Clinical Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Among Pediatric Patients in Jiangsu Province, China
Clinical Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Among Pediatric Patients in Jiangsu Province, China
复制标题
江苏省儿童肺炎克雷伯菌对碳青霉烯类耐药的临床分子流行病学
DOI：
10.2147/idr.s293206
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发表时间：
2020-12-22
影响因子：
3.9
通讯作者：
Gu B
中科院分区：
文献类型：
--
作者：
Kong Z;Liu X;Li C;Cheng S;Xu F;Gu B
碳青霉烯类耐药肺炎克雷伯菌（CRKP）的不断出现已成为全球严重的公共卫生问题，尤其是儿童，但儿科患者CRKP感染的数据有限。本研究旨在确定中国江苏省儿童CRKP的流行病学和分子模式。CRKP于2018年7月至2019年5月在中国南京医科大学儿童医院连续采集。对分离的CRKP菌株进行药敏试验、耐药基因筛选和同源性分析。我们从94名儿童中收集了94个CRKP。总体而言，blaKPC-2（79.8%）是主要的碳青霉烯酶基因，其次是blaNDM-1（14.9%）、blaIMP-4（5.3%）和blaNDM-5（4.3%）。值得注意的是，两个分离株共携带blaKPC-2和blaIMP-4，两个分离株共携带blaKPC-2和blaNDM-5。MLST分析显示，14个不同的序列类型（ST）被确定，其中ST 11是最常见的序列类型。此外，在本研究中检测到两种新的ST，ST 4854和ST 4855。PFGE显示，鉴定出由产KPC-2 CRKP ST 11克隆分离株组成的主要簇，主要分布在儿科重症监护病房（PICU）和心脏重症监护病房（CCU）。此外，这是第一份鉴定ST 716 CRKP共产生KPC-2和IMP-4克隆的传播的报告。在多个部门中观察到产生KPC-2的CRKP ST 11的克隆传播。此外，还鉴定了两种新型ST（ST 4854和ST 4855），这表明CRKP菌株的多样性增加。据我们所知，这是第一份报告，确定传播肺炎克雷伯菌共生产KPC-2和IMP-4克隆的儿童，这是一个重大的健康风险，儿科患者。迫切需要积极监测和有效控制措施，以防止这些菌株在儿童中进一步传播。
The continuous emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious public health problem globally, especially for children, but data on CRKP infection in pediatric patients are limited. This study aimed to identify epidemiological and molecular patterns of CRKP among pediatric patients in Jiangsu province, China. CRKP were consecutively collected from the Children’s Hospital of Nanjing Medical University in China from July 2018 to May 2019. Then, CRKP strains were performed for further study: antimicrobial susceptibility testing, drug-resistance determinants screening and homology analysis. We collected 94 CRKP from 94 children. Overall, blaKPC-2 (79.8%) was the predominant carbapenemase gene, followed by blaNDM-1(14.9%), blaIMP-4 (5.3%) and blaNDM-5(4.3%). Notably, two isolates coharbored blaKPC-2 and blaIMP-4, and two isolates coharbored blaKPC-2 and blaNDM-5. MLST analysis revealed that 14 distinct sequence types (STs) were identified, of which ST11 was the most common sequence type identified. Moreover, two novel STs, ST4854 and ST4855, were detected in this study. PFGE revealed that a predominant cluster consisting of KPC-2-producing CRKP ST11 clone isolates was identified and was distributed mainly in the pediatric intensive care unit (PICU) and cardiac intensive care unit (CCU). Moreover, this is the first report to identify the dissemination of ST716 CRKP coproducing KPC-2 and IMP-4 clones. Clonal dissemination of KPC-2-producing CRKP ST11 was observed in multiple departments. Moreover, two novel STs (ST4854 and ST4855) were identified, which indicates an increased diversity of CRKP strains. To our knowledge, this is the first report that identified the dissemination of Klebsiella pneumoniae coproducing KPC-2 and IMP-4 clones among children, which represents a significant health risk to pediatric patients. Active surveillance and effective control measures are urgently needed to prevent further transmission of these strains among children.