Clinical thiab molecular yam ntxwv ntawm carbapenem-resistant Hypervi

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Clinical thiab molecular yam ntxwv ntawm carbapenem-resistant high-virulence Klebsiella pneumoniae nyob rau hauv lub tsev kho mob tertiary hauv 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 Tuam Tshoj;2 Shanghai Jiaotong Department of Laboratory Medicine, Shanghai Children's Hospital, Shanghai, Tib neeg lub koom pheej ntawm Tuam Tshoj;3 Department of 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 ntawm ChinaTel +86 18021073261 Email [email tiv thaiv] Keeb Kwm: Kev sib xyaw ntawm carbapenem tsis kam thiab hypervirulence hauv Klebsiella pneumoniae tau ua rau muaj teeb meem loj rau pej xeem kev noj qab haus huv.Nyob rau hauv xyoo tas los no, muaj ntau thiab ntau cov ntaub ntawv qhia txog carbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) cais.Cov ntaub ntawv thiab cov txheej txheem: Kev tshuaj xyuas rov qab los ntawm kev soj ntsuam cov ntaub ntawv soj ntsuam ntawm cov neeg mob uas muaj CR-hvKP txij Lub Ib Hlis 2019 txog Lub Kaum Ob Hlis 2020 hauv tsev kho mob tertiary.Xam cov Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) thiab carbapenem-resistant high-virulence pneumonia khaws tau li ntawm 2 xyoos Tus naj npawb ntawm kev sib cais ntawm Leberella (CR-hvKP).PCR nrhiav pom ntawm cov noob tiv thaiv, cov noob kab mob ntsig txog kab mob, cov noob tshuaj capsular serotypes thiab multilocus sequence typing (MLST) ntawm CR-hvKP cais.Cov txiaj ntsig: Tag nrho ntawm 1081 yam tsis rov ua dua Klebsiella pneumoniae raug cais tawm thaum txoj kev tshawb fawb., suav nrog 392 hom Klebsiella pneumoniae (36.3%), 39 hom CR-hmKP (3.6%) thiab 16 hom CR-hvKP (1.5%).Kwv yees li 31.2% (5/16) ntawm CR-hvKP yuav raug cais tawm hauv 2019, thiab kwv yees li 68.8% (11/16) ntawm CR-hvKP yuav raug cais tawm hauv 2020. Ntawm 16 CR-hvKP hom, 13 hom kab mob thiab ST. serotype K64, 1 hom yog ST11 thiab K47 serotypes, 1 hom yog ST23 thiab K1 serotypes, thiab 1 hom yog ST86 thiab K2 serotypes.Cov virulence-related genes entB, fimH, rmpA2, iutA, thiab iucA muaj nyob rau hauv tag nrho 16 CR-hvKP cais, ua raws li mrkD (n=14), rmpA (n=13), aerobactin (n=2), AllS ( n=1).Lub 16 CR-hvKP cais tag nrho cov carbapenemase gene blaKPC-2 thiab txuas ntxiv-spectrum β-lactamase noob blaSHV.Cov txiaj ntsig ntawm ERIC-PCR DNA ntiv tes qhia tau tias 16 CR-hvKP hom kab mob yog polymorphic heev, thiab cov hlua ntawm txhua hom kab mob sib txawv heev, uas qhia txog lub xeev tsis sib xws.Xaus: Txawm hais tias CR-hvKP tau muab faib ua ntu zus, nws nce zuj zus txhua xyoo.xyoo.Yog li ntawd, kev saib xyuas kev kho mob yuav tsum tau txhawb nqa, thiab kev ntsuas tsim nyog yuav tsum tau ua kom tsis txhob muaj cloning thiab kis tus kab mob superbug CR-hvKP.Hot Tags: Klebsiella pneumoniae, carbapenem tsis kam, siab virulence, siab mucus, kab mob sib kis
Klebsiella pneumoniae yog ib hom kab mob uas ua rau muaj ntau yam kab mob, xws li mob ntsws, kab mob urinary, kab mob, thiab kab mob meningitis.1 Nyob rau peb caug xyoo dhau los, tsis zoo li cov classic Klebsiella pneumoniae (cKP), tus kab mob tshiab Klebsiella pneumoniae (hvKP) hypermucosal mucus tau dhau los ua cov kab mob tseem ceeb hauv chaw kho mob, uas tuaj yeem pom muaj kab mob hnyav heev xws li daim siab ua rau mob plab. thiab immunocompromised cov neeg.2 Nws yog ib qho tsim nyog yuav tsum nco ntsoov tias cov kab mob no feem ntau nrog cov kab mob sib kis, nrog rau cov kab mob endophthalmitis thiab meningitis.3 Kev tsim cov mucosal mucosal phenotype hvKP feem ntau yog vim muaj kev tsim cov capsular polysaccharides ntau ntxiv thiab muaj cov kab mob tshwj xeeb, xws li rmpA thiab rmpA2.4.Lub siab mucus phenotype feem ntau yog txiav txim los ntawm "txoj hlua kuaj".Cov kab mob Klebsiella pneumoniae loj hlob ib hmos ntawm cov ntshav agar daim hlau yog stretched nrog ib lub voj.Thaum ib txoj hlua khov nrog qhov ntev> 5 hli raug tsim, "txoj hlua kuaj" yog qhov zoo.5 Ib txoj kev tshawb fawb tsis ntev los no tau pom tias peg-344, iroB, iucA, rmpA rmpA2 thiab rmpA2 yog biomarkers uas tuaj yeem txheeb xyuas qhov tseeb ntawm hvkp.6 Hauv txoj kev tshawb no, Klebsiella pneumoniae muaj kev phom sij heev tau raug txhais tias muaj cov hnoos qeev viscous phenotype (cov txiaj ntsig zoo ntawm txoj hlua) thiab nqa Klebsiella pneumoniae virulence plasmid ntsig txog qhov chaw (rmpA2, iutA, iucA) Hauv 1980s tshaj tawm hauv zej zog. - kis tau daim siab abscesses tshwm sim los ntawm hvKP, nrog rau qhov kawg ntawm lub cev puas tsuaj, xws li meningitis thiab endophthalmitis.7,8 hvKP muaj kev sib kis tsis zoo hauv ntau lub tebchaws hauv Asia, Europe thiab Asmeskas.Txawm hais tias ob peb kis ntawm hvKP tau tshaj tawm hauv Tebchaws Europe thiab Asmeskas, qhov tshwm sim ntawm hvKP feem ntau tshwm sim hauv cov tebchaws Esxias, tshwj xeeb tshaj yog Tuam Tshoj.9
Feem ntau, hvKP yog rhiab heev rau cov tshuaj tua kab mob, thaum carbapenem-resistant Klebsiella pneumonia (CRKP) tsis muaj tshuaj lom.Txawm li cas los xij, nrog kev sib kis ntawm cov tshuaj tiv thaiv thiab kev ua phem plasmids, CR-hvKP tau piav qhia thawj zaug los ntawm Zhang li al.nyob rau hauv 2015, thiab muaj ntau thiab ntau cov ntaub ntawv hauv tsev.10 Txij li thaum CR-hvKP tuaj yeem ua rau mob hnyav thiab nyuaj-kho-kho, yog tias tus kab mob sib kis tshwm sim, nws yuav dhau los ua "tus kab mob zoo tshaj".Txog niaj hnub no, feem ntau cov kab mob tshwm sim los ntawm CR-hvKP tau tshwm sim tsis tu ncua, thiab cov kab mob me me tsis tshua muaj.11,12 ib
Tam sim no, qhov kev kuaj pom tus nqi ntawm CR-hvKP yog qhov tsawg, thiab muaj qee qhov kev tshawb fawb ntsig txog.Lub molecular epidemiology ntawm CR-hvKP yog sib txawv nyob rau hauv txawv cheeb tsam, yog li ntawd nws yog tsim nyog los kawm txog kev faib tshuaj thiab molecular epidemiological yam ntxwv ntawm CR-hvKP nyob rau hauv cheeb tsam no.Txoj kev tshawb fawb no tau txheeb xyuas cov noob tiv thaiv kab mob, kab mob ntsig txog kab mob thiab MLST ntawm CR-hvKP.Peb tau sim tshawb xyuas qhov nthuav dav thiab kev kis kab mob molecular ntawm CR-hvKP hauv tsev kho mob tertiary hauv Shanghai, sab hnub tuaj Suav teb.Txoj kev tshawb no tseem ceeb heev rau kev nkag siab txog kev kis kab mob molecular ntawm CR-hvKP hauv Shanghai.
Cov Klebsiella pneumoniae uas tsis yog rov qab cais tawm ntawm Shanghai Fifth People's Hospital koom nrog Fudan University txij lub Ib Hlis 2019 txog Lub Kaum Ob Hlis 2020 tau rov qab los, thiab feem pua ​​​​ntawm hmKP, CRKP, CR-hmkp thiab CR-hvKP tau suav.Txhua qhov kev sib cais tau txheeb xyuas los ntawm VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Fabkis).Maldi-Tof pawg spectrometry (Bruker Daltonics, Billerica, MA, USA) tau siv los txheeb xyuas qhov txheeb xyuas cov kab mob kab mob.Lub siab mucus phenotype yog txiav txim los ntawm "string test".Thaum imipenem lossis meropenem tiv taus, carbapenem tsis kam yog txiav txim siab los ntawm kev ntsuas tshuaj tiv thaiv.Klebsiella pneumoniae muaj kab mob siab heev yog txhais tau tias muaj cov hnoos qeev phenotype (cov txiaj ntsig zoo ntawm txoj hlua) thiab nqa Klebsiella pneumoniae virulence plasmid ntsig txog qhov chaw (rmpA2, iutA, iucA)6.
Ib qho Klebsiella pneumoniae colony raug inoculated ntawm 5% yaj ntshav agar phaj.Tom qab incubating ib hmos ntawm 37 ° C, maj mam rub lub colony nrog ib tug inoculating voj thiab rov ua 3 zaug.Yog hais tias ib tug viscous kab yog tsim peb zaug thiab qhov ntev yog ntau tshaj 5 hli, "kab xeem" yog xam tau tias zoo, thiab lub hom muaj ib tug siab mucus phenotype.
Hauv VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Fabkis), cov tshuaj tiv thaiv kab mob rau ntau yam tshuaj tua kab mob tau kuaj pom los ntawm broth micro-dilution.Cov txiaj ntsig tau raug txhais raws li cov ntaub ntawv qhia tau tsim los ntawm Clinical and Laboratory Standards Institute (CLSI, 2019).E. coli ATCC 25922 thiab Klebsiella pneumoniae ATCC 700603 tau siv los ua kev tswj xyuas cov tshuaj tiv thaiv kab mob tiv thaiv kab mob.
Genomic DNA ntawm tag nrho cov Klebsiella pneumoniae cais tawm los ntawm TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, Suav).Extended-spectrum β-lactamase genes (blaCTX-M, blaSHV thiab blaTEM), carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP thiab blaOXA-48) thiab 9 tus neeg sawv cev muaj feem cuam tshuam cov noob, suav nrog pLVPK Plasmid-zoo li loci (txhua tus, , mrkD, entB, iutA, rmpA, rmpA2, iucA, thiab aerobactin) tau nthuav dav los ntawm PCR raws li tau piav qhia dhau los.13,14 Capsular serotype-specific genes (K1, K2, K5, K20, K54, thiab K57) tau nthuav dav los ntawm PCR raws li tau piav qhia saum toj no.14 Yog hais tias tsis zoo, ua kom nrov nrov thiab ua raws cov wzi locus los txiav txim siab cov noob caj noob ces serotype.15 Cov primers siv nyob rau hauv txoj kev tshawb no yog teev nyob rau hauv Table S1.Cov khoom PCR zoo tau ua raws li NextSeq 500 sequencing platform (Illumina, San Diego, CA, USA).Sib piv nucleotide sequences los ntawm kev khiav BLAST ntawm NCBI lub vev xaib (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Kev ntaus ntawv ntau qhov chaw (MLST) tau ua raws li tau piav qhia hauv Pasteur Institute MLST lub vev xaib (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Xya lub tsev tu noob gapA, infB, mdh, pgi, phoE, rpoB thiab tonB tau nthuav dav los ntawm PCR thiab ua ntu zus.Hom kab ke (ST) yog txiav txim siab los ntawm kev sib piv cov txiaj ntsig ua ke nrog MLST database.
Homology ntawm Klebsiella pneumoniae tau txheeb xyuas.Klebsiella pneumoniae genomic DNA tau muab rho tawm los ua tus qauv, thiab ERIC primers tau qhia hauv Table S1.PCR txhawb nqa genomic DNA thiab tsim cov ntiv tes ntawm genomic DNA.16 PCR cov khoom raug kuaj pom los ntawm 2% agarose gel electrophoresis.DNA ntiv tes tau txheeb xyuas siv QuantityOne software band lees paub, thiab kev tshuaj ntsuam caj ces tau ua los ntawm kev siv cov kev sib koom ua ke tsis hnyav (UPGMA) ntawm cov lej lej.Cov kev sib cais uas zoo sib xws> 75% raug suav tias yog tib hom genotype, thiab cov uas muaj qhov sib xws <75% suav tias yog cov genotypes sib txawv.
Siv statistical software pob SPSS rau Windows 22.0 los tshuaj xyuas cov ntaub ntawv.Cov ntaub ntawv tau piav raws li txhais tau tias ± tus qauv sib txawv (SD).Categorical variables raug soj ntsuam los ntawm chi-square test los yog Fisher qhov tseeb.Tag nrho cov kev xeem txheeb cais yog 2-tailed, thiab tus nqi P ntawm <0.05 yog suav tias yog qhov tseem ceeb.
Shanghai Fifth People's Hospital koom nrog Fudan University tau sau 1081 Klebsiella pneumoniae cais tawm txij lub Ib Hlis 1, 2019 txog rau Lub Kaum Ob Hlis 31, 2020, thiab tsis suav cov kev cais tawm ntawm tib tus neeg mob.Ntawm lawv, 392 hom (36.3%) yog hmKP, 341 hom (31.5%) yog CRKP, 39 hom (3.6%) yog CR-hmKP, thiab 16 hom (1.5%) yog CR-hvKP.Nws yog tsim nyog sau cia tias 33.3% (13/39) ntawm CR-hmKP thiab 31.2% (5/16) ntawm CR-hvKP yog los ntawm 2019, 66.7% (26/39) ntawm CR-hmKP thiab 68.8% (11/16). ) CR-hvKP raug cais tawm xyoo 2020. Los ntawm cov hnoos qeev (17 hom), zis (12 hom), kua dej (4 hom), ntshav (2 hom), kua paug (2 hom), kua tsib (1 cais tawm) thiab pleural effusion (1 cais), raws.Kaum rau hom CR-hvKP tau zoo los ntawm cov hnoos qeev (9 cais), tso zis (5 cais), ntshav (1 cais tawm) thiab pleural effusion (1 cais).
Los ntawm kev txheeb xyuas tus kab mob, kev sim tshuaj rhiab heev, kuaj kab thiab kuaj kab mob ntsig txog noob, 16 hom kab mob CR-hvKP raug tshuaj xyuas.Cov yam ntxwv kho mob ntawm 16 tus neeg mob kis tus kab mob CR-hvKP cais tawm yog sau tseg hauv Table 1. 13 ntawm 16 tus neeg mob (81.3%) yog txiv neej, thiab tag nrho cov neeg mob laus dua 62 xyoo (qhov nruab nrab hnub nyoog: 83.1 ± 10.5 xyoo).Lawv tuaj ntawm 8 pawg ntseeg, thiab ntau dua ib nrab tuaj ntawm lub hauv paus ICU (9 kis).Cov kab mob tseem ceeb muaj xws li kab mob cerebrovascular (75%, 12/16), kub siab (50%, 8/16), kab mob obstructive pulmonary (50%, 8/16), thiab lwm yam. Invasive phais muaj xws li cov tshuab ua pa (62.5%, 10/ 16), urinary catheter (37.5%, 6/16), gastric tube (18.8%, 3/16), phais (12.5%, 2/16) thiab intravenous catheter (6.3%, 1/16).Cuaj ntawm 16 tus neeg mob tuag, thiab 7 tus neeg mob tau zoo tuaj thiab raug tso tawm.
39 CR-hmKP cais tawm tau muab faib ua ob pawg raws li qhov ntev ntawm txoj hlua nplaum.Ntawm lawv, 20 CR-hmKP cais nrog cov hlua khi ntev ≤ 25 mm tau muab faib ua ib pawg, thiab 19 CR-hmKP cais nrog cov hlua khi ntev> 25 mm tau muab faib ua lwm pawg.PCR txoj kev kuaj pom tus nqi zoo ntawm cov kab mob ntsig txog kab mob rmpA, rmpA2, iutA thiab iucA.Cov txiaj ntsig zoo ntawm CR-hmKP virulence-related genes nyob rau hauv ob pawg yog qhia hauv Table 2. Tsis muaj qhov sib txawv ntawm qhov zoo ntawm CR-hmKP virulence-related genes ntawm ob pawg.
Table 3 teev cov ncauj lus kom ntxaws txog tshuaj tiv thaiv kab mob ntawm cov tshuaj 16.16 CR-hvKP cais tawm tau pom ntau yam tshuaj tiv thaiv.Txhua qhov kev sib cais tau raug kho nrog ampicillin, ampicillin / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, thiab meropenem yog resistant.Trimethoprim-sulfamethoxazole muaj qhov tsis kam qis tshaj (43.8%), tom qab ntawd amikacin (62.5%), gentamicin (68.8%) thiab ciprofloxacin (87.5%).
Kev faib tawm ntawm cov kab mob ntsig txog kab mob, cov tshuaj tiv thaiv kab mob tiv thaiv kab mob, cov noob caj noob ces thiab MLST ntawm 16 CR-hvKP cais tawm yog qhia hauv daim duab 1. Cov txiaj ntsig ntawm agarose gel electrophoresis ntawm qee cov noob kab mob ntsig txog kab mob, cov tshuaj tiv thaiv kab mob tiv thaiv kab mob yog cov noob thiab caps qhia hauv daim duab 1. Daim duab 2. Kev tshuaj xyuas MLST qhia tag nrho 3 STs, ST11 yog qhov tseem ceeb tshaj plaws ST (87.5%, 14/16), ua raws li ST23 (6.25%, 1/16) thiab ST86 (6.25%, 1. /16).Raws li cov txiaj ntsig ntawm wzi typing, 4 txawv capsular serotypes tau txheeb xyuas (Daim duab 1).Ntawm 16 carbapenem-resistant hvKP cais, K64 yog cov serotype ntau tshaj plaws (n=13), ua raws li K1 (n=1), K2 (n=1) thiab K47 (n=1).Tsis tas li ntawd, capsular serotype K1 strain yog ST23, capsular serotype K2 strain yog ST86, thiab seem 13 hom K64 thiab 1 hom K47 yog tag nrho ST11.Cov txiaj ntsig zoo ntawm 9 cov noob kab mob hauv 16 CR-hvKP cais tawm tau pom hauv daim duab 1. , Cov kab mob ntsig txog kab mob entB, fimH, rmpA2, iutA, thiab iucA muaj nyob hauv 16 CR-hvKP hom, ua raws li mrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n = 1).Lub 16 CR-hvKP cais tag nrho cov carbapenemase gene blaKPC-2 thiab txuas ntxiv-spectrum β-lactamase noob blaSHV.16 CR-hvKP cais tsis tau nqa carbapenem noob blaNDM, blaVIM, blaIMP, blaOXA-48 thiab txuas ntxiv-spectrum β-lactamase noob blaTEM, blaCTX-M-2 pawg, thiab pawg blaCTX-M-8.Ntawm 16 CR-hvKP hom kab mob, 5 hom kab mob tau nqa cov kab mob txuas ntxiv-spectrum β-lactamase gene blaCTX-M-1 pawg, thiab 6 hom kab mob nqa cov kab txuas ntxiv-spectrum β-lactamase noob blaCTX-M-9 pawg.
Daim duab 1 Cov noob kab mob ntsig txog kab mob, cov tshuaj tiv thaiv kab mob tiv thaiv kab mob, cov noob tshuaj capsular serotype thiab MLST ntawm 16 CR-hvKP cais tawm.
Daim duab 2 Agarose gel electrophoresis ntawm qee yam kab mob ntsig txog cov noob, cov tshuaj tiv thaiv kab mob tiv thaiv kab mob thiab cov tshuaj capsular serotype noob.
Lus Cim: 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, tag nrho S (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR tau siv los txheeb xyuas homology ntawm 16 CR-hvKP cais.Tom qab PCR amplification thiab agarose gel electrophoresis, muaj 3-9 DNA fragments.Cov txiaj ntsig ntawm cov ntiv tes tau pom tias 16 CR-hvKP cais tawm yog cov polymorphic heev, thiab muaj qhov sib txawv pom tseeb ntawm cov kev sib cais (Daim duab 3).
Nyob rau hauv xyoo tas los no, muaj ntau thiab ntau cov lus ceeb toom ntawm CR-hvKP cais.Cov tsos mob ntawm CR-hvKP cais tawm ua rau muaj kev hem thawj loj rau pej xeem kev noj qab haus huv vim tias lawv tuaj yeem ua rau mob hnyav, nyuaj rau kev kho mob rau cov neeg noj qab haus huv.Nyob rau hauv txoj kev tshawb no, qhov nthuav dav thiab molecular epidemiological yam ntxwv ntawm CR-hvKP nyob rau hauv ib lub tsev kho mob tertiary hauv Shanghai los ntawm 2019 txog 2020 tau kawm los ntsuam xyuas seb puas muaj kev pheej hmoo ntawm CR-hvKP tshwm sim thiab nws txoj kev loj hlob nyob rau hauv cheeb tsam no.Nyob rau tib lub sijhawm, txoj kev tshawb fawb no tuaj yeem muab kev ntsuam xyuas ntau dua ntawm kev kuaj mob kis kab mob, uas yog qhov tseem ceeb rau kev tiv thaiv kev sib kis ntxiv ntawm cov kev sib cais.
Txoj kev tshawb no rov qab txheeb xyuas qhov kev faib tawm thiab cov qauv ntawm CR-hvKP los ntawm 2019 txog 2020. Los ntawm 2019 txog 2020, CR-hvKP cais tawm tau pom tias muaj kev nce ntxiv.Kwv yees li ntawm 31.2% (5/16) ntawm CR-hvKP raug cais tawm hauv 2019, thiab 68.8% (11/16) ntawm CR-hvKP raug cais tawm hauv 2020, uas zoo ib yam nrog kev nce siab ntawm CR-hvKP qhia hauv cov ntaub ntawv.Raws li Zhang et al.thawj zaug tau piav qhia txog CR-hvKP hauv xyoo 2015, 10 ntau thiab ntau dua CR-hvKP cov ntaub ntawv tau tshaj tawm, 17-20 feem ntau nyob hauv thaj av Asia-Pacific, tshwj xeeb hauv Suav teb.CR-hvKP yog cov kab mob super nrog super virulence thiab ntau yam tshuaj tiv thaiv.Nws muaj kev phom sij rau tib neeg txoj kev noj qab haus huv thiab muaj kev tuag ntau.Yog li ntawd, yuav tsum tau saib xyuas thiab ntsuas yuav tsum tau coj los tiv thaiv nws txoj kev sib kis.
Cov tshuaj tua kab mob tiv thaiv kab mob ntawm 16 CR-hvKP cais tawm tau pom tias muaj cov tshuaj tua kab mob siab heev.Txhua qhov kev sib cais tau raug kho nrog ampicillin, ampicillin / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, thiab meropenem yog resistant.Trimethoprim-sulfamethoxazole muaj qhov tsis kam qis tshaj (43.8%), tom qab ntawd amikacin (62.5%), gentamicin (68.8%) thiab ciprofloxacin (87.5%).Qhov kev tawm tsam ntawm CR-hmkp kawm los ntawm Lingling Zhan thiab lwm tus zoo ib yam li txoj kev tshawb no [12].Cov neeg mob uas muaj tus kab mob CR-hvKP muaj ntau yam kab mob yooj yim, tiv thaiv kab mob tsawg, thiab muaj peev xwm ua kom tsis muaj menyuam tsis muaj zog.Yog li ntawd, kev kho mob raws sij hawm raws li cov txiaj ntsig ntawm cov tshuaj tiv thaiv kab mob rhiab heev yog qhov tseem ceeb heev.Yog tias tsim nyog, qhov chaw muaj kab mob tuaj yeem nrhiav tau thiab kho tau los ntawm kev tso dej, debridement thiab lwm txoj hauv kev.
39 CR-hmKP cais tawm tau muab faib ua ob pawg raws li qhov ntev ntawm txoj hlua nplaum.Ntawm lawv, 20 CR-hmKP cais nrog cov hlua khi ntev ≤ 25 mm tau muab faib ua ib pawg, thiab 19 CR-hmKP cais nrog cov hlua khi ntev> 25 mm tau muab faib ua lwm pawg.Sib piv cov txiaj ntsig zoo ntawm CR-hmKP virulence-related genes ntawm ob pawg, tsis muaj qhov sib txawv tseem ceeb hauv cov txiaj ntsig zoo ntawm virulence noob ntawm ob pawg.Kev tshawb fawb los ntawm Lin Ze et al.pom tau hais tias qhov zoo ntawm cov kab mob virulence noob ntawm Klebsiella pneumoniae tau nce siab dua li ntawm classic Klebsiella pneumoniae.21 Txawm li cas los xij, seb qhov txiaj ntsig zoo ntawm cov noob caj noob ces muaj kev cuam tshuam zoo nrog qhov ntev ntawm cov hlua nplaum tseem tsis paub meej.Lwm cov kev tshawb fawb tau pom tias cov classic Klebsiella pneumoniae kuj yog ib qho mob hnyav heev Klebsiella pneumoniae, nrog rau cov txiaj ntsig zoo ntawm cov noob caj noob ces.22 Txoj kev tshawb no pom tau hais tias tus kab mob virulence gene zoo npaum li cas ntawm CR-hmKP tsis zoo correlated nrog qhov ntev ntawm cov hnoos qeev.Txoj hlua (lossis tsis nce nrog qhov ntev ntawm txoj hlua nplaum).
ERIC PCR ntiv tes ntawm txoj kev tshawb no yog polymorphic, thiab tsis muaj qhov chaw kho mob crossover ntawm cov neeg mob, yog li 16 tus neeg mob uas muaj tus kab mob CR-hvKP yog qhov sib txawv.Yav dhau los, feem ntau cov kab mob tshwm sim los ntawm CR-hvKP tau tshaj tawm tias muaj kev sib cais lossis tsis sib xws, 23,24 thiab kis mob me me ntawm CR-hvKP tsis tshua muaj nyob hauv cov ntaub ntawv.11,25 ST11 yog feem ntau ST11 hauv CRKP thiab CR-hvKP cais tawm hauv Suav teb.26,27 Txawm hais tias ST11 CR-hvKP suav txog 87.5% (14/16) ntawm 16 CR-hvKP cais tawm hauv txoj kev tshawb no, nws tsis tuaj yeem xav tias 14 ST11 CR-hvKP hom yog los ntawm tib lub clone, yog li ERIC PCR ntiv tes. yog yuav tsum tau.Homology tsom xam.
Nyob rau hauv txoj kev tshawb no, tag nrho 16 tus neeg mob kis tus kab mob CR-hvKP tau txais kev phais mob.Raws li cov lus ceeb toom, qhov kev tuag ntawm lub tshuab ua pa uas cuam tshuam nrog mob ntsws los ntawm CR-hvKP11 qhia tias cov txheej txheem cuam tshuam tuaj yeem ua rau muaj kev pheej hmoo ntawm CR-hvKP kab mob.Nyob rau tib lub sijhawm, 16 tus neeg mob kis tus kabmob CR-hvKP muaj cov kab mob hauv qab, ntawm cov kab mob cerebrovascular yog qhov tshwm sim ntau tshaj.Ib txoj kev tshawb fawb yav dhau los tau pom tias kab mob cerebrovascular yog ib qho tseem ceeb ntawm kev pheej hmoo rau tus kab mob CR-hvKP.28 Yog vim li cas rau qhov tshwm sim no tej zaum yuav tsis muaj zog tiv thaiv ntawm cov neeg mob uas muaj kab mob cerebrovascular, cov kab mob pathogenic tsis tuaj yeem raug cais tawm ntawm nws tus kheej, thiab tsuas yog lawv cov kab mob bactericidal nkaus xwb.Cov tshuaj tua kab mob yuav ua rau muaj kev sib xyaw ntawm ntau cov tshuaj tiv thaiv thiab hypervirulence nyob rau lub sijhawm ntev.Ntawm 16 tus neeg mob, 9 tus neeg tuag, thiab cov neeg tuag yog 56.3% (9/16).Cov neeg tuag tau siab dua 10,12 hauv kev tshawb fawb yav dhau los, thiab qis dua 11,21 qhia hauv cov kev tshawb fawb dhau los.Qhov nruab nrab hnub nyoog ntawm 16 tus neeg mob yog 83.1 ± 10.5 xyoo, qhia tias cov neeg laus muaj kev cuam tshuam ntau dua rau CR-hvKP.Cov kev tshawb fawb yav dhau los tau pom tias cov tub ntxhais hluas muaj kev kis kab mob ntau dua.Tus kab mob ntawm Klebsiella pneumoniae.29 Txawm li cas los xij, lwm cov kev tshawb fawb tau pom tias cov neeg laus muaj kev phom sij rau Klebsiella pneumoniae24,28.Qhov kev tshawb fawb no zoo ib yam li qhov no.
Ntawm 16 CR-hvKP hom, tshwj tsis yog rau ib qho ST23 CR-hvKP thiab ib qho ST86 CR-hvKP, lwm 14 hom yog tag nrho ST11 CR-hvKP.Lub capsular serotype sib raug rau ST23 CR-hvKP yog K1, thiab cov capsular serotype ntawm ST86 CR-HVKP yog K2, zoo ib yam li cov kev tshawb fawb yav dhau los.30-32 Cov neeg mob uas muaj tus kab mob ST23 (K1) CR-hvKP lossis ST86 (K2) CR-hvKP tau tuag, thiab cov neeg tuag (100%) tau ntau dua li cov neeg mob ST11 CR-hvKP (50%).Raws li pom nyob rau hauv daim duab 1, qhov zoo ntawm ST23 (K1) lossis ST86 (K2) hom kab mob ntsig txog kab mob yog siab dua li ntawm ST11 (K64) hom.Qhov kev tuag yuav muaj feem cuam tshuam rau qhov zoo ntawm cov noob caj noob ces.Nyob rau hauv txoj kev tshawb no, 16 hom ntawm CR-hvKP tag nrho cov carbapenemase gene blaKPC-2 thiab cov ncua-spectrum β-lactamase noob blaSHV.blaKPC-2 yog cov noob carbapenemase ntau tshaj plaws hauv CR-hvKP hauv Suav teb.33 Hauv kev tshawb fawb ntawm Zhao li al., 25blaSHV yog qhov txuas ntxiv-spectrum β-lactamase noob uas muaj qhov zoo tshaj plaws.Cov virulence genes entB, fimH, rmpA2, iutA, thiab iucA muaj nyob rau hauv tag nrho 16 CR-hvKP cais, ua raws li mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), uas zoo ib yam li kev kawm yav dhau los.34 Qee cov kev tshawb fawb tau pom tias rmpA thiab rmpA2 (modulators ntawm mucus phenotypes genes) tuaj yeem txhawb kev tso tawm ntawm capsular polysaccharides, ua rau hypermucoid phenotypes thiab nce virulence.35 Aerobacterins yog encoded los ntawm iucABCD gene, thiab lawv homologous receptors yog encoded los ntawm iutA gene, yog li ntawd lawv muaj ib tug ntau dua ntawm virulence nyob rau hauv qhov kev ntsuam xyuas kab mob G. mellonella.allS yog tus cim ntawm K1-ST23, tsis yog nyob rau hauv pLVPK, pLVPK yog ib qho plasmid virulence los ntawm K2 super virulence hom.allS yog HTH hom transcription activator.Cov noob kab mob virulence no paub tias yuav ua rau muaj kev phom sij thiab muaj lub luag haujlwm rau kev ua liaj ua teb, ntxeem tau thiab pathogenicity.36
Txoj kev tshawb no piav qhia txog kev nthuav dav thiab kab mob molecular ntawm CR-hvKP hauv Shanghai, Suav.Txawm hais tias tus kab mob tshwm sim los ntawm CR-hvKP tsis tshua muaj tshwm sim, nws nce zuj zus txhua xyoo.Cov txiaj ntsig txhawb kev tshawb fawb yav dhau los thiab qhia tias ST11 CR-hvKP yog qhov nrov tshaj plaws CR-hvKP hauv Suav teb.ST23 thiab ST86 CR-hvKP tau pom tias muaj kev ua phem ntau dua li ST11 CR-hvKP, txawm hais tias lawv yog ob qho tib si muaj kab mob Klebsiella pneumoniae.Raws li feem pua ​​​​ntawm cov kab mob Klebsiella pneumoniae tau nce siab, qhov kev tiv thaiv ntawm Klebsiella pneumoniae yuav txo qis, uas yuav ua rau qhov muag tsis pom kev zoo hauv kev kho mob.Yog li ntawd, nws yog ib qho tsim nyog los kawm txog kev ua phem thiab tshuaj tiv thaiv ntawm Klebsiella pneumoniae.
Txoj kev tshawb no tau pom zoo los ntawm Pawg Neeg Saib Xyuas Kev Noj Qab Haus Huv ntawm Shanghai Fifth People's Hospital (No. 104, 2020).Cov qauv kuaj mob yog ib feem ntawm cov txheej txheem kuaj hauv tsev kho mob niaj hnub.
Ua tsaug rau txhua tus neeg ua haujlwm ntawm Central Laboratory ntawm Shanghai Fifth People's Hospital rau kev muab kev cob qhia rau kev kawm no.
Txoj haujlwm no tau txais kev txhawb nqa los ntawm Natural Science Foundation ntawm Minhang District, Shanghai (tus naj npawb pom zoo: 2020MHZ039).
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