两例ST65-KL2和ST11-KL64高毒性耐碳青霉烯肺炎克雷伯菌暴发：相似性和多样性分析

IF 5.1 1区生物学 Q1 BIOLOGY

Communications Biology Pub Date : 2024-12-02 DOI:10.1038/s42003-024-07310-2

Feilong Zhang, Zhihua Li, Ziyao Li, Xinmeng Liu, Zichen Lei, Xianxia Zhuo, Xinrui Yang, Jiankang Zhao, Yulin Zhang, Binghuai Lu

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引用次数: 0

摘要

近年来，肺炎克雷伯菌高毒力和碳青霉烯类耐药性的趋同现象越来越多，然而，这些产生NDM碳青霉烯类酶的暴发病例很少。在本研究中，从两个不同的暴发病例中鉴定出ST65-KL2和ST11-KL64高毒性和碳青霉烯类耐药肺炎克雷伯菌（hvCRKP）：(1) ST65-KL2在移植病房内5例患者中克隆传播，时间长达3个月；(2) 10例患者10个月内ST11-KL64的克隆传播。ST65-KL2和ST11-KL64 hvCRKP的代表菌株K22877和K56649分别产生碳青霉烯酶NDM-5和双碳青霉烯酶KPC-2和NDM-13，均表现出高水平的碳青霉烯抗性。毒力分析表明，K22877和K56649具有强毒力，前者毒力更强。进化途径提示ST65-KL2和ST11-KL64 hvCRKP可分别归类为CR-hvKP （hvKP获得碳青霉烯烯抗性）和hv-CRKP （CRKP获得高毒力）。出乎意料的是，ST65-KL2 CR-hvKP在传播过程中表现出对质粒获取介导的环丙沙星的耐药性，ST11-KL64 hv-CRKP表现出增强的毒力和巨噬细胞耐药性。此外，与ST65-KL2的CR-hvKP相比，ST11-KL64的hv-CRKP更倾向于引起隐匿性和持续性感染。全球基因组分析显示，ST11-KL64 hv-CRKP和ST65-KL2 CR-hvKP主要携带blaKPC-2，在Ompk35/36、ybt、抗性和毒力方面存在显著差异。应实施有效的监测，并迫切需要新的治疗策略来处理难治性感染。高毒力和多药耐药肺炎克雷伯菌ST65-KL2 CR-hvKP和ST11-KL64 hv-CRKP具有很强的传播能力并导致高死亡率。耐药性和毒力进化加速了它们对人类健康的威胁。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Two outbreak cases involving ST65-KL2 and ST11-KL64 hypervirulent carbapenem-resistant Klebsiella pneumoniae: similarity and diversity analysis

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Two outbreak cases involving ST65-KL2 and ST11-KL64 hypervirulent carbapenem-resistant Klebsiella pneumoniae: similarity and diversity analysis

The rise of the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae has been increasingly reported in recent years, however, there are few outbreak cases for these producing NDM carbapenemase. In this study, ST65-KL2 and ST11-KL64 hypervirulent and carbapenem-resistant K. pneumoniae (hvCRKP) were identified from two different outbreak cases: (1) clonal spreading of ST65-KL2 in five patients within transplantation wards spanning three months; and (2) clonal transmission of ST11-KL64 in ten patients across 10 months. The representative strains of ST65-KL2 and ST11-KL64 hvCRKP, K22877 and K56649, produced carbapenemase NDM-5 and dual carbapenemases KPC-2 and NDM-13, respectively, and both exhibited high-level carbapenem resistance. Moreover, virulent analysis showed that K22877 and K56649 were hypervirulent and the former possessed stronger virulence. Evolutionary pathways suggested ST65-KL2 and ST11-KL64 hvCRKP could be classified as CR-hvKP (hvKP acquiring carbapenem resistance) and hv-CRKP (CRKP acquiring hypervirulence), respectively. Unexpectedly, ST65-KL2 CR-hvKP showed resistance to ciprofloxacin mediated by plasmid acquisition as its spread, and ST11-KL64 hv-CRKP developed into enhanced virulence and macrophage resistance. Furthermore, compared to the ST65-KL2 CR-hvKP, the ST11-KL64 hv-CRKP tends to cause occult and persistent infection. Global genome analysis revealed ST11-KL64 hv-CRKP and ST65-KL2 CR-hvKP mainly carried blaKPC-2 and had significant differences in Ompk35/36, ybt, resistance and virulence. Effective surveillance should be implemented and novel therapeutic strategies are urgently needed to deal with refractory infections. The hypervirulent and multidrug-resistant K. pneumonia ST65-KL2 CR-hvKP and ST11-KL64 hv-CRKP, pose an intense ability to disseminate and cause high mortality. Resistance and virulence evolution accelerate their threat to human health.

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来源期刊

Communications Biology Medicine-Medicine (miscellaneous)

CiteScore

8.60

自引率

1.70%

发文量

1233

审稿时长

13 weeks

期刊介绍： Communications Biology is an open access journal from Nature Research publishing high-quality research, reviews and commentary in all areas of the biological sciences. Research papers published by the journal represent significant advances bringing new biological insight to a specialized area of research.