{"title":"重症监护室耐碳青霉烯类肺炎克雷伯菌的毒力基因分布和分子流行病学特征。","authors":"Yaxuan Huang, Yihan Cai, Wanxia He, Liyan Zhang, Yue Zhao","doi":"10.11817/j.issn.1672-7347.2024.240029","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The drug-resistant genes carried by carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) limit clinical treatment options, and its virulence genes severely affect patient prognosis. This study aims to investigate the distribution of virulence genes, capsular serotypes, and molecular epidemiological characteristics of CRKP in ICU, to understand the characteristics of CRKP infections in ICU, and to provide a scientific basis for effective monitoring and control of CRKP infections in ICU.</p><p><strong>Methods: </strong>A total of 40 non-duplicate strains of CRKP isolated from the ICU of Guangdong Provincial People's Hospital between January 2021 and December 2022 were collected and analyzed. Whole-genome sequencing was used to analyze the distribution of resistance genes, virulence genes, and capsular serotypes of the strains. The sequences of 7 housekeeping genes of CRKP genome were uploaded to the <i>Klebsiella pneumoniae</i> (KPN)multilocus sequence typing (MLST) database to determine the sequence types (STs) of the strains.</p><p><strong>Results: </strong>The age of the 40 ICU CRKP-infected patients was (69.03±17.82) years old, with various underlying diseases, and there were 20 patients with improved clinical outcome and 20 patients with death. The isolated strains primarily originated from mid-stream urine and bronchoalveolar lavage fluid. Whole-genome sequencing results revealed that the strains predominantly carried <i>bla</i><sub>KPC-1</sub> (29 strains, 72.5%) and <i>bla</i><sub>NDM-1</sub> (6 strains, 15.0%), with 5 strains carrying both <i>bla</i><sub>KPC-1</sub> and <i>bla</i><sub>NDM-1</sub>. Various virulence genes were detected, among which the carriage rates of genes such as <i>entA</i>, <i>entB</i>, <i>entE</i>, <i>entS</i>, <i>fepA</i>, <i>fepC</i>, <i>fepG</i>, <i>yag</i>/<i>ecp</i>, and <i>ompA</i> reached 100%, while the carriage rates of genes such as <i>entD</i>, <i>fimB</i>, <i>iroB</i>, <i>iroD</i>, <i>fes</i>,and <i>pla</i> were low. The CRKP strains isolated from ICU were predominantly ST11 (27 cases, 67.5%), with KL64 being the main capsular serotype (29 cases, 72.5%). A total of 23 ST11-KL64 CRKP strains were detected, accounting for 57.5%.</p><p><strong>Conclusions: </strong>The main type of ICU CRKP is ST11-KL64, carrying various virulence genes, primarily those related to iron absorption. Furthermore, <i>bla</i><sub>KPC</sub> has shifted from <i>bla</i><sub>KPC-2</sub> to <i>bla</i><sub>KPC-1</sub>. Therefore, close monitoring of the molecular epidemiological changes of CRKP is necessary, and strict control measures should be implemented to effectively curb the occurrence of CRKP infections.</p>","PeriodicalId":39801,"journal":{"name":"中南大学学报(医学版)","volume":"49 5","pages":"730-736"},"PeriodicalIF":0.0000,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341222/pdf/","citationCount":"0","resultStr":"{\"title\":\"Virulence gene distribution and molecular epidemiological characteristics of carbapenem-resistant <i>Klebsiella pneumoniae</i> in the ICU.\",\"authors\":\"Yaxuan Huang, Yihan Cai, Wanxia He, Liyan Zhang, Yue Zhao\",\"doi\":\"10.11817/j.issn.1672-7347.2024.240029\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The drug-resistant genes carried by carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) limit clinical treatment options, and its virulence genes severely affect patient prognosis. This study aims to investigate the distribution of virulence genes, capsular serotypes, and molecular epidemiological characteristics of CRKP in ICU, to understand the characteristics of CRKP infections in ICU, and to provide a scientific basis for effective monitoring and control of CRKP infections in ICU.</p><p><strong>Methods: </strong>A total of 40 non-duplicate strains of CRKP isolated from the ICU of Guangdong Provincial People's Hospital between January 2021 and December 2022 were collected and analyzed. Whole-genome sequencing was used to analyze the distribution of resistance genes, virulence genes, and capsular serotypes of the strains. The sequences of 7 housekeeping genes of CRKP genome were uploaded to the <i>Klebsiella pneumoniae</i> (KPN)multilocus sequence typing (MLST) database to determine the sequence types (STs) of the strains.</p><p><strong>Results: </strong>The age of the 40 ICU CRKP-infected patients was (69.03±17.82) years old, with various underlying diseases, and there were 20 patients with improved clinical outcome and 20 patients with death. The isolated strains primarily originated from mid-stream urine and bronchoalveolar lavage fluid. Whole-genome sequencing results revealed that the strains predominantly carried <i>bla</i><sub>KPC-1</sub> (29 strains, 72.5%) and <i>bla</i><sub>NDM-1</sub> (6 strains, 15.0%), with 5 strains carrying both <i>bla</i><sub>KPC-1</sub> and <i>bla</i><sub>NDM-1</sub>. Various virulence genes were detected, among which the carriage rates of genes such as <i>entA</i>, <i>entB</i>, <i>entE</i>, <i>entS</i>, <i>fepA</i>, <i>fepC</i>, <i>fepG</i>, <i>yag</i>/<i>ecp</i>, and <i>ompA</i> reached 100%, while the carriage rates of genes such as <i>entD</i>, <i>fimB</i>, <i>iroB</i>, <i>iroD</i>, <i>fes</i>,and <i>pla</i> were low. The CRKP strains isolated from ICU were predominantly ST11 (27 cases, 67.5%), with KL64 being the main capsular serotype (29 cases, 72.5%). A total of 23 ST11-KL64 CRKP strains were detected, accounting for 57.5%.</p><p><strong>Conclusions: </strong>The main type of ICU CRKP is ST11-KL64, carrying various virulence genes, primarily those related to iron absorption. Furthermore, <i>bla</i><sub>KPC</sub> has shifted from <i>bla</i><sub>KPC-2</sub> to <i>bla</i><sub>KPC-1</sub>. Therefore, close monitoring of the molecular epidemiological changes of CRKP is necessary, and strict control measures should be implemented to effectively curb the occurrence of CRKP infections.</p>\",\"PeriodicalId\":39801,\"journal\":{\"name\":\"中南大学学报(医学版)\",\"volume\":\"49 5\",\"pages\":\"730-736\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-05-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341222/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"中南大学学报(医学版)\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.11817/j.issn.1672-7347.2024.240029\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"中南大学学报(医学版)","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.11817/j.issn.1672-7347.2024.240029","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Virulence gene distribution and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae in the ICU.
Objectives: The drug-resistant genes carried by carbapenem-resistant Klebsiella pneumoniae (CRKP) limit clinical treatment options, and its virulence genes severely affect patient prognosis. This study aims to investigate the distribution of virulence genes, capsular serotypes, and molecular epidemiological characteristics of CRKP in ICU, to understand the characteristics of CRKP infections in ICU, and to provide a scientific basis for effective monitoring and control of CRKP infections in ICU.
Methods: A total of 40 non-duplicate strains of CRKP isolated from the ICU of Guangdong Provincial People's Hospital between January 2021 and December 2022 were collected and analyzed. Whole-genome sequencing was used to analyze the distribution of resistance genes, virulence genes, and capsular serotypes of the strains. The sequences of 7 housekeeping genes of CRKP genome were uploaded to the Klebsiella pneumoniae (KPN)multilocus sequence typing (MLST) database to determine the sequence types (STs) of the strains.
Results: The age of the 40 ICU CRKP-infected patients was (69.03±17.82) years old, with various underlying diseases, and there were 20 patients with improved clinical outcome and 20 patients with death. The isolated strains primarily originated from mid-stream urine and bronchoalveolar lavage fluid. Whole-genome sequencing results revealed that the strains predominantly carried blaKPC-1 (29 strains, 72.5%) and blaNDM-1 (6 strains, 15.0%), with 5 strains carrying both blaKPC-1 and blaNDM-1. Various virulence genes were detected, among which the carriage rates of genes such as entA, entB, entE, entS, fepA, fepC, fepG, yag/ecp, and ompA reached 100%, while the carriage rates of genes such as entD, fimB, iroB, iroD, fes,and pla were low. The CRKP strains isolated from ICU were predominantly ST11 (27 cases, 67.5%), with KL64 being the main capsular serotype (29 cases, 72.5%). A total of 23 ST11-KL64 CRKP strains were detected, accounting for 57.5%.
Conclusions: The main type of ICU CRKP is ST11-KL64, carrying various virulence genes, primarily those related to iron absorption. Furthermore, blaKPC has shifted from blaKPC-2 to blaKPC-1. Therefore, close monitoring of the molecular epidemiological changes of CRKP is necessary, and strict control measures should be implemented to effectively curb the occurrence of CRKP infections.
期刊介绍：
Journal of Central South University (Medical Sciences), founded in 1958, is a comprehensive academic journal of medicine and health sponsored by the Ministry of Education and Central South University. The journal has been included in many important databases and authoritative abstract journals at home and abroad, such as the American Medline, Pubmed and its Index Medicus (IM), the Netherlands Medical Abstracts (EM), the American Chemical Abstracts (CA), the WHO Western Pacific Region Medical Index (WPRIM), and the Chinese Science Citation Database (Core Database) (CSCD); it is a statistical source journal of Chinese scientific and technological papers, a Chinese core journal, and a "double-effect" journal of the Chinese Journal Matrix; it is the "2nd, 3rd, and 4th China University Excellent Science and Technology Journal", "2008 China Excellent Science and Technology Journal", "RCCSE China Authoritative Academic Journal (A+)" and Hunan Province's "Top Ten Science and Technology Journals". The purpose of the journal is to reflect the new achievements, new technologies, and new experiences in medical research, medical treatment, and teaching, report new medical trends at home and abroad, promote academic exchanges, improve academic standards, and promote scientific and technological progress.
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