Co-outbreak of multidrug resistance and a novel ST3006 Klebsiella pneumoniae in a neonatal intensive care unit A retrospective study
Co-outbreak of multidrug resistance and a novel ST3006 Klebsiella pneumoniae in a neonatal intensive care unit A retrospective study
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DOI：
10.1097/md.0000000000014285
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发表时间：
2019-01-01
期刊：
影响因子：
1.6
通讯作者：
Chen, Yusheng
中科院分区：
文献类型：
--
作者：
Chen, Dongjie;Hu, Xinlan;Chen, Yusheng
耐碳青霉烯肺炎克雷伯菌的爆发是一个严重的公共卫生问题，特别是在新生儿重症监护病房（NICU）。2017年6月3日至28日在某NICU新生儿中分离出肺炎克雷伯菌15株。采用Vitek 2体系和微肉汤稀释法测定药敏。采用多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）对分离菌株进行遗传亲缘性分析。采用全基因组测序和基因功能分析研究致病性和耐药性，筛选基因组岛。从7例新生儿中鉴定出3株肺炎克雷伯菌：ST37株7株，新型ST3006株7株，ST1224株1株。基因测序结果显示，kpn1343 （ST37）菌株含有12个抗性基因(OXA-33、TEM-1、SHV-11、AAC（6’）-IId、AAC (3)IIa、AAC（6’）-Ib-cr、catB3、arr-3、sul1、oqxB、oqxA、CRP和catB3)，包括15个基因组岛和205个毒力降低基因。kpn1344 （ST3006）菌株携带4个耐药基因（TEM-1、CTX-M-3、vgaC和CRP），包括19个基因组岛和209个毒力降低基因。MLST和PFGE结果显示，15株肺炎克雷伯菌可分为3组，同源性较高。ST1224 （kpn1362）于2017年6月28日分离到，比最后一次分离到的时间晚10天（kpn1359, 2017年6月18日）；因此，我们推测ST1224不是引起爆发的克隆。这次肺炎克雷伯菌共暴发涉及2个克隆：ST37和ST3006。ST37携带OXA-33、TEM-1、SHV-11等多重耐药基因，ST3006为新型肺炎克雷伯菌ST分型。全基因组测序可能是筛选细菌耐药基因及其功能的有效方法。
The outbreak of carbapenem-resistant Klebsiella pneumoniae is a serious public health problem, especially in the neonatal intensive care unit (NICU).Fifteen K. pneumoniae strains were isolated from 7 neonates during June 3 to 28, 2017 in an NICU. Antimicrobial susceptibility was determined by the Vitek 2 system and microbroth dilution method. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used to analyze the genetic relatedness of the isolates. Whole-genome sequencing and gene function analysis were performed to investigate pathogenicity and drug resistance and screen genomic islands.Three clones of K. pneumoniae were identified from 7 neonates: 7 strains of ST37, 7 of novel ST3006, and 1 of ST1224. Gene sequencing showed that the kpn1343 (ST37) strain harbored 12 resistance genes (OXA-33, TEM-1, SHV-11, AAC (6')-IId, AAC (3)IIa, AAC (6')-Ib-cr, catB3, arr-3, sul1, oqxB, oqxA, CRP, and catB3) and included 15 genomic islands and 205 reduced virulence genes. The kpn1344 (ST3006) strain harbored 4 antibiotic-resistant genes (TEM-1, CTX-M-3, vgaC, and CRP) and included 19 genomic islands and 209 reduced virulence genes. MLST and PFGE showed that 15 strains of K. pneumoniae were divided into 3 groups with a high level of homology. ST1224 (kpn1362) was isolated on June 28, 2017, which was 10 days after the last isolate (kpn1359, June 18, 2017); thus, we speculated that ST1224 was not the clone that caused the outbreak.This co-outbreak of K. pneumoniae involved 2 clones: ST37 and ST3006. ST37 carried the multidrug-resistant genes, such as OXA-33, TEM-1, and SHV-11, and ST3006 was a novel K. pneumoniae ST typing. Whole-genome sequencing may be an effective method for screening bacterial-resistant genes and their functions.