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O uiga faʻapitoa ma mole mole o le carbapenem-resistant high-virulence Klebsiella pneumoniae i se falemaʻi maualuga i 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 Saina;2 Shanghai Jiaotong Department of Laboratory Medicine, Shanghai Children's Hospital, Shanghai, Republic of People's Republic of Saina;3 Matagaluega o Neurology, Shanghai Fifth People's Hospital, Fudan University Tusitala tutusa: Fang Shen, Matagaluega o Falemaʻi Falemaʻi Falemaʻi, Shanghai Fifth People's Hospital, Fudan University, Numera 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 o ChinaTel +86 18021073261 Imeli [imeli puipuia] Fa'amatalaga: O le tu'ufa'atasiga o le tete'e o le carbapenem ma le hypervirulence i Klebsiella pneumoniae ua mafua ai le tele o lu'itau o le soifua maloloina lautele.I tausaga talu ai nei, ua tele ma sili atu lipoti i luga ole carbapenem-resistant high-virulence Klebsiella pneumoniae (CR-hvKP) vavae ese.Mea ma metotia: O se su'esu'ega i tua o su'esu'ega o fa'amaumauga a le falema'i o gasegase na a'afia ile CR-hvKP mai Ianuari 2019 ia Tesema 2020 ile falema'i maualuga.Fa'atatau le Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), Carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) ma le carbapenem-resistant high-virulence pneumoniae aoina i totonu ole 2 tausaga Le numera o vavae'ese o Leberella (CR-hvKP).Su'esu'eina PCR o kenera tetee, genes e feso'ota'i ma le virulence, genes serotype capsular ma le fa'asologa o fa'asologa fa'asologa (MLST) o fa'aesea CR-hvKP.I'uga: Ole aofa'i ole 1081 ole Klebsiella pneumoniae e le toe faia na fa'ate'aina ile taimi ole su'esu'ega., E aofia ai 392 strains o Klebsiella pneumoniae (36.3%), 39 strains o CR-hmKP (3.6%) ma 16 strains o CR-hvKP (1.5%).E tusa ma le 31.2% (5/16) o le CR-hvKP o le a fa'aesea i le 2019, ma e tusa ma le 68.8% (11/16) o le CR-hvKP o le a fa'aesea i le 2020. I totonu o le 16 CR-hvKP strains, 13 strains o ST11 ma serotype K64, 1 strain o ST11 ma K47 serotypes, 1 strain o ST23 ma K1 serotypes, ma 1 strain o ST86 ma K2 serotypes.O genes e feso'ota'i ma virulence entB, fimH, rmpA2, iutA, ma le iucA o lo'o i ai i vaega uma e 16 CR-hvKP, sosoo ai ma mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).O le 16 CR-hvKP fa'aesea uma e ave uma le ga'o carbapenemase blaKPC-2 ma le ga'o β-lactamase lautele blaSHV.O faʻaiʻuga o le ERIC-PCR DNA fingerprinting na faʻaalia ai o 16 CR-hvKP strains na matua polymorphic, ma o fusi o faʻalavelave taʻitasi e matua ese lava, faʻaalia ai se tulaga faʻapitoa.Fa'ai'uga: E ui ina fa'asoa fa'atasi le CR-hvKP, ae o lo'o fa'atupula'ia i lea tausaga ma lea tausaga.tausaga.O le mea lea, e tatau ona faʻaosofia le mafaufau ile falemaʻi, ma e tatau ona faia ni faiga talafeagai e aloese ai mai le faʻapipiʻiina ma le salalau o le superbug CR-hvKP.upu autu: Klebsiella pneumoniae, carbapenem teteʻe, maualuga virulence, maualuga mucus, epidemiology
Klebsiella pneumoniae ose fa'ama'i fa'alavelave e mafai ona mafua ai le tele o fa'ama'i pipisi, e aofia ai le niumonia, fa'ama'i o le urinary tract, bacteremia, ma le maningitis.1 I le tolusefulu tausaga talu ai, e le pei o le Klebsiella pneumoniae (cKP), o se Klebsiella pneumoniae fou (hvKP) hypermucosal mucus ua avea ma se fa'ama'i taua tele, lea e mafai ona maua i fa'ama'i pipisi maualuga e pei ole ate abscesses e mafua ile soifua maloloina. ma tagata immunocompromised.2 E tatau ona maitauina o nei faʻamaʻi pipisi e masani lava ona faʻatasi ma faʻamaʻi pipisi faʻaleagaina, e aofia ai le endophthalmitis ma le maningitis.3 O le gaosiga o le maualuga o le mucosal phenotype hvKP e masani lava ona o le faateleina o le gaosiga o polysaccharides capsular ma le i ai o genes faʻamaʻi faʻapitoa, e pei o le rmpA ma le rmpA2.4.O le maualuga o le mucus phenotype e masani lava ona fuafuaina e le "su'ega manoa".O le Klebsiella pneumoniae colonies e ola i le po i luga o ipu agar toto e faʻaloloa i se matasele.A fai se maea viscous e >5mm le umi, o le "su'ega maea" e lelei.5 O se su'esu'ega talu ai nei na fa'aalia ai o le pine-344, iroB, iucA, rmpA rmpA2 ma le rmpA2 o ni fa'ailoga olaola e mafai ona fa'ailoa sa'o le hvkp.6 I lenei suʻesuʻega, o le Klebsiella pneumoniae sili ona mataʻutia na faʻamatalaina o loʻo i ai le maualuga o le mucus viscous phenotype (suʻega manoa lelei) ma le tauaveina o Klebsiella pneumoniae virulence plasmid nofoaga e fesoʻotai i ai (rmpA2, iutA, iucA) I le 1980s, o lipoti a Taiwan na muamua faʻamatalaina le alalafaga. -ma'i ga'o o le ate e mafua mai i le hvKP, fa'atasi ma fa'aleagaina tele o totoga, e pei o le fiva fai'ai ma le endophthalmitis.7,8 hvKP o loʻo faʻasalalau faʻasalalau i le tele o atunuu i Asia, Europa ma Amerika.E ui ina tele mataupu o le hvKP ua lipotia i Europa ma Amerika, o le taatele o le hvKP e masani lava ona tupu i atunuu Asia, aemaise lava Saina.9
I se tulaga lautele, o le hvKP e sili atu ona maʻaleʻale i vailaʻau faʻamaʻi, ae o le Klebsiella pneumonia (CRKP) e tetee i le carbapenem e itiiti le oona.Ae ui i lea, faatasi ai ma le salalau atu o fualaau faasaina ma plasmids virulence, CR-hvKP na muamua faamatalaina e Zhang et al.i le 2015, ma o loʻo faʻateleina lipoti faʻapitonuʻu.10 Talu ai ona o le CR-hvKP e mafai ona mafua ai faʻamaʻi ogaoga ma faigata ona togafitia, afai e aliali mai se faʻamaʻi faʻamaʻi, atonu o le a avea ma isi "superbug".E oo mai i le taimi nei, o le tele o faʻamaʻi pipisi e mafua mai i le CR-hvKP ua tutupu i faʻalavelave faʻafuaseʻi, ma e seasea faʻamaʻi laiti.11,12
I le taimi nei, o le suʻesuʻeina o le CR-hvKP e maualalo, ma e itiiti ni suʻesuʻega faʻatatau.O le molecular epidemiology o le CR-hvKP e eseese i itulagi eseese, o lea e tatau ai ona suʻesuʻeina le tufatufaina atu o falemaʻi ma uiga faʻamaʻi mole mole o le CR-hvKP i lenei itulagi.O lenei suʻesuʻega na suʻesuʻeina faʻapitoa ia kenera tetee, genes e fesoʻotaʻi ma le MLST o le CR-hvKP.Na matou taumafai e suʻesuʻe le faʻateleina ma le molecular epidemiology o le CR-hvKP i se falemaʻi maualuga i Shanghai, i sasaʻe o Saina.O lenei suʻesuʻega e taua tele mo le malamalama i le molecular epidemiology o le CR-hvKP i Shanghai.
O le Klebsiella pneumoniae e le toe faia faʻaesea mai le Shanghai Fifth People's Hospital e fesoʻotaʻi ma le Iunivesite o Fudan mai Ianuari 2019 ia Tesema 2020 na toe aoina mai, ma o pasene o hmKP, CRKP, CR-hmkp ma CR-hvKP sa fuafuaina.Na fa'ailoa uma mea tu'ufua e le VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Farani).Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, ISA) na faʻaaogaina e toe siaki ai le faʻamaoniga o siama siama.O le maualuga o le mucus phenotype e fuafuaina e le "su'ega manoa".Afai e tete'e le imipenem po'o le meropenem, e fa'amauina le tete'e o le carbapenem e ala i se su'esu'ega fa'aletonu o vaila'au.O le Klebsiella pneumoniae sili ona mata'utia o lo'o faauigaina o le maualuga o le mucus phenotype (su'ega manoa lelei) ma le tauaveina o Klebsiella pneumoniae virulence plasmid nofoaga e feso'ota'i (rmpA2, iutA, iucA)6.
Ose kolone Klebsiella pneumoniae e tasi na tui i luga o le 5% sheep blood agar plate.A mae'a ona fa'asusu i le po i le 37°C, toso malie i luga le kolone ma se matasele tui ma toe fai fa'atolu.Afai o se laina viscous e faatolu ona fai ma o le umi e sili atu i le 5mm, o le "laina suʻega" e manatu lelei, ma o le galu e maualuga lona mucus phenotype.
I le VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, Farani), o le antimicrobial susceptibility i le tele o vailaʻau faʻaaogaina masani na iloa e le broth micro-dilution.O fa'ai'uga o lo'o fa'amatalaina e tusa ai ma le ta'iala na fausia e le Clinical and Laboratory Standards Institute (CLSI, 2019).E. coli ATCC 25922 ma Klebsiella pneumoniae ATCC 700603 na faʻaaogaina e fai ma taʻiala mo suʻega faʻamaʻi faʻamaʻi.
Genomic DNA o Klebsiella pneumoniae isolates uma na maua mai e TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, Saina).O kenera β-lactamase fa'alautele (blaCTX-M, blaSHV ma blaTEM), kenera carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP ma blaOXA-48) ma 9 fa'atusa fa'atupu fa'aleagaina, e aofia ai pLVPK Plasmid-pei loci (allS, fimH , mrkD, entB, iutA, rmpA, rmpA2, iucA, ma aerobactin) na faʻateleina e le PCR e pei ona faʻamatalaina muamua.13,14 Capsular serotype-specific genes (K1, K2, K5, K20, K54, ma K57) na faʻateleina e le PCR e pei ona faʻamatalaina i luga.14 Afai e le lelei, fa'alautele ma fa'asologa le wzi locus e fa'amautu ai kenera fa'apitoa serotype capsular.15 O fa'amuamua sa fa'aogaina i lenei su'esu'ega o lo'o lisiina ile Siata S1.O oloa lelei PCR na faʻasolosolo e le NextSeq 500 faʻasologa faʻasologa (Illumina, San Diego, CA, ISA).Fa'atusatusa fa'asologa o nucleotide e ala i le fa'aogaina o le BLAST i luga o le upega tafa'ilagi a le NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Fa'asologa o fa'asologa fa'asologa (MLST) sa fa'atinoina e pei ona fa'amatalaina i le upegatafa'ilagi a le Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).O genes tausi fale e fitu gapA, infB, mdh, pgi, phoE, rpoB ma tonB na faʻateleina e le PCR ma faʻasologa.Ole ituaiga fa'asologa (ST) e fa'atatau ile fa'atusatusaina o fa'ai'uga fa'asologa ma le MLST database.
Na suʻesuʻeina le homology o Klebsiella pneumoniae.Klebsiella pneumoniae genomic DNA na maua mai e fai ma faʻataʻitaʻiga, ma o faʻamatalaga ERIC o loʻo faʻaalia i le Laulau S1.O le PCR e fa'ateleina le genomic DNA ma fausia se tamatamai lima ole genomic DNA.16 PCR oloa na maua e 2% agarose gel electrophoresis.O fa'ai'uga o le fa'ailoga tamatamai lima na fa'ailoaina i le fa'aogaina o le QuantityOne software band recognition, ma sa fa'atinoina le su'esu'ega fa'a kenera i le fa'aogaina o le unweighted paired group method (UPGMA) o le numera o fuainumera.O mea fa'apitoa e tutusa> 75% e fa'atatauina o le genotype tutusa, ma i latou e tutusa <75% o lo'o ta'ua o genotypes eseese.
Fa'aaogā le pusa fa'akomepiuta fa'afuainumera SPSS mo le Windows 22.0 e iloilo ai fa'amaumauga.O faʻamatalaga o loʻo faʻamatalaina o lona uiga ± tulaga masani (SD).Na su'esu'eina fa'avasegaga e ala ile su'ega chi-square po'o le su'ega sa'o a Fisher.O su'ega fa'afuainumera uma e 2 si'usi'u, ma o le tau o le P <0.05 e fa'atatau i fuainumera taua.
O le Shanghai Fifth People's Hospital e fa'atasi ma le Iunivesite o Fudan na aoina mai le 1081 Klebsiella pneumoniae mai ia Ianuari 1, 2019 e o'o ia Tesema 31, 2020, ma le aofia ai kopi fa'alua mai le ma'i lava e tasi.Faatasi ai ma i latou, o le 392 strains (36.3%) o le hmKP, 341 strains (31.5%) o le CRKP, 39 strains (3.6%) o le CR-hmKP, ma le 16 strains (1.5%) o le CR-hvKP.E taua le maitauina o le 33.3% (13/39) o le CR-hmKP ma le 31.2% (5/16) o le CR-hvKP e mai le 2019, 66.7% (26/39) o le CR-hmKP ma le 68.8% (11/16). ) O le CR-hvKP na vavae ese mai le 2020. Mai sputum (17 strains), urine (12 strains), alavai vai (4 strains), toto (2 strains), pus (2 strains), bile (1 isolation) ma pleural effusion (1 fa'aesea), fa'asologa.E sefulu ma le ono ituaiga o CR-hvKP na maua mai le fuga (9 tu'ufua), mimi (5 tu'ufua), toto (1 tu'ufua) ma pleural effusion (1 tu'ufua).
E ala i le fa'ailoaina o fa'ama'i, fa'ata'ita'iga o vaila'au ma'ale'ale, su'ega o manoa ma le su'esu'eina o kenera e feso'ota'i fa'ama'i, 16 CR-hvKP fa'ata'ita'iga na su'esu'eina.O uiga faʻapitoa o le 16 tagata mamaʻi na aʻafia i le CR-hvKP vavae ese o loʻo aoteleina i le Laulau 1. 13 o le 16 maʻi (81.3%) o tamaʻitaʻi, ma o tagata mamaʻi uma na matutua atu i le 62 tausaga (fuafuaga: 83.1 ± 10.5 tausaga).Na o mai i latou mai le 8 uarota, ma sili atu ma le afa na sau mai le ICU tutotonu (9 mataupu).O faʻamaʻi masani e aofia ai faʻamaʻi o le cerebrovascular (75%, 12/16), toto maualuga (50%, 8/16), faʻamaʻi faʻamaʻi faʻamaʻi (50%, 8/16), ma isi. 16), urinary catheter (37.5%, 6/16), gastric tube (18.8%, 3/16), taotoga (12.5%, 2/16) ma intravenous catheter (6.3%, 1/16).E iva mai le 16 gasegase na maliliu, ma e 7 gasegase na faaleleia ma ua faatea.
O le 39 CR-hmKP vavae ese na vaevaeina i ni vaega se lua e tusa ai ma le umi o le manoa pipii.Faatasi ai ma i latou, 20 CR-hmKP vavae ese ma viscous manoa umi ≤ 25 mm na vaevaeina i le tasi vaega, ma 19 CR-hmKP vavae ese ma viscous manoa umi> 25 mm na vaevaeina i se isi vaega.O le auala PCR e iloa ai le fua faatatau lelei o kenera e feso'ota'i ma virulence rmpA, rmpA2, iutA ma iucA.O fua faatatau lelei o CR-hmKP virulence-related genes i vaega e lua o loʻo faʻaalia i le Laulau 2. E leai se eseesega faʻafuainumera i le fua faatatau lelei o CR-hmKP virulence-fesoʻotaʻiga genes i le va o vaega e lua.
Ole Siata 3 o lo'o lisiina ai fa'amatalaga au'ili'ili ole fa'ama'i fa'ama'i ole vaila'au e 16.16 CR-hvKP fa'ato'ese na fa'aalia le tele o vaila'au tete'e.O mea fa'apitoa uma na togafitia i le ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, ma meropenem e tetee.O le Trimethoprim-sulfamethoxazole e sili ona maualalo le tetee (43.8%), sosoo ai ma le amikacin (62.5%), gentamicin (68.8%) ma le ciprofloxacin (87.5%).
O le tufatufaga o kenera e fesoʻotaʻi ma le virulence, genes resistance antimicrobial, genes serotype capsular ma MLST o 16 CR-hvKP isolates o loʻo faʻaalia i le Ata 1. O taunuʻuga o le electrophoresis gel agarose o nisi o genes e fesoʻotaʻi ma le virulence, genes resistance antimicrobial ma genes serotype capsular e. o loʻo faʻaalia i le Ata 1. Ata 2. Faʻamatalaga MLST o loʻo faʻaalia ai le aofaʻi o 3 STs, ST11 o le ST sili ona lauiloa (87.5%, 14/16), sosoo ai ma ST23 (6.25%, 1/16) ma ST86 (6.25%, 1). /16).E tusa ai ma taunuʻuga o le wzi typing, e 4 ituaiga capsular serotypes na iloa (Ata 1).I totonu o le 16 carbapenem-resistant hvKP isolates, K64 o le serotype sili ona taatele (n=13), sosoo ai ma K1 (n=1), K2 (n=1) ma K47 (n=1).E le gata i lea, o le capsular serotype K1 strain o le ST23, o le capsular serotype K2 strain o le ST86, ma o le 13 strains o totoe o le K64 ma le 1 strain o le K47 o ST11 uma.O fua faatatau lelei o 9 virulence genes i 16 CR-hvKP isolates o loʻo faʻaalia i le Ata 1. , O genes e fesoʻotaʻi ma virulence entB, fimH, rmpA2, iutA, ma iucA o loʻo i ai i 16 CR-hvKP strains, sosoo ai ma mrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2) , AllS (n=1).O le 16 CR-hvKP fa'aesea uma e ave uma le ga'o carbapenemase blaKPC-2 ma le ga'o β-lactamase lautele blaSHV.16 CR-hvKP fa'ato'ese e le'i fa'auluina le carbapenem genes blaNDM, blaVIM, blaIMP, blaOXA-48 ma extended-spectrum β-lactamase genes blaTEM, blaCTX-M-2 vaega, ma blaCTX-M-8 vaega.I totonu o le 16 CR-hvKP strains, 5 strains na tauaveina le extended-spectrum β-lactamase gene blaCTX-M-1 vaega, ma 6 strains na tauaveina le extended-spectrum β-lactamase gene blaCTX-M-9 vaega.
Ata 1 O kenera e feso'ota'i ma le fa'ama'i, kenera fa'aantimicrobial resistance, genes serotype capsular ma le MLST o 16 CR-hvKP tu'ufua.
Ata 2 Agarose gel electrophoresis o nisi o kenera e feso'ota'i ma fa'ama'i, kenera fa'ama'i fa'ama'i ma kenera serotype capsular.
Faʻaaliga: M, faʻailoga 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, S uma (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR na faʻaaogaina e suʻesuʻe ai le homology o 16 CR-hvKP vavae ese.A maeʻa le PCR faʻateleina ma le agarose gel electrophoresis, o loʻo i ai le 3-9 DNA vaega.O fa'ai'uga o tamatamai lima na fa'aalia ai o le 16 CR-hvKP fa'ato'ese e matua'i polymorphic, ma sa iai fo'i le eseesega o va'aiga (Ata 3).
I tausaga talu ai nei, ua tele ma sili atu lipoti i luga ole CR-hvKP tuʻufua.Ole fa'aaliga ole CR-hvKP tu'u'ese'ese e fa'atupu ai se fa'amata'u tele ile soifua maloloina lautele ona e mafai ona fa'atupu fa'ama'i tuga ma faigata ona togafitia i tagata soifua maloloina.I lenei suʻesuʻega, o le faʻateleina ma le molecular epidemiological uiga o le CR-hvKP i se falemaʻi maualuga i Shanghai mai le 2019 i le 2020 na suʻesuʻeina e iloilo pe iai se lamatiaga o le CR-hvKP faʻamaʻi ma lona atinaʻe i lenei vaega.I le taimi lava e tasi, o lenei suʻesuʻega e mafai ona maua ai se suʻesuʻega sili atu ona manino o faʻamaʻi pipisi, lea e taua tele mo le puipuia o le faʻasalalau atili o ia faʻaesea.
O lenei suʻesuʻega na suʻesuʻeina i tua le tufatufaina atu o falemaʻi ma le tulaga o le CR-hvKP mai le 2019 i le 2020. Mai le 2019 i le 2020, o CR-hvKP vavae ese na faʻaalia le faʻatupulaia o tulaga.E tusa ma le 31.2% (5/16) o le CR-hvKP na fa'aesea i le 2019, ma le 68.8% (11/16) o le CR-hvKP na fa'aesea i le 2020, lea e ogatasi ma le aga'i i luga o le CR-hvKP na lipotia i tusitusiga.Talu mai Zhang et al.muamua faamatalaina CR-hvKP i 2015,10 sili atu ma sili atu tusitusiga CR-hvKP ua lipotia, 17-20 aemaise i le itulagi Asia ma le Pasefika, aemaise lava i Saina.O le CR-hvKP o se siama sili ona leaga ma le tele o fualaau faasaina.E afaina ai le soifua maloloina o tagata ma e maualuga le maualuga o le oti.O le mea lea, e tatau ona gauai atu ma e tatau ona faia ni faiga e puipuia ai le sosolo.
Ole su'esu'ega fa'ama'i fa'ama'i ole 16 CR-hvKP na fa'aalia ai le maualuga ole tete'e o vaila'au.O mea fa'apitoa uma na togafitia i le ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, ma meropenem e tetee.O le Trimethoprim-sulfamethoxazole e sili ona maualalo le tetee (43.8%), sosoo ai ma le amikacin (62.5%), gentamicin (68.8%) ma le ciprofloxacin (87.5%).Ole fua faʻatatau ole CR-hmkp suʻesuʻeina e Lingling Zhan ma isi e tutusa ma lenei suʻesuʻega [12].O ma'i ua a'afia i le CR-hvKP e tele fa'ama'i fa'avae, maualalo le puipuiga, ma vaivai tuto'atasi le mafai ona fa'ama'i.O le mea lea, e taua tele togafitiga faʻatatau ile taimi e faʻatatau i faʻaiʻuga o le suʻega faʻamaʻi faʻamaʻi.Afai e mana'omia, e mafai ona maua le nofoaga ua pisia ma togafitia i alavai, fa'amama ma isi auala.
O le 39 CR-hmKP vavae ese na vaevaeina i ni vaega se lua e tusa ai ma le umi o le manoa pipii.Faatasi ai ma i latou, 20 CR-hmKP vavae ese ma viscous manoa umi ≤ 25 mm na vaevaeina i le tasi vaega, ma 19 CR-hmKP vavae ese ma viscous manoa umi> 25 mm na vaevaeina i se isi vaega.O le faʻatusatusaina o fua faatatau lelei o CR-hmKP virulence-related genes i le va o vaega e lua, e leai se eseesega taua i fuainumera i fua faatatau lelei o genes virulence i le va o vaega e lua.Suesuega a Lin Ze et al.na fa'aalia ai o le tulaga lelei o genes virulence o Klebsiella pneumoniae na matua maualuga atu nai lo le masani Klebsiella pneumoniae.21 Ae ui i lea, pe o le fua faatatau lelei o genes virulence e fetaui lelei ma le umi o le filifili pipii e tumau pea le le manino.O isi suʻesuʻega ua faʻaalia ai o le Klebsiella pneumoniae masani e mafai foi ona avea ma Klebsiella pneumoniae sili ona leaga, ma e maualuga atu le maualuga o le maualuga o genes virulence.22 O lenei suʻesuʻega na maua ai o le virulence gene positive rate o le CR-hmKP e leʻo faʻatasi lelei ma le umi o le mucus.Manoa (pe le fa'ateleina i le umi o le manoa pipii).
O tamatamai lima ERIC PCR o lenei suʻesuʻega e polymorphic, ma e leai se faʻasalalauga faʻapitoa i le va o tagata mamaʻi, o lea e 16 tagata mamaʻi e maua i le CR-hvKP faʻamaʻi o ni faʻalavelave faʻafuaseʻi.I le taimi ua tuanaʻi, o le tele o faʻamaʻi pipisi e mafua mai i le CR-hvKP ua lipotia mai o ni tulaga faʻapitoa pe faʻapitoa, 23,24 ma faʻamaʻi laiti o CR-hvKP e seasea i tusitusiga.11,25 ST11 ole ST11 sili ona taatele ile CRKP ma CR-hvKP fa'ato'ese i Saina.26,27 E ui lava o le ST11 CR-hvKP na maua ai le 87.5% (14/16) o le 16 CR-hvKP fa'aesea i lenei su'esu'ega, e le mafai ona manatu o le 14 ST11 CR-hvKP strains e mai le clone tutusa, o lea ERIC PCR fingerprinting. e manaomia.Su'esu'ega Homology.
I lenei suʻesuʻega, o gasegase uma e 16 na aʻafia i le CR-hvKP na faia se taotoga faʻafefe.E tusa ai ma lipoti, o le afaina o le niumonia e fesoʻotaʻi ma ventilator e mafua mai i le CR-hvKP11 o loʻo faʻaalia ai o faiga faʻalavelave e mafai ona faʻateleina ai le lamatiaga o le faʻamaʻi pipisi o le CR-hvKP.I le taimi lava e tasi, e 16 tagata mamaʻi na aʻafia i le CR-hvKP o loʻo i ai faʻamaʻi faʻavae, o faʻamaʻi o le cerebrovascular e sili ona taatele.O se suʻesuʻega talu ai na faʻaalia ai o le faʻamaʻi o le cerebrovascular o se faʻalavelave tutoʻatasi tutoʻatasi mo faʻamaʻi CR-hvKP.28 O le mafuaʻaga o lenei faʻalavelave atonu o le faʻavaivaia o le puipuiga o tagata mamaʻi e maua i le cerebrovascular maʻi, o siama faʻamaʻi e le mafai ona faʻaesea tutoatasi, ma e naʻo lo latou aʻafiaga faʻamaʻi e faʻalagolago i ai.O vaila'au fa'ama'i o le a ta'ita'i atu ai i le tu'ufa'atasiga o le tele o fualaau fa'asaina ma le hypervirulence i se taimi umi.I totonu o le 16 tagata mamaʻi, 9 na maliliu, ma o le numera o maliu e 56.3% (9/16).Ole fua ole maliu e maualuga atu nai lo le 10,12 i suʻesuʻega muamua, ma maualalo ifo nai lo le 11,21 na lipotia i suʻesuʻega muamua.O le averesi o tausaga o 16 maʻi e 83.1 ± 10.5 tausaga, e faʻaalia ai o tagata matutua e sili atu ona aʻafia i le CR-hvKP.O suʻesuʻega muamua na faʻaalia ai o tupulaga talavou e sili atu ona faigofie i faʻamaʻi pipisi.Le leaga ole Klebsiella pneumoniae.29 Ae ui i lea, o isi suʻesuʻega ua faʻaalia ai o tagata matutua e aʻafia i le Klebsiella pneumoniae24,28 sili ona mataʻutia.O lenei suʻesuʻega e ogatasi ma lenei.
I totonu o le 16 CR-hvKP strains, vagana ai le tasi ST23 CR-hvKP ma le tasi ST86 CR-hvKP, o le isi 14 strains o ST11 CR-hvKP uma.O le serotype capsular e fetaui ma ST23 CR-hvKP o le K1, ma le serotype capsular tutusa o ST86 CR-HVKP o le K2, tutusa ma suʻesuʻega muamua.30-32 O ma'i na a'afia i le ST23 (K1) CR-hvKP po'o le ST86 (K2) CR-hvKP na maliliu, ma o le numera o tagata maliliu (100%) na matua maualuga atu nai lo tagata mama'i na maua i le ST11 CR-hvKP (50%).E pei ona faʻaalia i le Ata 1, o le maualuga o le ST23 (K1) poʻo le ST86 (K2) faʻasologa o genes e fesoʻotaʻi ma virulence e maualuga atu nai lo le ST11 (K64).O le maliu e mafai ona fesoʻotaʻi ma le tulaga lelei o genes e fesoʻotaʻi ma virulence.I lenei su'esu'ega, e 16 galu o le CR-hvKP o lo'o tauaveina uma le ga'o carbapenemase blaKPC-2 ma le fa'alauteleina o alaleo β-lactamase gene blaSHV.blaKPC-2 o le gene carbapenemase sili ona taatele i CR-hvKP i Saina.33 I le suʻesuʻega a Zhao et al., 25blaSHV o le faʻalauteleina o alaleo β-lactamase gene ma le maualuga maualuga maualuga.O genes virulence entB, fimH, rmpA2, iutA, ma le iucA o loʻo i ai i vaega uma e 16 CR-hvKP, sosoo ai ma mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), e tutusa ma le suʻesuʻega muamua.34 O nisi suʻesuʻega ua faʻaalia ai o le rmpA ma le rmpA2 (modulators of mucus phenotype genes) e mafai ona faʻalauteleina le faʻaogaina o polysaccharides capsular, e oʻo atu ai i le hypermucoid phenotypes ma faʻateleina le virulence.35 Aerobacterins e fa'ailogaina e le iucABCD gene, ma o latou tali tutusa o lo'o fa'ailogaina e le iutA gene, o lea e maualuga atu ai le fa'ama'i i le su'esu'ega o fa'ama'i pipisi o le G. mellonella.allS o se faʻailoga o le K1-ST23, e le o le pLVPK, pLVPK o se virulence plasmid mai K2 super virulence type.allS o se HTH ituaiga transcription activator.O nei genes virulence ua iloa e saofagā i le faʻaleagaina ma e nafa ma le nofoia, osofaʻiga ma pathogenicity.36
O lenei suʻesuʻega o loʻo faʻamatalaina ai le taatele ma le molecular epidemiology o le CR-hvKP i Shanghai, Saina.E ui lava o le faʻamaʻi pipisi e mafua mai i le CR-hvKP e faʻasolosolo, e faʻateleina i lea tausaga ma lea tausaga.O fa'ai'uga e lagolagoina su'esu'ega talu ai ma fa'aalia ai o le ST11 CR-hvKP o le CR-hvKP sili ona lauiloa i Saina.O le ST23 ma le ST86 CR-hvKP na fa'aalia le maualuga atu o le fa'aleagaina nai lo le ST11 CR-hvKP, e ui lava oi latou uma o Klebsiella pneumoniae e sili ona leaga.A'o fa'atupula'ia le pasene o le Klebsiella pneumoniae sili ona mata'utia, e ono fa'aitiitia le fua o le tete'e o Klebsiella pneumoniae, lea o le a ta'ita'ia ai le fa'amoemoe tauaso ile fa'ata'ita'iga fa'afoma'i.O le mea lea, e manaʻomia le suʻesuʻeina o le faʻaleagaina ma le teteʻeina o vailaʻau o Klebsiella pneumoniae.
O lenei suʻesuʻega na faʻamaonia e le Komiti o Amio Taualoa a le Shanghai Fifth People's Hospital (Nu. 104, 2020).O fa'ata'ita'iga fa'ata'ita'i fa'ata'ita'i o se vaega o fa'ata'ita'iga masani a le falema'i.
Fa'afetai i le aufaigaluega uma a le Central Laboratory o Shanghai Fifth People's Hospital mo le tu'uina atu o ta'iala fa'apitoa mo lenei su'esu'ega.
O lenei galuega na lagolagoina e le Natural Science Foundation a Minhang District, Shanghai (numera faʻamaonia: 2020MHZ039).
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Taimi meli: Iul-15-2021