产NDM-1和产KPC-2耐碳青霉烯类肺炎克雷伯菌临床及分子流行病学特征比较

Comparison in clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae

摘要:

目的 比较产NDM-1和产KPC-2耐碳青霉烯类肺炎克雷伯菌(CRKP)的临床及分子流行病学特征。 方法 回顾性分析2017—2020年某儿童医院非重复儿童住院患者临床分离的CRKP, 查阅菌株来源患者的病历资料获得患者的基本临床特征。对CRKP进行药敏试验及多位点序列分型(MLST)分析, 比较产NDM-1和产KPC-2的CRKP临床及分子流行病学特征。 结果 2017—2020年共收集164株CRKP菌株, 其中96株携带bla_NDM-1, 68株携带bla_KPC-2, 产NDM-1的CRKP主要分布在新生儿科室, 产KPC-2的CRKP以非新生儿科室居多, 两组在标本来源、患者年龄、科室分布和预后情况方面比较, 差异均有统计学意义(均P＜0.05);产NDM-1的CRKP菌株以ST 17型和ST 278型为主, 分别为40.63%、18.75%;而产KPC-2的CRKP菌株以ST 11为主, 达73.53%。产KPC-2的CRKP分离株对头孢吡肟、氨曲南、亚胺培南、阿米卡星、庆大霉素、呋喃妥因和磷霉素的耐药率均高于产NDM-1的CRKP分离株, 差异均有统计学意义(均P＜0.05)。 结论 产NDM-1和产KPC-2的CRKP菌株在临床及分子流行病学方面均存在差异, 产KPC-2的CRKP菌株表现出更严重的耐药性, 感染KPC-2 CRKP的患者预后较差, 应引起临床和感控的重视。

Abstract:

Objective To compare the clinical and molecular epidemiological characteristics between NDM-1-procucing and KPC-2-procucing carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods Clinically isolated non-repetitive CRKP strains from children in a children's hospital from 2017 to 2020 were retrospectively analyzed. Basic clinical characteristics of the patients from whom strains were detected were obtained by referring to their medical records. Antimicrobial susceptibility testing and multilocus sequence typing (MLST) analysis on CRKP were performed. Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP were compared. Results A total of 164 CRKP strains were collected from 2017 to 2020, among which 96 strains carried bla_NDM-1 and 68 strains carried bla_KPC-2. NDM-1-producing CRKP were mainly from neonatal department, while KPC-2-producing CRKP were mostly from non-neonatal departments. There were statistically significant differences in specimen sources, patient's age, department distribution, and prognosis between the two groups (all P < 0.05). NDM-1-producing CRKP strains were mainly ST 17 and ST 278, accounting for 40.63% and 18.75% respectively, while KPC-2-producing CRKP strains were mainly ST 11 (73.53%). Resistance rates of KPC-2-producing CRKP to cefepime, aztreonam, imipenem, amikacin, gentamicin, furanotoin and fosfomycin were higher than those of NDM-1-producing CRKP, all with statistical significance (all P < 0.05). Conclusion Clinical and molecular epidemiological characteristics of NDM-1-procucing and KPC-2-producing CRKP strains are different. KPC-2-producing CRKP strains show more serious antimicrobial resistance and poor prognosis in patients, thus should be paid more attention in clinic and infection control.