʻokaʻawale ʻia mai nā ʻano fecal holoholona like ʻole, enterobacteria repetitive gene type consensus polymerase chain reaction (ERIC-PCR) genotyping [J].Iran J Pathol.2017;12(1): 25–34.doi:10.30699/ijp.2017.21506