Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai, China.
Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai, China.
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在中国上海的一家综合医院中出现和建立KPC-2产生的ST11 klebsiella肺炎。
DOI：
10.1007/s10096-017-3131-4
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发表时间：
2018-03
期刊：
影响因子：
--
通讯作者：
Shen L
中科院分区：
文献类型：
--
作者：
Liu J;Yu J;Chen F;Yu J;Simner P;Tamma P;Liu Y;Shen L
本研究的目的是调查在中国教学医院爆发期间收集的碳青霉烯类耐药肺炎克雷伯菌（CRKP）的特征，并为医院感染的预防和控制提供见解。我们从2009年至2013年收集了独特的CRKP临床分离株。通过聚合酶链反应（PCR）和测序鉴定抗生素耐药基因。采用脉冲场凝胶电泳（PFGE）和多位点序列分型（MLST）对分离株进行分型。使用基于PCR的不相容性/复制子分型方法和复制子序列分型方法对质粒进行分类。进行接合实验以评估碳青霉烯类耐药基因的可转移性。全基因组测序（WGS）进行进一步调查的菌株的遗传背景。在整个研究期间审查了感染控制实践。肺炎克雷伯菌序列型（ST）11出现于2010年，并在2011年获得bla KPC-2基因。2011年至2013年，ST 11 KPC-2型CRKP（G型）在我院流行，是最常见的CRKP，造成了长期暴发。这些CRKP菌株中的大多数具有IncPII质粒，其中Tn 1721-bla KPC-2-Δ Tn 3-IS 26具有bla KPC-2的遗传结构。当时可用的感染预防控制措施控制了最初的爆发，但对后来的CRKP传播没有影响。本研究证实了产KPC-2的ST 11 CRKP在中国医院传播的严重性，表明目前对碳青霉烯类耐药肠杆菌科（CRE）医院感染的预防和控制策略需要调查和调整。本文的在线版本（10.1007/s10096-017-3131-4）包含补充材料，可供授权用户使用。
The aim of this study was to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) collected during an outbreak in a Chinese teaching hospital and to provide insights into the prevention and control of nosocomial infection. We collected unique CRKP clinical isolates from 2009 to 2013. Antibiotic-resistant genes were identified by polymerase chain reaction (PCR) and sequencing. The isolates were typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmids were classified using a PCR-based incompatibility/replicon typing method and a replicon sequence typing method. Conjugation experiments were performed to evaluate the transferability of carbapenem-resistant genes. Whole genome sequencing (WGS) was conducted to further investigate the genetic background of the isolates. Infection control practices were reviewed throughout the study period. Klebsiella pneumoniae sequence type (ST) 11 emerged in 2010 and acquired the bla KPC-2 gene by 2011. From 2011 to 2013, ST11 KPC-2-producing CRKP (G type) prevailed as the most common CRKP in our hospital, causing a prolonged outbreak. The majority of these CRKP strains possess an IncFII plasmid, with Tn1721-bla KPC-2-ΔTn3-IS26 bearing the genetic structure for bla KPC-2. Infection prevention control measures available at the time contained the initial outbreak, but had no effect on the spread of CRKP later. This study demonstrated the seriousness concerning the spread of KPC-2-producing ST11 CRKP in a Chinese hospital, indicating that current prevention and control strategies for carbapenem-resistant Enterobacteriaceae (CRE) nosocomial infection need to be investigated and adjusted. The online version of this article (10.1007/s10096-017-3131-4) contains supplementary material, which is available to authorized users.
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