Antimicrobial resistance and virulence of carbapenem-resistant <i>Klebsiella pneumoniae</i> strains isolated from children in intensive care and surgical units

Q3 Medicine
Irina E. Novikova, Zulfirya Z. Sadeeva, Natalya M. Alyabyeva, Ekaterina A. Samoylova, Olga V. Karaseva, Olga G. Yanyushkina, Anna V. Lazareva
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Abstract

Introduction. Infections associated with carbapenem-resistant (Carba-R) Klebsiella pneumoniae (KP) are a serious public health problem because they lead to an increase in hospital stays, treatment costs, and an increase in patient morbidity and mortality. Aim to characterize antimicrobial resistance, virulence factors and genotypes of Carba-R KP strains isolated from patients in intensive care and surgical units. Materials and methods. In total, 455 KP strains that were resistant to meropenem and/or imipenem, or susceptible to meropenem and/or imipenem at increased exposure were collected in 20182020. For further analysis, total 90 KP strains isolated from clinically significant sites blood/сerebrospinal fluid/urine/lower respiratory tract/wounds/abdominal cavity of patients in intensive care and surgical units were selected. Antibiotic susceptibility was determined using the broth microdilution method. Carbapenemase genes were detected by real-time PCR. The virulence genes and K1/K2 capsular serotypes were determined by multiplex PCR. Sequence types (ST) were determined using multilocus sequence typing. Results. Most of the selected isolates (97%) were recognized as extensively drug-resistant pathogens, three isolates were classified as multidrug-resistant pathogens. The major determinant of carbapenem resistance was blaOXA-48-like (53%), blaNDM-group was detected in 13% strains, a combination of blaNDM-group and blaOXA-48-like genes was found in 31% isolates. Two isolates harbored blaKPC-group. Most of the isolates had the virulence genes entB (100%), mrkD (99%), and ybtS (78%). The iutA gene was found in 16% strains. Four isolates had kfu gene and four strains carried rmpA gene. The K2 capsule type was determined in 13% isolates. Four ST dominated in the studied population: ST395 (26%), ST2975 (19%), ST198 (12%) and ST307 (11%). Conclusion. Carba-R KP isolates had a high level of resistance not only to carbapenems, but also to antibiotics of other classes. Carbapenem resistance was mainly associated with OXA-48 carbapenemase. The entB, mrkD and ybtS genes were the main determinants of virulence. The epidemically successful clones CG395 and CG307 were the predominant genetic lines. Resistance to antimicrobials was combined with the presence of various virulence factors. The data obtained are important for the epidemiological surveillance of the spread of KP and have important clinical implications.
耐碳青霉烯肺炎克雷伯菌的耐药性和毒力;从重症监护室和外科病房的儿童中分离出的菌株
介绍。与碳青霉烯耐药肺炎克雷伯菌(KP)相关的感染是一个严重的公共卫生问题,因为它们会导致住院时间增加、治疗费用增加以及患者发病率和死亡率增加。目的了解重症监护病房和外科病房患者分离的Carba-R KP菌株的耐药性、毒力因子和基因型。 材料和方法。2018 - 2020年共收集到455株对美罗培南和/或亚胺培南耐药,或对暴露量增加的美罗培南和/或亚胺培南敏感的KP菌株。为进一步分析,共从重症监护病房和外科病房患者的临床重要部位血液/ 脑脊液/尿液/下呼吸道/伤口/腹腔分离出90株KP菌株。采用微量肉汤稀释法测定药敏。实时荧光定量PCR检测碳青霉烯酶基因。采用多重PCR检测毒力基因和荚膜K1/K2血清型。序列类型(ST)采用多位点序列分型确定。 结果。大多数(97%)被认为是广泛耐药病原体,3株被归类为多重耐药病原体。耐药的主要决定因素是blaoxa -48样基因(53%),blandm基因组占13%,blandm基因组与blaoxa -48样基因组合占31%。两个分离株含有blaKPC-group。大多数分离株具有entB(100%)、mrkD(99%)和ybtS(78%)毒力基因。在16%的菌株中发现了iutA基因。4株菌株携带kfu基因,4株菌株携带rmpA基因。13%的菌株被确定为K2胶囊型。4个基因型在研究人群中占主导地位:ST395(26%)、ST2975(19%)、ST198(12%)和ST307(11%)。结论。Carba-R KP分离株不仅对碳青霉烯类抗生素具有较高的耐药性,而且对其他种类的抗生素也具有较高的耐药性。碳青霉烯耐药主要与OXA-48碳青霉烯酶有关。entB、mrkD和ybtS基因是毒力的主要决定因素。流行成功的无性系CG395和CG307为优势遗传系。对抗菌素的耐药性与各种毒力因子的存在相结合。获得的数据对KP传播的流行病学监测具有重要意义,并具有重要的临床意义。
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来源期刊
Zhurnal mikrobiologii, epidemiologii, i immunobiologii
Zhurnal mikrobiologii, epidemiologii, i immunobiologii Immunology and Microbiology-Immunology and Microbiology (miscellaneous)
CiteScore
1.40
自引率
0.00%
发文量
51
审稿时长
8 weeks
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