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Zachipatala ndi mamolekyu a carbapenem-resistant high-virulence Klebsiella pneumoniae mu chipatala chapamwamba ku Shanghai
Zhou Cong, 1 Wu Qiang, 1 He Leqi, 1 Zhang Hui, 1 Xu Maosuo, 1 Bao Yuyuan, 2 Jin Zhi, 3 Fang Shen 11 Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, People's Republic of China;2 Shanghai Jiaotong Department of Laboratory Medicine, Shanghai Children's Hospital, Shanghai, People's Republic of China;3 Dipatimenti ya Neurology, Shanghai Fifth People's Hospital, Fudan University Wolemba: Fang Shen, Dipatimenti ya Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, No. 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 ya ChinaTel +86 18021073 Imelo [imelo yotetezedwa] Mbiri: Kuphatikizika kwa carbapenem kukana ndi hypervirulence ku Klebsiella pneumoniae kwadzetsa mavuto akulu azaumoyo.M'zaka zaposachedwapa, pakhala pali malipoti ochulukirapo okhudza carbapenem-resistant high-virus Klebsiella pneumoniae (CR-hvKP) ipatulas.Zipangizo ndi Njira: Kuwunika kobwerezabwereza kwa kafukufuku wazachipatala wa odwala omwe ali ndi CR-hvKP kuyambira Januware 2019 mpaka Disembala 2020 kuchipatala chapamwamba.Werengani Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), Klebsiella pneumoniae (CR-hmKP) wosamva carbapenem ndi chibayo cholimbana ndi carbapenem chomwe chasonkhanitsidwa mkati mwa zaka 2 Chiwerengero cha zopatula za Leberella (CR-hvKP).Kuzindikira kwa PCR kwa majini otsutsa, majini okhudzana ndi virulence, ma capsular serotype gene ndi multilocus sequence typing (MLST) ya CR-hvKP isolates.Results: Zonse za 1081 zosabwerezabwereza za Klebsiella pneumoniae zinapatulidwa panthawi yophunzira., Kuphatikizapo mitundu 392 ya Klebsiella pneumoniae (36.3%), 39 CR-hmKP (3.6%) ndi 16 CR-hvKP (1.5%).Pafupifupi 31.2% (5/16) ya CR-hvKP idzadzipatula mu 2019, ndipo pafupifupi 68.8% (11/16) ya CR-hvKP idzadzipatula mu 2020. Pakati pa mitundu 16 ya CR-hvKP, mitundu 13 ndi ST11 ndi ST11. serotype K64, 1 strain ndi ST11 ndi K47 serotypes, 1 strain ndi ST23 ndi K1 serotypes, ndi 1 strain ndi ST86 ndi K2 serotypes.Majini okhudzana ndi virulence entB, fimH, rmpA2, iutA, ndi iucA amapezeka m'magulu onse 16 a CR-hvKP, kutsatiridwa ndi mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).Ma 16 CR-hvKP amawapatula onse amanyamula jini ya carbapenemase blaKPC-2 ndi jini yotalikirapo ya β-lactamase blaSHV.Zotsatira za zolemba zala za ERIC-PCR DNA zidawonetsa kuti 16 CR-hvKP zovuta zinali polymorphic kwambiri, ndipo magulu amtundu uliwonse anali wosiyana kwambiri, akuwonetsa mkhalidwe waposachedwa.Kutsiliza: Ngakhale CR-hvKP imagawidwa mwa apo ndi apo, ikukula chaka ndi chaka.chaka.Choncho, chisamaliro chachipatala chiyenera kudzutsidwa, ndipo njira zoyenera ziyenera kuchitidwa kuti zisawonongeke ndi kufalikira kwa superbug CR-hvKP.Keywords: Klebsiella pneumoniae, carbapenem resistance, high virulence, high mucus, epidemiology
Klebsiella pneumoniae ndi tizilombo toyambitsa matenda timene timayambitsa matenda osiyanasiyana, kuphatikizapo chibayo, matenda a mkodzo, bacteremia, ndi meningitis.1 M'zaka makumi atatu zapitazi, mosiyana ndi Klebsiella pneumoniae (cKP), kachilombo koyambitsa matenda a Klebsiella pneumoniae (hvKP) hypermucosal mucus yakhala tizilombo toyambitsa matenda, timene timapezeka m'matenda oopsa kwambiri monga zilonda zam'chiwindi zimayamba kukhala zathanzi. ndi anthu omwe ali ndi immunocompromised.2 Ndikoyenera kudziwa kuti matendawa nthawi zambiri amatsagana ndi matenda owononga, kuphatikizapo endophthalmitis ndi meningitis.3 Kupanga kwapamwamba kwa mucosal mucosal phenotype hvKP nthawi zambiri kumakhala chifukwa cha kuwonjezeka kwa ma polysaccharides a capsular ndi kukhalapo kwa majini enieni a virulence, monga rmpA ndi rmpA2.4.The high mucus phenotype nthawi zambiri amatsimikiziridwa ndi "chingwe kuyesa".Magulu a Klebsiella pneumoniae omwe amakula usiku umodzi pama mbale a agar amagazi amatambasulidwa ndi lupu.Pamene chingwe cha viscous chokhala ndi kutalika kwa> 5mm chimapangidwa, "chiyeso cha chingwe" chimakhala chabwino.5 Kafukufuku waposachedwapa anasonyeza kuti peg-344, iroB, iucA, rmpA rmpA2 ndi rmpA2 ndi biomarkers zomwe zingathe kuzindikira molondola hvkp.6 M'kafukufukuyu, Klebsiella pneumoniae yemwe anali woopsa kwambiri amatanthauzidwa kukhala ndi ntchofu kwambiri (zotsatira zoyesa zingwe zabwino) komanso kunyamula malo okhudzana ndi Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA) M'zaka za m'ma 1980, nkhani ya ku Taiwan idafotokoza koyamba za dera. - anapeza zilonda za chiwindi chifukwa cha hvKP, limodzi ndi kuwonongeka kwakukulu kwa chiwalo, monga meningitis ndi endophthalmitis.7,8 hvKP imakhala ndi kufalikira kwapawiri m'maiko ambiri ku Asia, Europe ndi America.Ngakhale kuti milandu yambiri ya hvKP yanenedwa ku Ulaya ndi ku America, kufalikira kwa hvKP kunachitika makamaka m'mayiko aku Asia, makamaka China.9
Nthawi zambiri, hvKP imakhudzidwa kwambiri ndi maantibayotiki, pomwe carbapenem-resistant Klebsiella pneumonia (CRKP) imakhala ndi poizoni wochepa.Komabe, ndi kufalikira kwa kukana mankhwala osokoneza bongo komanso ma plasmids a virulence, CR-hvKP idafotokozedwa koyamba ndi Zhang et al.mu 2015, ndipo pali malipoti ambiri apanyumba.10 Popeza CR-hvKP imatha kuyambitsa matenda oopsa komanso ovuta kuchiza, ngati mliri ukuwonekera, utha kukhala "superbug" wotsatira.Mpaka pano, matenda ambiri omwe amayamba chifukwa cha CR-hvKP achitika mwapang'onopang'ono, ndipo miliri yaying'ono ndiyosowa.11, 12
Pakalipano, chiwerengero cha CR-hvKP ndi chochepa, ndipo pali maphunziro ochepa okhudzana nawo.Epidemiology ya mamolekyulu a CR-hvKP ndi yosiyana m'magawo osiyanasiyana, kotero ndikofunikira kuti tiphunzire kugawa kwachipatala ndi mawonekedwe a CR-hvKP m'chigawo chino.Kafukufukuyu adasanthula mozama za majini okana, majini okhudzana ndi virulence ndi MLST ya CR-hvKP.Tidayesa kufufuza kuchuluka kwa CR-hvKP pachipatala chapamwamba ku Shanghai, kum'mawa kwa China.Kafukufukuyu ndi wofunikira kwambiri pakumvetsetsa miliri ya maselo a CR-hvKP ku Shanghai.
Klebsiella pneumoniae yosabwerezabwereza yodzipatula ku Shanghai Fifth People's Hospital yolumikizana ndi Fudan University kuyambira Januware 2019 mpaka Disembala 2020 idasonkhanitsidwa mobwerezabwereza, ndipo maperesenti a hmKP, CRKP, CR-hmkp ndi CR-hvKP adawerengedwa.Zodzipatula zonse zidadziwika ndi VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France).Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) idagwiritsidwa ntchito kuwunikanso kuzindikirika kwa mitundu ya bakiteriya.The high mucus phenotype imatsimikiziridwa ndi "chingwe kuyesa".Ngati imipenem kapena meropenem ikugonjetsedwa, kukana kwa carbapenem kumatsimikiziridwa kupyolera mu kuyesa kwa mankhwala.Klebsiella pneumoniae yoopsa kwambiri imatanthauzidwa kukhala ndi mamina amtundu wa phenotype (zotsatira zoyesa zingwe zabwino) ndi kunyamula Klebsiella pneumoniae virulence plasmid malo okhudzana ndi plasmid (rmpA2, iutA, iucA)6.
Gulu limodzi la Klebsiella pneumoniae colony linayikidwa pa 5% ya nkhosa ya agar plate.Pambuyo poyakira usiku wonse pa 37 ° C, kokerani pang'onopang'ono koloni ndi loop yolowera ndikubwereza katatu.Ngati mzere wa viscous umapangidwa katatu ndipo kutalika kwake ndi kwakukulu kuposa 5mm, "mayeso a mzere" amaonedwa kuti ndi abwino, ndipo zovutazo zimakhala ndi phenotype ya mucus.
Mu VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France), kutengeka kwa maantimicrobial ku maantibayotiki angapo omwe amagwiritsidwa ntchito nthawi zambiri kunadziwika ndi kuchepetsedwa kwa msuzi.Zotsatira zimatanthauziridwa molingana ndi chikalata chowongolera chopangidwa ndi Clinical and Laboratory Standards Institute (CLSI, 2019).E. coli ATCC 25922 ndi Klebsiella pneumoniae ATCC 700603 anagwiritsidwa ntchito ngati zowongolera zoyezetsa kutengeka kwa antimicrobial.
DNA ya Genomic ya zopatula zonse za Klebsiella pneumoniae zinatengedwa ndi TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Mitundu yowonjezereka ya β-lactamase (blaCTX-M, blaSHV ndi blaTEM), majini a carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP ndi blaOXA-48) ndi majini 9 okhudzana ndi virulence, kuphatikizapo pLVPK Plasmid-like fimHS (yonse , mrkD, entB, iutA, rmpA, rmpA2, iucA, ndi aerobactin) adakulitsidwa ndi PCR monga momwe tafotokozera kale.Mitundu ya 13,14 Capsular serotype-enieni (K1, K2, K5, K20, K54, ndi K57) idakulitsidwa ndi PCR monga tafotokozera pamwambapa.14 Ngati alibe, kulitsa ndi kutsata malo a wzi kuti mudziwe ma jini amtundu wa capsular serotype.15 Zoyambira zomwe zidagwiritsidwa ntchito mu kafukufukuyu zalembedwa mu Table S1.Zogulitsa zabwino za PCR zidatsatiridwa ndi NextSeq 500 sequencing platform (Illumina, San Diego, CA, USA).Fananizani masanjidwe a nucleotide poyendetsa BLAST patsamba la NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Mipikisano malo sequence typing (MLST) anachitidwa monga anafotokozera Pasteur Institute MLST webusaiti (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Mitundu isanu ndi iwiri yosunga nyumba gapA, infB, mdh, pgi, phoE, rpoB ndi tonB idakulitsidwa ndi PCR ndikutsatiridwa.Mtundu wa sequence (ST) umatsimikiziridwa poyerekezera zotsatira zotsatizana ndi nkhokwe ya MLST.
Homology ya Klebsiella pneumoniae idawunikidwa.Klebsiella pneumoniae genomic DNA adatengedwa ngati template, ndipo zoyambira za ERIC zikuwonetsedwa mu Table S1.PCR imakulitsa ma genomic DNA ndikupanga chala cha DNA ya genomic.Zogulitsa 16 za PCR zidapezeka ndi 2% agarose gel electrophoresis.Zotsatira za zolemba zala za DNA zidadziwika pogwiritsa ntchito QuantityOne software band recognition, ndipo kusanthula kwa majini kunachitika pogwiritsa ntchito njira ya gulu lopanda kulemera (UPGMA) ya masamu amatanthauza.Odzipatula omwe ali ndi kufanana> 75% amaonedwa kuti ndi ofanana ndi genotype, ndipo omwe ali ndi zofanana <75% amaonedwa kuti ndi osiyana.
Gwiritsani ntchito pulogalamu yowerengera SPSS ya Windows 22.0 kusanthula deta.Deta imafotokozedwa ngati ± kusintha kokhazikika (SD).Zosintha zamagulu zidawunikidwa ndi chi-square test kapena mayeso enieni a Fisher.Mayeso onse owerengera ndi 2-tailed, ndipo mtengo wa P <0.05 umawonedwa ngati wofunikira.
Chipatala cha Shanghai Fifth People's Hospital chogwirizana ndi Fudan University chinatenga zopatula 1081 za Klebsiella pneumoniae kuyambira Januware 1, 2019 mpaka Disembala 31, 2020, ndikupatulanso zodzipatula za wodwala yemweyo.Pakati pawo, zovuta za 392 (36.3%) zinali hmKP, zovuta za 341 (31.5%) zinali CRKP, zovuta za 39 (3.6%) zinali CR-hmKP, ndipo 16 (1.5%) zinali CR-hvKP.Ndizofunikira kudziwa kuti 33.3% (13/39) ya CR-hmKP ndi 31.2% (5/16) ya CR-hvKP ikuchokera ku 2019, 66.7% (26/39) ya CR-hmKP ndi 68.8% (11/16). ) CR-hvKP inalekanitsidwa ndi 2020. Kuchokera ku sputum (17 sputum), mkodzo (12 strains), drainage fluid (4 strains), magazi (2 strains), mafinya (2 strains), bile (1 isolation) ndi pleural effusion (1 kudzipatula), motsatana.Mitundu khumi ndi isanu ndi umodzi ya CR-hvKP inapezedwa ku sputum (9 isolate), mkodzo (5 isolate), magazi (1 isolate) ndi pleural effusion (1 isolate).
Kupyolera mu chizindikiritso cha zovuta, kuyesa kukhudzidwa kwa mankhwala, kuyesa kwa chingwe ndi kudziwika kwa majini okhudzana ndi virulence, 16 CR-hvKP mitundu inayesedwa.Makhalidwe achipatala a odwala 16 omwe ali ndi CR-hvKP amadzipatula akufotokozedwa mwachidule mu Table 1. 13 mwa odwala 16 (81.3%) anali amuna, ndipo odwala onse anali okalamba kuposa zaka 62 (zaka zakubadwa: 83.1 ± 10.5 zaka).Adachokera ku mawodi 8, ndipo opitilira theka adachokera ku ICU yapakati (milandu 9).Matenda oyambirira akuphatikizapo matenda a cerebrovascular (75%, 12/16), matenda oopsa (50%, 8/16), matenda osokoneza bongo (50%, 8/16), etc. Opaleshoni yowonongeka imaphatikizapo mpweya wabwino (62.5%, 10 / 16), catheter ya mkodzo (37.5%, 6/16), chubu chapamimba (18.8%, 3/16), opaleshoni (12.5%, 2/16) ndi catheter ya mtsempha (6.3%, 1/16).Odwala asanu ndi anayi mwa 16 adamwalira, ndipo odwala 7 adachira ndikutulutsidwa.
Zodzipatula za 39 CR-hmKP zidagawidwa m'magulu awiri molingana ndi kutalika kwa chingwe chomata.Pakati pawo, 20 CR-hmKP yodzipatula yokhala ndi chingwe cha viscous kutalika ≤ 25 mm inagawidwa mu gulu limodzi, ndipo 19 CR-hmKP yodzipatula yokhala ndi viscous chingwe kutalika> 25 mm inagawidwa mu gulu lina.Njira ya PCR imazindikira kuchuluka kwa majini okhudzana ndi virulence rmpA, rmpA2, iutA ndi iucA.Makhalidwe abwino a CR-hmKP okhudzana ndi majeremusi okhudzana ndi majeremusi m'magulu awiriwa akuwonetsedwa mu Table 2. Panalibe kusiyana kwa chiwerengero cha chiwerengero chabwino cha majeremusi okhudzana ndi CR-hmKP pakati pa magulu awiriwa.
Gulu 3 likuwonetsa mbiri yamankhwala 16 a antimicrobial resistance.Zodzipatula za 16 CR-hvKP zidawonetsa kukana mankhwala ambiri.Zodzipatula zonse zimathandizidwa ndi ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, ndi meropenem.Trimethoprim-sulfamethoxazole inali ndi mlingo wochepa kwambiri wotsutsa (43.8%), wotsatiridwa ndi amikacin (62.5%), gentamicin (68.8%) ndi ciprofloxacin (87.5%).
Kugawidwa kwa majeremusi okhudzana ndi tizilombo toyambitsa matenda, tizilombo toyambitsa matenda tizilombo toyambitsa matenda, tizilombo toyambitsa matenda a capsular serotype ndi MLST ya 16 CR-hvKP isolates ikuwonetsedwa mu Chithunzi 1. kuwonetsedwa mu Chithunzi 1. Chithunzi 2. Kusanthula kwa MLST kumasonyeza chiwerengero cha 3 STs, ST11 ndi ST (87.5%, 14 / 16), yotsatiridwa ndi ST23 (6.25%, 1/16) ndi ST86 (6.25%, 1 /16).Malinga ndi zotsatira za kulemba kwa wzi, ma serotypes osiyanasiyana a 4 a capsular adadziwika (Chithunzi 1).Pakati pa 16 carbapenem-resistant hvKP, K64 ndi serotype yodziwika kwambiri (n=13), yotsatiridwa ndi K1 (n=1), K2 (n=1) ndi K47 (n=1).Kuphatikiza apo, mtundu wa capsular serotype K1 ndi ST23, mtundu wa capsular serotype K2 ndi ST86, ndipo mitundu 13 yotsala ya K64 ndi 1 ya K47 yonse ndi ST11.Miyezo yabwino ya 9 gene gene mu 16 CR-hvKP yodzipatula ikuwonetsedwa mu Chithunzi 1. , Ma genes okhudzana ndi virulence entB, fimH, rmpA2, iutA, ndi iucA alipo mu 16 CR-hvKP mitundu, yotsatiridwa ndi mrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n=1).Ma 16 CR-hvKP amawapatula onse amanyamula jini ya carbapenemase blaKPC-2 ndi jini yotalikirapo ya β-lactamase blaSHV.Zodzipatula za 16 CR-hvKP sizinanyamule majini a carbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 ndi majini otalikirapo a β-lactamase blaTEM, gulu la blaCTX-M-2, ndi gulu la blaCTX-M-8.Pakati pa mitundu 16 ya CR-hvKP, mitundu ya 5 inanyamula gulu lotalikirapo la β-lactamase jini blaCTX-M-1, ndipo mitundu 6 idanyamula gulu lotalikirapo la β-lactamase jini blaCTX-M-9.
Chithunzi cha 1 Ma jini okhudzana ndi ma virulence, majeremusi oletsa tizilombo toyambitsa matenda, tizilombo toyambitsa matenda a capsular serotype ndi MLST ya 16 CR-hvKP yodzipatula.
Chithunzi 2 Agarose gel electrophoresis ya majini ena okhudzana ndi virulence, ma antimicrobial resistance genes ndi capsular serotype majini.
Chidziwitso: M, chikhomo cha DNA;1, blaKPC (893bp);2, entB (400bp);3, rmpA2 (609bp);4, rmpA (429bp);5, iucA (239bp);6, iutA (880bp);7, Aerobacterin (556bp);8, K1 (1283bp);9, K2 (641bp);10, onse S (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR idagwiritsidwa ntchito kusanthula homology ya 16 CR-hvKP kudzipatula.Pambuyo pakukulitsa kwa PCR ndi agarose gel electrophoresis, pali zidutswa za 3-9 za DNA.Zotsatira zala zala zidawonetsa kuti zodzipatula za 16 CR-hvKP zinali polymorphic kwambiri, ndipo panali kusiyana koonekeratu pakati pa zodzipatula (Chithunzi 3).
M'zaka zaposachedwa, pakhala pali malipoti ochulukirachulukira pazodzipatula za CR-hvKP.Maonekedwe a CR-hvKP amadzipatula amakhala pachiwopsezo chachikulu ku thanzi la anthu chifukwa amatha kuyambitsa matenda oopsa, ovuta kuchiza mwa anthu athanzi.Mu kafukufukuyu, kufalikira komanso kufalikira kwa maselo a CR-hvKP pachipatala chapamwamba ku Shanghai kuyambira 2019 mpaka 2020 adaphunziridwa kuti awone ngati pali chiwopsezo cha kufalikira kwa CR-hvKP komanso momwe chitukuko chikuyendera mderali.Panthawi imodzimodziyo, phunziroli likhoza kupereka kuwunika kowonjezereka kwa matenda opatsirana, omwe ali ofunika kwambiri poletsa kufalikira kwa zodzipatula zoterezi.
Kafukufukuyu adawunikanso momwe CR-hvKP imagawidwira komanso momwe amakhalira kuyambira 2019 mpaka 2020. Kuchokera mu 2019 mpaka 2020, kudzipatula kwa CR-hvKP kunawonetsa kuchuluka.Pafupifupi 31.2% (5/16) ya CR-hvKP idasiyidwa mu 2019, ndipo 68.8% (11/16) ya CR-hvKP idasiyidwa mu 2020, zomwe zikugwirizana ndi kukwera kwa CR-hvKP komwe kunanenedwa m'mabuku.Popeza Zhang et al.poyamba anafotokoza CR-hvKP mu 2015,10 zambiri CR-hvKP mabuku wakhala lipoti, 17-20 makamaka Asia-Pacific dera, makamaka China.CR-hvKP ndi bakiteriya wapamwamba kwambiri wokhala ndi ma virus komanso osagwiritsa ntchito mankhwala ambiri.Zimawononga thanzi la anthu ndipo zimafa kwambiri.Choncho, chidwi chiyenera kuperekedwa ndipo njira ziyenera kuchitidwa kuti zipewe kufalikira.
Kusanthula kwa 16 CR-hvKP zodzipatula kunawonetsa kuchuluka kwa maantibayotiki kukana.Zodzipatula zonse zimathandizidwa ndi ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, ndi meropenem.Trimethoprim-sulfamethoxazole inali ndi mlingo wochepa kwambiri wotsutsa (43.8%), wotsatiridwa ndi amikacin (62.5%), gentamicin (68.8%) ndi ciprofloxacin (87.5%).Mlingo wa kukana kwa CR-hmkp wophunziridwa ndi Lingling Zhan ndi ena ndi wofanana ndi phunziroli [12].Odwala omwe ali ndi CR-hvKP ali ndi matenda ambiri ofunikira, chitetezo chokwanira chochepa, komanso kuthekera kofooka kodziyimira pawokha kolera.Chifukwa chake, chithandizo chanthawi yake chotengera zotsatira za mayeso a antimicrobial sensitivity ndikofunikira kwambiri.Ngati ndi kotheka, malo omwe ali ndi kachilomboka amatha kupezeka ndikuthandizidwa ndi ngalande, kuwononga ndi njira zina.
Zodzipatula za 39 CR-hmKP zidagawidwa m'magulu awiri molingana ndi kutalika kwa chingwe chomata.Pakati pawo, 20 CR-hmKP yodzipatula yokhala ndi chingwe cha viscous kutalika ≤ 25 mm inagawidwa mu gulu limodzi, ndipo 19 CR-hmKP yodzipatula yokhala ndi viscous chingwe kutalika> 25 mm inagawidwa mu gulu lina.Poyerekeza miyeso yabwino ya CR-hmKP yokhudzana ndi majeremusi okhudzana ndi majeremusi pakati pa magulu awiriwa, panalibe kusiyana kwakukulu kwa chiwerengero cha majeremusi abwino pakati pa magulu awiriwa.Kafukufuku wa Lin Ze et al.anasonyeza kuti mlingo wabwino wa chibadwa cha virulence wa Klebsiella pneumoniae unali wokwera kwambiri kuposa wa classic Klebsiella pneumoniae.21 Komabe, ngati kuchuluka kwabwino kwa majini a virulence kumagwirizana bwino ndi kutalika kwa tcheni chomata sichidziwika.Kafukufuku wina wasonyeza kuti Klebsiella pneumoniae yachikale ingakhalenso yoopsa kwambiri ya Klebsiella pneumoniae, yokhala ndi chiwopsezo chapamwamba cha majini a virulence.22 Kafukufukuyu adapeza kuti jini la virulence labwino la CR-hmKP silikugwirizana bwino ndi kutalika kwa ntchentche.Chingwe (kapena sichikuwonjezeka ndi kutalika kwa chingwe chomata).
Zolemba zala za ERIC PCR za phunziroli ndi za polymorphic, ndipo palibe kuphatikizika kwachipatala pakati pa odwala, kotero kuti odwala 16 omwe ali ndi matenda a CR-hvKP amakhala ocheperako.M'mbuyomu, matenda ambiri omwe amayamba chifukwa cha CR-hvKP adanenedwa ngati milandu yokhayokha kapena yapang'onopang'ono, 23,24 ndi miliri yaying'ono ya CR-hvKP sipezeka m'mabuku.11,25 ST11 ndiye ST11 yodziwika kwambiri ku CRKP ndi CR-hvKP kudzipatula ku China.26,27 Ngakhale kuti ST11 CR-hvKP inali 87.5% (14/16) ya 16 CR-hvKP yodzipatula mu phunziroli, sitingaganizidwe kuti mitundu 14 ST11 CR-hvKP ikuchokera ku clone yomweyo, kotero ERIC PCR zolemba zala. chofunika.Kusanthula kwa Homology.
Mu kafukufukuyu, odwala onse 16 omwe ali ndi kachilombo ka CR-hvKP adachitidwa opaleshoni yosokoneza.Malinga ndi malipoti, kuphulika koopsa kwa chibayo chogwirizana ndi mpweya woyendera mpweya woyambitsidwa ndi CR-hvKP11 kukuwonetsa kuti njira zowononga zitha kuonjezera chiopsezo cha matenda a CR-hvKP.Panthawi imodzimodziyo, odwala 16 omwe ali ndi matenda a CR-hvKP ali ndi matenda oyambitsa matenda, omwe matenda a cerebrovascular ndi omwe amapezeka kwambiri.Kafukufuku wam'mbuyomu adawonetsa kuti matenda a cerebrovascular ndi chiopsezo chodziyimira pawokha cha matenda a CR-hvKP.28 Chifukwa cha chodabwitsa ichi chikhoza kukhala chitetezo chofooka cha odwala omwe ali ndi matenda a cerebrovascular, mabakiteriya a pathogenic sangathe kuchotsedwa paokha, ndipo mphamvu yawo ya bactericidal yokha ndiyo yomwe imadalira.Maantibayotiki adzatsogolera ku kuphatikiza kwa mankhwala osokoneza bongo ambiri komanso hypervirulence pakapita nthawi.Mwa odwala 16, 9 adamwalira, ndipo chiwerengero cha imfa chinali 56.3% (9/16).Chiwopsezo cha kufa ndipamwamba kuposa 10,12 m'maphunziro apitalo, ndipo otsika kuposa 11,21 omwe adanenedwa m'maphunziro am'mbuyomu.Avereji ya zaka za odwala 16 anali zaka 83.1 ± 10.5, zomwe zikuwonetsa kuti okalamba ndi omwe ali pachiwopsezo cha CR-hvKP.Kafukufuku wam'mbuyomu wasonyeza kuti achinyamata ndi omwe amatha kutenga matenda.Kuopsa kwa Klebsiella pneumoniae.29 Komabe, kafukufuku wina wasonyeza kuti okalamba amatha kudwala Klebsiella pneumoniae24,28 yoopsa kwambiri.Phunziro ili likugwirizana ndi izi.
Pakati pa mitundu 16 ya CR-hvKP, kupatula ST23 CR-hvKP imodzi ndi ST86 CR-hvKP imodzi, ma 14 ena onse ndi ST11 CR-hvKP.Serotype ya capsular yofanana ndi ST23 CR-hvKP ndi K1, ndipo serotype yofanana ya ST86 CR-HVKP ndi K2, yofanana ndi maphunziro apitalo.30-32 Odwala omwe ali ndi matenda a ST23 (K1) CR-hvKP kapena ST86 (K2) CR-hvKP anamwalira, ndipo chiwerengero cha imfa (100%) chinali chachikulu kwambiri kuposa cha odwala omwe ali ndi ST11 CR-hvKP (50%).Monga momwe tawonetsera pa Chithunzi 1, mlingo wabwino wa ST23 (K1) kapena ST86 (K2) wa jini wokhudzana ndi virulence ndi wapamwamba kuposa wa ST11 (K64).Imfa ikhoza kukhala yokhudzana ndi kuchuluka kwabwino kwa majini okhudzana ndi virulence.Mu phunziroli, mitundu 16 ya CR- hvKP yonse imakhala ndi jini ya carbapenemase blaKPC-2 ndi jini yotalikirapo ya β-lactamase blaSHV.blaKPC-2 ndi jini yodziwika bwino ya carbapenemase ku CR-hvKP ku China.33 Pakufufuza kwa Zhao et al., 25blaSHV ndi jini yotalikirapo ya β-lactamase yokhala ndi mulingo wapamwamba kwambiri.Majini a virulence entB, fimH, rmpA2, iutA, ndi iucA amapezeka m'magulu onse 16 a CR-hvKP, kutsatiridwa ndi mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), zomwe zikufanana ndi phunziro lapitalo.34 Kafukufuku wina wasonyeza kuti rmpA ndi rmpA2 (modulators of mucus phenotype genes) akhoza kulimbikitsa kutulutsidwa kwa ma polysaccharides a capsular, zomwe zimapangitsa kuti hypermucoid phenotypes ndi kuwonjezeka kwa virulence.35 Aerobacterins amasungidwa ndi jini ya iucABCD, ndipo ma homologous receptors awo amasungidwa ndi jini ya iutA, motero amakhala ndi kuchuluka kwa virulence mu kuyesa kwa matenda a G. mellonella.allS ndi chikhomo cha K1-ST23, osati mu pLVPK, pLVPK ndi plasmid ya virulence yochokera ku mtundu wa K2 super virulence.allS ndi mtundu wa HTH transcript activator.Ma jini a virulence awa amadziwika kuti amathandizira kuti pakhale ma virulence ndipo ali ndi udindo woyambitsa utsamunda, kuwukira komanso kuyambitsa matenda.36
Kafukufukuyu akufotokoza za kufalikira ndi kufalikira kwa maselo a CR-hvKP ku Shanghai, China.Ngakhale kuti matenda obwera chifukwa cha CR-hvKP ndi osowa, akuwonjezeka chaka ndi chaka.Zotsatira zimathandizira kafukufuku wam'mbuyomu ndikuwonetsa kuti ST11 CR-hvKP ndi CR-hvKP yotchuka kwambiri ku China.ST23 ndi ST86 CR-hvKP adawonetsa ma virus ochulukirapo kuposa ST11 CR-hvKP, ngakhale onse ali owopsa kwambiri a Klebsiella pneumoniae.Pamene chiwopsezo cha Klebsiella pneumoniae chowopsa kwambiri chikuwonjezeka, kukana kwa Klebsiella pneumoniae kungachepe, zomwe zingapangitse chiyembekezo chakhungu m'zachipatala.Choncho, m'pofunika kuphunzira virulence ndi mankhwala kukana Klebsiella pneumoniae.
Kafukufukuyu adavomerezedwa ndi Medical Ethics Committee ya Shanghai Fifth People's Hospital (No. 104, 2020).Zitsanzo zachipatala ndi mbali ya njira zachipatala zachipatala.
Zikomo kwa ogwira ntchito ku Central Laboratory ya Shanghai Fifth People's Hospital popereka malangizo aukadaulo a kafukufukuyu.
Ntchitoyi idathandizidwa ndi Natural Science Foundation ya Minhang District, Shanghai (nambala yovomerezeka: 2020MHZ039).
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Nthawi yotumiza: Jul-15-2021