High Prevalence of Multidrug-Resistant Klebsiella pneumoniae Harboring Several Virulence and β-Lactamase Encoding Genes in a Brazilian Intensive Care Unit
High Prevalence of Multidrug-Resistant Klebsiella pneumoniae Harboring Several Virulence and β-Lactamase Encoding Genes in a Brazilian Intensive Care Unit
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DOI：
10.3389/fmicb.2018.03198
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发表时间：
2019-01-22
影响因子：
5.2
通讯作者：
da Silva Pranchevicius, Maria-Cristina
中科院分区：
文献类型：
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作者：
Ferreira, Roumayne L.;da Silva, Brenda C. M.;da Silva Pranchevicius, Maria-Cristina
肺炎克雷伯菌是一种重要的机会性病原体，通常引起医院感染，并导致大量发病率和死亡率。我们试图调查巴西北部地区一家三级医院重症监护病房（icu）中从患者和来源分离的肺炎克雷伯菌（n = 25）的抗生素耐药谱、致病潜力和克隆关系。大多数肺炎克雷伯菌分离株（n = 21, 84%）被分类为多重耐药（MDR），对β -内酰胺类、氨基糖苷类、喹诺酮类、替加环素和粘菌素具有高水平耐药。25株菌株均具有广谱β -内酰胺酶产生菌（ESBL），包括碳青霉烯酶产生菌，携带bla(KPC)（100%）、bla(TEM)（100%）、bla（SHV）变异株（n = 24, 96%）、bia（OXA-1）群（n = 21, 84%）和bla（CTX_M_1）群（n = 18, 72%）基因。在4% （n = 1）的分离株中检测到K2血清型，未检测到K1血清型。25株毒力相关基因分别为mrkD （n = 24, 96%）、fimH-1 （n = 22, 88%）、entB（100%）、iutA （n = 10, 40%）、ybtS （n = 15, 60%）。外排泵和外膜孔蛋白相关基因为AcrAB（100%）、to/C （n = 24、96%）、mdtK （n = 22、88%）、OmpK35 （n = 15、60%）、OmpK36 （n = 7、28%）。采用ERIC-PCR法测定不同分离株间的克隆关系。得到的ERIC-PCR图谱显示，分离株之间的相似性在70%以上。为了确定序列类型（STs），采用多位点序列分型（MLST）试验。结果表明，分离物中存在高危国际克隆。在我们的研究中，多种耐多药肺炎克雷伯菌含有β -内酰胺和毒力基因，这强烈表明有必要实施有效的策略来预防和控制抗生素耐药感染的传播。
Klebsiella pneumoniae is an important opportunistic pathogen that commonly causes nosocomial infections and contributes to substantial morbidity and mortality. We sought to investigate the antibiotic resistance profile, pathogenic potential and the clonal relationships between K. pneumoniae (n = 25) isolated from patients and sources at a tertiary care hospital's intensive care units (ICUs) in the northern region of Brazil. Most of K. pneumoniae isolates (n = 21, 84%) were classified as multidrug resistant (MDR) with high-level resistance to beta-lactams, aminoglycosides, quinolones, tigecycline, and colistin. All the 25 isolates presented extended-spectrum beta-lactamase-producing (ESBL), including carbapenemase producers, and carried the bla(KPC) (100%), bla(TEM) (100%), bla(SHV) variants (n = 24, 96%), bia(OXA-1) group (n = 21, 84%) and bla(CTX_M_1) group (n = 18, 72%) genes. The K2 serotype was found in 4% (n = 1) of the isolates, and the K1 was not detected. The virulence-associated genes found among the 25 isolates were mrkD (n = 24, 96%), fimH-1 (n = 22, 88%), entB (100%), iutA (n = 10, 40%), ybtS (n = 15, 60%). The genes related with efflux pumps and outer membrane porins found were AcrAB (100%), to/C (n = 24, 96%), mdtK (n = 22, 88%), OmpK35 (n = 15, 60%), and OmpK36 (n = 7, 28%). ERIC-PCR was employed to determine the clonal relationship between the different isolated strains. The obtained ERIC-PCR patterns revealed that the similarity between isolates was above 70%. To determine the sequence types (STs) a multilocus sequence typing (MLST) assay was used. The results indicated the presence of high-risk international clones among the isolates. In our study, the wide variety of MDR K. pneumoniae harboring beta-lactams and virulence genes strongly suggest a necessity for the implementation of effective strategies to prevent and control the spread of antibiotic resistant infections.