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Clinical na molecular njirimara nke carbapenem na-eguzogide elu-virulence Klebsiella pneumoniae na ụlọ ọgwụ dị elu na 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 Department of Neurology, Shanghai Fifth People's Hospital, Fudan University kwekọrọ na-ede akwụkwọ: Fang Shen, Department of Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, No. 128 Ruili Road, Minhang District, Shanghai, Postcode 200240 nke ChinaTel +86 18021073261 Email [email protected] Ihe ndabere: Njikọ nke mgbochi carbapenem na hypervirulence na Klebsiella pneumoniae ebutela nnukwu nsogbu ahụike ọha.N'ime afọ ndị na-adịbeghị anya, enweela akụkọ na-arịwanye elu banyere ihe ndị dịpụrụ adịpụ nke Klebsiella pneumoniae (CR-hvKP) na-eguzogide carbapenem.Akụrụngwa na ụzọ: Nyocha azụ azụ nke nyocha data ụlọ ọgwụ nke ndị ọrịa butere CR-hvKP site na Jenụwarị 2019 ruo Disemba 2020 n'ụlọ ọgwụ dị elu.Gbakọọ Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem na-eguzogide Klebsiella pneumoniae (CR-hmKP) na carbapenem na-eguzogide elu-virulence oyi baa anakọtara n'ime afọ 2 Ọnụ ọgụgụ nke iche nke Leberella (CR-hvKP).Nchọpụta PCR nke mkpụrụ ndụ ihe nketa na-eguzogide, mkpụrụ ndụ ihe nketa metụtara nje, mkpụrụ ndụ serotype capsular na ntinye usoro multilocus (MLST) nke CR-hvKP dịpụrụ adịpụ.Nsonaazụ: Ngụkọta nke ụdị 1081 na-abụghị nke Klebsiella pneumoniae na-adịghị emegharị emegharị dịpụrụ adịpụ n'oge ọmụmụ ihe., Gụnyere ụdị 392 nke Klebsiella pneumoniae (36.3%), ụdị 39 nke CR-hmKP (3.6%) na ụdị 16 nke CR-hvKP (1.5%).Ihe dị ka 31.2% (5/16) nke CR-hvKP ga-anọpụ iche na 2019, na ihe dịka 68.8% (11/16) nke CR-hvKP ga-anọpụ iche na 2020. N'ime ụdị 16 CR-hvKP, ụdị 13 bụ ST11. serotype K64, 1 strain bụ ST11 na K47 serotypes, 1 strain bụ ST23 na K1 serotypes, na 1 ụdị bụ ST86 na K2 serotypes.Mkpụrụ ndụ ihe nketa metụtara nje entB, fimH, rmpA2, iutA, na iucA dị na 16 CR-hvKP dịpụrụ adịpụ, sochiri mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).16 CR-hvKP kewapụrụ ihe niile na-ebu mkpụrụ ndụ carbapenemase blaKPC-2 yana agbatị-ụdị β-lactamase gene blaSHV.Nsonaazụ nke akara mkpịsị aka DNA ERIC-PCR gosiri na ụdị 16 CR-hvKP dị oke polymorphic, na eriri nke ụdị ọ bụla dị iche iche nke ukwuu, na-egosi ọnọdụ oge.Mmechi: Ọ bụ ezie na a na-ekesa CR-hvKP obere oge, ọ na-abawanye kwa afọ.afọ.Ya mere, ekwesịrị ịkpalite nlebara anya ụlọ ọgwụ, yana ịkwesịrị ịme ihe ndị dị mkpa iji zere ịgbasa na mgbasa nke superbug CR-hvKP.Keywords: Klebsiella pneumoniae, carbapenem resistance, elu virulence, elu imi, epidemiology
Klebsiella pneumoniae bụ ihe na-akpata ohere nke nwere ike ibute ọrịa dị iche iche, gụnyere oyi baa, ọrịa urinary tract, bacteremia, na meningitis.1 N'ime afọ iri atọ gara aga, n'adịghị ka Klebsiella pneumoniae (cKP) nke kpochapụrụ, ụbụrụ hypermucosal ọhụrụ nke Klebsiella pneumoniae (hvKP) aghọwo ihe na-akpata ọrịa dị mkpa nke ụlọ ọgwụ, nke a na-ahụ na ọrịa na-akpa ike dị ka imeju imeju na-ebute ahụike. na ndị nwere immunocompromised.2 Ọ dị mma ịmara na ọrịa ndị a na-ebutekarị ọrịa na-emebi emebi, gụnyere endphthalmitis na meningitis.3 Mmepụta nke mucosal mucosal phenotype hvKP na-abụkarị n'ihi mmụba nke polysaccharides capsular na ọnụnọ nke mkpụrụ ndụ ihe nketa virulence kpọmkwem, dị ka rmpA na rmpA2.4.A na-ekpebikarị phenotype imi dị elu site na “nnwale eriri”.A na-eji akaghị gbatịa mpaghara Klebsiella pneumoniae nke toro n'otu abalị n'elu efere agar ọbara.Mgbe a na-emepụta eriri viscous nwere ogologo> 5mm, "nnwale ụdọ" dị mma.5 Nnyocha e mere n'oge na-adịbeghị anya gosiri na peg-344, iroB, iucA, rmpA rmpA2 na rmpA2 bụ ihe ndị na-emepụta ihe na-emepụta ihe nke nwere ike ịmata hvkp nke ọma.6 N'ime ọmụmụ ihe a, a kọwapụtara Klebsiella pneumoniae na-efe efe nke ukwuu dị ka onye nwere phenotype viscous nke ukwuu (nyocha ule eriri dị mma) na iburu saịtị Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA) Na 1980s, akọwara ikpe obodo Taiwan na mbụ. -nwetara abscesses imeju nke hvKP kpatara, na-esonyere ya na mmebi akụkụ ahụ siri ike, dị ka meningitis na endphthalmitis.7,8 hvKP nwere mgbasa ozi sporadic n'ọtụtụ mba na Eshia, Europe na America.Ọ bụ ezie na a kọwo ọtụtụ ikpe hvKP na Europe na America, ọnụ ọgụgụ hvKP na-emekarị na mba Eshia, karịsịa China.9
N'ozuzu, hvKP na-enwe mmetụta nke ọma maka ọgwụ nje, ebe Klebsiella pneumonia na-eguzogide carbapenem (CRKP) adịghị egbu egbu.Otú ọ dị, na mgbasawanye nke nguzogide ọgwụ na plasmids virulence, CR-hvKP bu ụzọ kọwaa Zhang et al.na 2015, ma enwere ọtụtụ akụkọ gbasara ụlọ.10 Ebe CR-hvKP nwere ike ibute ọrịa siri ike yana siri ike ịgwọ ọrịa, ọ bụrụ na clone ọrịa na-efe efe pụtara, ọ nwere ike bụrụ “superbug” na-esote.Ka ọ dị ugbu a, ihe ka ọtụtụ n'ọrịa ndị CR-hvKP kpatara na-eme n'oge na-adịghị anya, na obere ntiwapụ dị ụkọ.11,12
Ka ọ dị ugbu a, ọnụọgụ nchọpụta nke CR-hvKP dị ala, ma enwere ọmụmụ ole na ole metụtara ya.Ọrịa ọrịa molekụla nke CR-hvKP dị iche na mpaghara dị iche iche, yabụ ọ dị mkpa ịmụ gbasara nkesa ụlọ ọgwụ na njirimara epidemiological nke CR-hvKP na mpaghara a.Ọmụmụ ihe a nyochachara nke ọma mkpụrụ ndụ ihe nketa na-eguzogide, mkpụrụ ndụ ihe nketa metụtara nje na MLST nke CR-hvKP.Anyị nwara ime nyocha gbasara ọrịa na-efe efe nke CR-hvKP na ụlọ ọgwụ dị elu na Shanghai, ọwụwa anyanwụ China.Ọmụmụ ihe a dị oke mkpa maka ịghọta ọrịa ọrịa molecular nke CR-hvKP na Shanghai.
Klebsiella pneumoniae nke anaghị emegharị emegharị na ụlọ ọgwụ Shanghai Fifth People's Hospital jikọtara na Mahadum Fudan site na Jenụwarị 2019 ruo Disemba 2020 ka anakọtara azụ azụ, na gbakọọ pasenti hmKP, CRKP, CR-hmkp na CR-hvKP.Achọpụtara ihe dịpụrụ adịpụ niile site na VITEK-2 kọmpat akpaaka microbial analyzer (Biomerieux, Marcy L'Etoile, France).Ejiri Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) nyochaa njirimara ụdị nje bacteria.A na-ekpebi phenotype mucus dị elu site na "nnwale eriri".Mgbe imipenem ma ọ bụ meropenem na-eguzogide ọgwụ, a na-ekpebi nguzogide carbapenem site na nyocha nke ike ọgwụ.Akọwapụtara nke ukwuu Klebsiella pneumoniae dị ka inwe nnukwu mucus phenotype (nyocha ule eriri dị mma) na iburu Klebsiella pneumoniae virulence plasmid saịtị (rmpA2, iutA, iucA)6.
A gbanyere otu mpaghara Klebsiella pneumoniae n'efere ọbara atụrụ 5%.Mgbe ịmechara n'abali na 37 Celsius, jiri nwayọọ dọpụta ógbè ahụ site na iji loop inoculating ma kwugharịa ugboro 3.Ọ bụrụ na a na-emepụta eriri viscous ugboro atọ na ogologo ya karịrị 5mm, a na-ewere "nyocha akara" dị mma, na eriri ahụ nwere nnukwu phenotype mucus.
N'ime VITEK-2 kọmpat akpaaka microbial analyzer (Biomerieux, Marcy L'Etoile, France), achọpụtara ihe mgbochi nje na ọtụtụ ọgwụ nje a na-ejikarị eme ihe site na broth microdilution.A tụgharịrị nsonaazụ ya dịka akwụkwọ ntuziaka nke Clinical and Laboratory Standards Institute (CLSI, 2019) mepụtara.E. coli ATCC 25922 na Klebsiella pneumoniae ATCC 700603 ka ejiri mee ihe nchịkwa maka nyocha ihe mgbochi mgbochi.
Genomic DNA nke Klebsiella pneumoniae dịpụrụ adịpụ bụ TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Mkpụrụ ndụ ihe nketa β-lactamase gbasaara (blaCTX-M, blaSHV na blaTEM), mkpụrụ ndụ carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP na blaOXA-48) na mkpụrụ ndụ ihe nketa 9 na-anọchite anya virulence metụtara, gụnyere pLVPK Plasmid dị ka loci (allS, fimH). , mrkD, entB, iutA, rmpA, rmpA2, iucA, na aerobactin) ka PCR kwalitere dịka akọwara mbụ.13,14 Capsular serotype-kpọmkwem mkpụrụ ndụ ihe nketa (K1, K2, K5, K20, K54, na K57) ka PCR kwalitere dịka akọwara n'elu.14 Ọ bụrụ na adịghị mma, gbasaa na usoro wzi mpaghara iji chọpụta mkpụrụ ndụ ihe nketa serotype nke capsular.15 Edepụtara ihe ndị e ji mee ihe n’ọmụmụ ihe na Tebụl S1.Ngwaahịa PCR dị mma bụ usoro usoro usoro nke NextSeq 500 (Illumina, San Diego, CA, USA).Tulee usoro nucleotide site na ịgba ọsọ BLAST na webụsaịtị NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Emere pịnye usoro ọtụtụ saịtị (MLST) dịka akọwara na webụsaịtị Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Mkpụrụ ndụ ihe nketa ụlọ asaa ahụ gapA, infB, mdh, pgi, phoE, rpoB na tonB bụ PCR kwalitere na usoro.A na-ekpebi ụdị usoro (ST) site n'ịtụle nsonaazụ usoro na nchekwa data MLST.
A nyochara homology nke Klebsiella pneumoniae.E weputara Klebsiella pneumoniae genomic DNA dị ka ndebiri, na ERIC primers ka egosiri na Tebụl S1.PCR na-abawanye DNA genomic ma wuo akara mkpịsị aka nke DNA genomic.Achọpụtara ngwaahịa PCR 16 site na 2% agarose gel electrophoresis.Achọpụtara nsonaazụ mkpịsị aka DNA site na iji njirimara sọftụwia QuantityOne, wee mee nyocha mkpụrụ ndụ ihe nketa site na iji usoro otu enweghị oke (UPGMA) nke pụtara mgbakọ.A na-ewere ndị dịpụrụ adịpụ na myirịta> 75% bụ otu genotype, na ndị nwere myirịta <75% ka a na-ewere dị ka genotypes dị iche iche.
Jiri ngwugwu ngwanrọ SPSS maka Windows 22.0 iji nyochaa data ahụ.Akọwara data a dị ka pụtara ± ọkọlọtọ deviation (SD).A tụlere ụdị mgbanwe dị iche iche site na ule chi-square ma ọ bụ nwale Fisher.Nnwale ọnụọgụgụ niile bụ ọdụ 2, yana uru P nke <0.05 ka a na-ewere dị ka ihe dị mkpa.
Hospitallọ ọgwụ ndị mmadụ nke ise nke Shanghai jikọtara na Mahadum Fudan anakọtara 1081 Klebsiella pneumoniae dịpụrụ adịpụ site na Jenụwarị 1, 2019 ruo Disemba 31, 2020, wee wepụrụ iche iche na otu onye ọrịa ahụ.N'ime ha, ụdị 392 (36.3%) bụ hmKP, ụdị 341 (31.5%) bụ CRKP, ụdị 39 (3.6%) bụ CR-hmKP, na ụdị 16 (1.5%) bụ CR-hvKP.Ọ dị mma ịmara na 33.3% (13/39) nke CR-hmKP na 31.2% (5/16) nke CR-hvKP sitere na 2019, 66.7% (26/39) nke CR-hmKP na 68.8% (11/16). ) Ekewapụrụ CR-hvKP site na 2020. Site na sputum (nsogbu iri na asaa), mmamịrị (nsogbu iri na abụọ), mmiri mmiri mmiri (4 strains), ọbara (2 strains), pus (2 strains), bile (1 iche) na pleural effusion. (1 iche), n'otu n'otu.A napụtara ụdị CR-hvKP iri na isii site na sputum (iche 9), mmamịrị (iche iche 5), ọbara (1 iche) na ọbara ọgbụgba (1 iche).
Site na njirimara nhụsianya, nnwale nnabata ọgwụ, ule eriri na nchọpụta mkpụrụ ndụ metụtara nje, 16 CR-hvKP enyocha.A na-achikota njirimara ahụike nke ndị ọrịa 16 nwere ọrịa CR-hvKP dịpụrụ adịpụ na Tebụl 1. 13 nke ndị ọrịa 16 (81.3%) bụ ụmụ nwoke, na ndị ọrịa niile toro karịa afọ 62 (afọ pụtara: 83.1 ± 10.5 afọ).Ha si na ngalaba 8, ihe karịrị ọkara si na Central ICU (ikpe 9).Ọrịa ndị bụ isi na-agụnye ọrịa cerebrovascular (75%, 12/16), ọbara mgbali elu (50%, 8/16), ọrịa na-adịghị ala ala obstructive pulmonary (50%, 8/16), wdg. Ịwa ahụ na-agụnye ikuku ventilashion (62.5%, 10/ 16), catheter urinary (37.5%, 6/16), tube gastric (18.8%, 3/16), ịwa ahụ (12.5%, 2/16) na catheter intravenous (6.3%, 1/16).Mmadụ itoolu n'ime ndị ọrịa 16 nwụrụ, na ndị ọrịa 7 katara mma ma wepụta ya.
E kewara ihe dịpụrụ adịpụ 39 CR-hmKP ụzọ abụọ dịka ogologo eriri nnyapade siri dị.N'ime ha, 20 CR-hmKP dịpụrụ adịpụ na ogologo eriri viscous ≤ 25 mm kewara n'otu otu, na 19 CR-hmKP dịpụrụ adịpụ na ogologo eriri viscous> 25 mm kewara n'ime otu ọzọ.Usoro PCR na-achọpụta ọnụọgụ dị mma nke mkpụrụ ndụ ihe nketa metụtara nje rmpA, rmpA2, iutA na iucA.A na-egosi ọnụọgụ dị mma nke CR-hmKP mkpụrụ ndụ ihe nketa na-emetụta nje na otu abụọ ahụ na Tebụl 2. Ọ dịghị ihe dị iche iche nchịkọta akụkọ dị na ọnụọgụ dị mma nke CR-hmKP na-emetụta mkpụrụ ndụ ihe nketa n'etiti ìgwè abụọ ahụ.
Tebụlụ 3 depụtara nkọwapụta profaịlụ mgbochi mgbochi nke ọgwụ iri na isii ahụ.16 CR-hvKP dịpụrụ adịpụ gosipụtara nguzogide ọtụtụ ọgwụ.A na-eji ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, na meropenem na-eguzogide ọgwụ.Trimethoprim-sulfamethoxazole nwere ọnụego nguzogide kacha ala (43.8%), sochiri amikacin (62.5%), gentamicin (68.8%) na ciprofloxacin (87.5%).
E gosipụtara nkesa nke mkpụrụ ndụ ihe nketa metụtara nje, mkpụrụ ndụ ihe mgbochi antimicrobial, mkpụrụ ndụ serotype capsular na MLST nke 16 CR-hvKP dịpụrụ adịpụ na eserese 1. Nsonaazụ nke agarose gel electrophoresis nke ụfọdụ mkpụrụ ndụ ihe nketa metụtara nje, mkpụrụ ndụ ihe mgbochi mgbochi na mkpụrụ ndụ serotype capsular bụ. egosiri na eserese 1. Ihe onyonyo 2. Nyocha MLST na-egosi ngụkọta nke 3 ST, ST11 bụ ST kachasị ike (87.5%, 14/16), sochiri ST23 (6.25%, 1/16) na ST86 (6.25%, 1). /16).Dịka nsonaazụ nke mpịnye wzi siri dị, 4 dị iche iche serotypes capsular ka achọpụtara (Njirimara 1).N'ime 16 carbapenem na-eguzogide hvKP dịpụrụ adịpụ, K64 bụ serotype kachasị (n=13), sochiri K1 (n=1), K2 (n=1) na K47 (n=1).Na mgbakwunye, eriri serotype K1 capsular bụ ST23, eriri serotype K2 capsular bụ ST86, na ụdị 13 fọdụrụnụ nke K64 na 1 ụdị nke K47 bụ ST11.A na-egosi ọnụọgụ dị mma nke mkpụrụ ndụ ihe nketa 9 na 16 CR-hvKP dịpụrụ adịpụ na Figure 1. 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n=1).16 CR-hvKP kewapụrụ ihe niile na-ebu mkpụrụ ndụ carbapenemase blaKPC-2 yana agbatị-ụdị β-lactamase gene blaSHV.16 CR-hvKP dịpụrụ adịpụ eburughị mkpụrụ ndụ carbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 na ụdị β-lactamase genes blaTEM, blaCTX-M-2, na blaCTX-M-8 otu.N'ime ụdị 16 CR-hvKP, ụdị 5 na-ebu ụdị β-lactamase gene blaCTX-M-1 gbatịrị agbatị, na ụdị 6 bu otu β-lactamase gene blaCTX-M-9 gbatịrị agbatị.
Ọgụgụ 1 Mkpụrụ ndụ ihe nketa metụtara nje, mkpụrụ ndụ ihe mgbochi mgbochi, mkpụrụ ndụ serotype capsular na MLST nke 16 CR-hvKP kewapụrụ.
Ọgụgụ 2 Agarose gel electrophoresis nke ụfọdụ mkpụrụ ndụ ihe nketa metụtara nje, mkpụrụ ndụ ihe mgbochi mgbochi na mkpụrụ ndụ serotype capsular.
Mara: M, akara 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 niile (508bp);11, mrkD (340bp);12, fimH (609bp).
Ejiri ERIC-PCR nyochaa homology nke iche iche 16 CR-hvKP.Mgbe nkwalite PCR na agarose gel electrophoresis gasịrị, enwere iberibe DNA 3-9.Nsonaazụ mkpisi aka gosiri na 16 CR-hvKP dịpụrụ adịpụ bụ nnukwu polymorphic, na enwere ọdịiche pụtara ìhè n'etiti ndị dịpụrụ adịpụ (Nyocha 3).
N'afọ ndị na-adịbeghị anya, enweela akụkọ na-arịwanye elu na mpụ CR-hvKP.Ọdịdị nke CR-hvKP kewapụrụ iche na-etinye nnukwu ihe iyi egwu na ahụike ọha n'ihi na ha nwere ike ibute ọrịa siri ike, siri ike ịgwọ ndị nwere ahụike.N'ime ọmụmụ ihe a, a mụọ gbasara mgbasa na ọrịa mkpụrụ ndụ nke CR-hvKP n'ụlọ ọgwụ dị na Shanghai site na 2019 ruo 2020 iji chọpụta ma enwere ihe egwu nke ntiwapụ CR-hvKP na mmepe mmepe ya na mpaghara a.N'otu oge ahụ, ọmụmụ ihe a nwere ike inye nyocha zuru oke nke ọrịa ọrịa ụlọ ọgwụ, nke dị oke mkpa maka igbochi mgbasawanye nke ndị dị otú ahụ.
Ọmụmụ ihe a tụgharịrị nyochagharị nkesa na omume nke CR-hvKP site na 2019 ruo 2020. Site na 2019 ruo 2020, iche iche CR-hvKP gosipụtara omume na-abawanye.Ihe dị ka 31.2% (5/16) nke CR-hvKP dịpụrụ adịpụ na 2019, yana 68.8% (11/16) nke CR-hvKP dịpụrụ adịpụ na 2020, nke kwekọrọ na nrịgo elu nke CR-hvKP kọrọ na akwụkwọ.Ebe ọ bụ na Zhang et al.Nke mbụ kọwara CR-hvKP na 2015,10 ka a kọwapụtala akwụkwọ CR-hvKP, 17-20 tumadi na mpaghara Eshia-Pacific, ọkachasị na China.CR-hvKP bụ nnukwu nje bacteria nwere nnukwu ike na-eguzogide ọgwụ na ọtụtụ ọgwụ.Ọ na-emerụ ahụ ike ndị mmadụ ma nwee ọnụ ọgụgụ ọnwụ dị elu.Ya mere, ekwesịrị itinye nlebara anya ma mee ihe iji gbochie mgbasa ya.
Ntụle mgbochi ọgwụ mgbochi nke 16 CR-hvKP dịpụrụ adịpụ gosipụtara ọnụ ọgụgụ dị elu nke nguzogide nje.A na-eji ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, na meropenem na-eguzogide ọgwụ.Trimethoprim-sulfamethoxazole nwere ọnụego nguzogide kacha ala (43.8%), sochiri amikacin (62.5%), gentamicin (68.8%) na ciprofloxacin (87.5%).Ọnụego nguzogide nke CR-hmkp nke Lingling Zhan na-amụ na ndị ọzọ yiri ihe ọmụmụ a [12].Ndị ọrịa butere CR-hvKP nwere ọtụtụ ọrịa ndị bụ isi, ihe mgbochi dị ala, yana ike ịgba ọgwụ mgbochi onwe ha adịghị ike.Ya mere, ọgwụgwọ oge na-adabere na nsonaazụ nke ule mmetụta uche antimicrobial dị ezigbo mkpa.Ọ bụrụ na ọ dị mkpa, enwere ike ịchọta ebe ọrịa ahụ ma gwọọ ya site na drainage, debridement na ụzọ ndị ọzọ.
E kewara ihe dịpụrụ adịpụ 39 CR-hmKP ụzọ abụọ dịka ogologo eriri nnyapade siri dị.N'ime ha, 20 CR-hmKP dịpụrụ adịpụ na ogologo eriri viscous ≤ 25 mm kewara n'otu otu, na 19 CR-hmKP dịpụrụ adịpụ na ogologo eriri viscous> 25 mm kewara n'ime otu ọzọ.N'ịtụle ọnụ ọgụgụ dị mma nke mkpụrụ ndụ ihe nketa CR-hmKP dị n'etiti otu abụọ ahụ, ọ dịghị ihe dị iche iche dị ịrịba ama na ọnụ ọgụgụ dị mma nke mkpụrụ ndụ ihe nketa n'etiti ìgwè abụọ ahụ.Nnyocha nke Lin Ze et al.gosiri na ọnụ ọgụgụ dị mma nke mkpụrụ ndụ ihe nketa virulence nke Klebsiella pneumoniae dị elu nke ukwuu karịa nke Klebsiella pneumoniae kpochapụwo.21 Otú ọ dị, ma ọ̀tụ̀tụ̀ dị mma nke mkpụrụ ndụ ihe nketa virulence na-ejikọta ya na ogologo yinye nyapayịrị ka amabeghị.Nnyocha ndị ọzọ egosila na Klebsiella pneumoniae kpochapụwo nwekwara ike bụrụ ihe na-akpata ọrịa Klebsiella pneumoniae nke ukwuu, yana ọnụ ọgụgụ dị elu nke mkpụrụ ndụ ihe nketa virulence.22 Ihe omumu a choputara na onu ogugu ihe omuma nke CR-hmKP adighi ejikọta ya na ogologo imi.Ụdọ (ma ọ bụ na-adịghị abawanye na ogologo nke nnyapade eriri).
Mkpịsị aka ERIC PCR nke ọmụmụ ihe a bụ polymorphic, ọ nweghịkwa crossover ụlọ ọgwụ n'etiti ndị ọrịa, ya mere, ndị ọrịa 16 nwere ọrịa CR-hvKP bụ ndị na-adịghị ahụ anya.N'oge gara aga, a na-akọ ọtụtụ ọrịa ndị CR-hvKP kpatara dị ka ndị dịpụrụ adịpụ ma ọ bụ oge, 23,24 na obere ntiwapụ nke CR-hvKP dị ụkọ na akwụkwọ.11,25 ST11 bụ ST11 kachasị na CRKP na CR-hvKP dịpụrụ adịpụ na China.26,27 Ọ bụ ezie na ST11 CR-hvKP nwetara 87.5% (14/16) nke 16 CR-hvKP dịpụrụ adịpụ na ọmụmụ ihe a, a pụghị iche na ụdị 14 ST11 CR-hvKP sitere na otu mmepụta ihe, ya mere, akara mkpịsị aka ERIC PCR. ihe achọrọ.Nyocha nke homology.
N'ime ọmụmụ ihe a, ndị ọrịa 16 niile bu ọrịa CR-hvKP nwere ịwa ahụ.Dị ka akụkọ si kwuo, ntiwapụ na-egbu egbu nke oyi oyi metụtara ventilashị nke CR-hvKP11 kpatara na-egosi na usoro mmegide nwere ike ịbawanye ohere nke ọrịa CR-hvKP.N'otu oge ahụ, ndị ọrịa 16 bu ọrịa CR-hvKP nwere ọrịa ndị na-akpata, bụ nke ọrịa cerebrovascular na-adịkarị.Nnyocha e mere n'oge gara aga gosiri na ọrịa cerebrovascular bụ nnukwu ihe ize ndụ nke onwe maka ọrịa CR-hvKP.28 Ihe kpatara ihe omume a nwere ike ịbụ mgbochi na-adịghị ike nke ndị ọrịa nwere ọrịa cerebrovascular, nje bacteria na-akpata enweghị ike iwepụ onwe ha, na naanị mmetụta nje ha na-adabere.Ọgwụ nje ga-eduga na nchikota nke ọtụtụ ọgwụ mgbochi na hypervirulence n'ikpeazụ.N'ime ndị ọrịa 16 ahụ, 9 nwụrụ, yana ọnụ ọgụgụ ndị nwụrụ anwụ bụ 56.3% (9/16).Ọnụ ọgụgụ ndị nwụrụ anwụ dị elu karịa 10,12 na ọmụmụ ihe gara aga, ma dị ala karịa 11,21 kọrọ na ọmụmụ gara aga.Nkezi afọ nke ndị ọrịa 16 bụ 83.1 ± 10.5 afọ, na-egosi na ndị agadi na-enwekarị ike ịnweta CR-hvKP.Nnyocha ndị gara aga gosiri na ndị na-eto eto na-enwekarị ike ibute ọrịa.Ọrịa nke Klebsiella pneumoniae.29 Otú ọ dị, nchọpụta ndị ọzọ egosiwo na ndị agadi na-enwe ike ịnweta ọrịa Klebsiella pneumoniae24,28 nke ukwuu.Ọmụmụ ihe a dabara na nke a.
N'ime ụdị 16 CR-hvKP, ewezuga otu ST23 CR-hvKP na otu ST86 CR-hvKP, ụdị iri na anọ ndị ọzọ bụ ST11 CR-hvKP.The capsular serotype kwekọrọ na ST23 CR-hvKP bụ K1, yana serotype capsular kwekọrọ na ST86 CR-HVKP bụ K2, yiri ọmụmụ gara aga.30-32 Ndị ọrịa butere ST23 (K1) CR-hvKP ma ọ bụ ST86 (K2) CR-hvKP nwụrụ, ọnụọgụ ọnwụ (100%) dị elu karịa nke ndị ọrịa butere ST11 CR-hvKP (50%).Dị ka egosiri na eserese 1, ọnụọgụ dị mma nke ST23 (K1) ma ọ bụ ST86 (K2) nke mkpụrụ ndụ ihe nketa metụtara nje dị elu karịa nke ST11 (K64).Ọnwụ ahụ nwere ike jikọta ya na ọnụọgụ dị mma nke mkpụrụ ndụ ihe nketa metụtara nje.N'ime ọmụmụ ihe a, ụdị 16 nke CR-hvKP niile na-ebu mkpụrụ ndụ carbapenemase blaKPC-2 na agbatị-ụdị β-lactamase gene blaSHV.blaKPC-2 bụ mkpụrụ ndụ carbapenemase kachasị na CR-hvKP na China.33 N'ime ọmụmụ nke Zhao et al., 25blaSHV bụ mkpụrụ ndụ β-lactamase nke gbatịrị agbatị nke nwere oke dị mma.Mkpụrụ ndụ ihe nketa entB, fimH, rmpA2, iutA, na iucA dị na mpaghara 16 CR-hvKP, sochiri mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), nke yiri ọmụmụ ihe gara aga.34 Ụfọdụ ọmụmụ egosila na rmpA na rmpA2 (modulators nke mucus phenotype genes) nwere ike ịkwalite nzuzo nke polysaccharides capsular, na-eduga na hypermucoid phenotypes na ịba ụba virulence.35 Aerobacterins na-etinye koodu site na iucABCD gene, na ndị na-anabata ha homologous bụ nke iutA gene na-echekwa ha, ya mere ha nwere ọkwa dị elu nke virulence na G. mellonella ọrịa assay.allS bụ akara nke K1-ST23, ọ bụghị na pLVPK, pLVPK bụ plasmid virulence sitere na ụdị K2 super virulence.allS bụ onye na-arụ ọrụ ntụgharị ụdị HTH.A maara mkpụrụ ndụ ihe nketa virulence ndị a ka ha na-enye aka na virulence ma na-ahụ maka ịchịisi, mbuso agha na pathogenicity.36
Ọmụmụ ihe a na-akọwa oke na ọrịa nje nke CR-hvKP na Shanghai, China.Ọ bụ ezie na ọrịa CR-hvKP na-akpata na-adịte aka, ọ na-abawanye kwa afọ.Nsonaazụ na-akwado nyocha gara aga wee gosi na ST11 CR-hvKP bụ CR-hvKP kacha ewu ewu na China.ST23 na ST86 CR-hvKP gosiri elu virulence karịa ST11 CR-hvKP, ọ bụ ezie na ha abụọ bụ nnukwu ọrịa Klebsiella pneumoniae.Ka pasent nke Klebsiella pneumoniae na-efe efe nke ukwuu na-abawanye, ọnụego nguzogide nke Klebsiella pneumoniae nwere ike ibelata, nke ga-eduga na nchekwube kpuru ìsì na omume ụlọ ọgwụ.Ya mere, ọ dị mkpa iji mụọ ọrịa na-adịghị mma na ọgwụ mgbochi nke Klebsiella pneumoniae.
Kọmiti ụkpụrụ ahụike ahụike nke ụlọ ọgwụ ndị mmadụ ise nke Shanghai (Mba 104, 2020) kwadoro ọmụmụ a.Ihe nlele ụlọọgwụ bụ akụkụ nke usoro ụlọ nyocha ụlọ ọgwụ na-aga n'ihu.
Daalụ ndị ọrụ niile nke Central Laboratory nke Shanghai Fifth People's Hospital maka inye ntụzịaka nka maka ọmụmụ ihe a.
Ndị ọrụ Natural Science Foundation nke Minhang District, Shanghai kwadoro ọrụ a (nọmba nkwenye: 2020MHZ039).
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Oge nzipu: Jul-15-2021