Litšobotsi tsa bongaka le limolek'hule tsa Hypervi e hanyetsanang le carbapenem

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Litšobotsi tsa bongaka le limolek'hule tsa klebsiella pneumoniae e hanyetsanang le carbapenem sepetleleng sa thuto e phahameng ea 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 Lefapha la Clinical Laboratory Medicine, Shanghai Fifth People's Hospital, Fudan University, Shanghai, People's Republic of China;2 Shanghai Jiaotong Lefapha la Bongaka ba Laboratori, Sepetlele sa Bana sa Shanghai, Shanghai, People's Republic of China;3 Lefapha la Neurology, Sepetlele sa Bohlano sa Shanghai sa Batho, Univesithi ea Fudan Sengoli se lumellanang: Fang Shen, Lefapha la Clinical Laboratory Medicine, Sepetlele sa Bohlano sa Batho ba Shanghai, Univesithi ea Fudan, No. 128 Ruili Road, Setereke sa Minhang, Shanghai, Postcode 200240 ea ChinaTel +86 18061073 Email [email protected] Background: Ho kopanngoa ha carbapenem resistance le hypervirulence ho Klebsiella pneumoniae ho lebisitse ho mathata a maholo a bophelo bo botle ba sechaba.Lilemong tsa morao tjena, ho bile le litlaleho tse ngata mabapi le lik'hemik'hale tse hanyetsanang le carbapenem Klebsiella pneumoniae (CR-hvKP) e isolates.Lisebelisoa le mekhoa: Tlhahlobo ea morao-rao ea tlhahlobo ea data ea kliniki ea bakuli ba tšoaelitsoeng ke CR-hvKP ho tloha ka Pherekhong 2019 ho fihlela ka Tšitoe 2020 sepetleleng sa thuto e phahameng.Bala Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), Klebsiella pneumoniae e hanyetsanang le carbapenem (CR-hmKP) le pneumonia e hanyetsanang le carbapenem e phahameng e bokeletsoeng nakong ea lilemo tse 2 Palo ea li-isolates tsa Leberella (CR-hvKP).Ho lemoha PCR ea liphatsa tsa lefutso tsa ho hanyetsa, liphatsa tsa lefutso tse amanang le likokoana-hloko, liphatsa tsa lefutso tsa capsular serotype le multilocus sequence typing (MLST) ea li-isolates tsa CR-hvKP.Liphello: Kakaretso ea mefuta ea 1081 e sa phete-phetoang ea Klebsiella pneumoniae e ile ea aroloa nakong ea thuto., Ho kenyeletsoa mefuta e 392 ea Klebsiella pneumoniae (36.3%), mefuta e 39 ea CR-hmKP (3.6%) le mefuta e 16 ea CR-hvKP (1.5%).Hoo e ka bang 31.2% (5/16) ea CR-hvKP e tla aroloa ka 2019, 'me hoo e ka bang 68.8% (11/16) ea CR-hvKP e tla aroloa ka 2020. Har'a mefuta e 16 ea CR-hvKP, mefuta e 13 ke ST11 le ST11. serotype K64, 1 strain ke ST11 le K47 serotypes, mofuta o le mong ke ST23 le K1 serotypes, mme mofuta o le mong ke ST86 le K2 serotypes.Liphatsa tsa lefutso tse amanang le vaerase entB, fimH, rmpA2, iutA, le iucA li teng likarolong tsohle tse ka thoko tse 16 tsa CR-hvKP, li lateloe ke mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).16 CR-hvKP e itšehla thajana kaofela e na le mofuta oa carbapenemase blaKPC-2 le mofuta o atolositsoeng oa β-lactamase blaSHV.Liphello tsa khatiso ea menoana ea ERIC-PCR DNA e bontšitse hore mefuta ea 16 CR-hvKP e ne e le polymorphic haholo, 'me lihlopha tsa mofuta o mong le o mong li ne li fapane haholo, li bontša boemo ba nakoana.Qetello: Leha CR-hvKP e ajoa khafetsa, e ntse e eketseha selemo le selemo.selemo.Ka hona, tlhokomelo ea bongaka e lokela ho tsosoa, 'me mehato e hlokahalang e lokela ho nkoa ho qoba ho kopanya le ho ata ha superbug CR-hvKP.Mantsoe a bohlokoa: Klebsiella pneumoniae, carbapenem resistance, high virulence, mucus e phahameng, lefu la seoa
Klebsiella pneumoniae ke kokoana-hloko e nkang monyetla e ka bakang mafu a fapaneng, ho kenyelletsa pneumonia, tšoaetso ea moroto, bacteremia le meningitis.1 Lilemong tse mashome a mararo tse fetileng, ho fapana le Klebsiella pneumoniae (cKP), klebsiella pneumoniae (hvKP) hypermucosal mucus e ncha e kotsi haholo e fetohile kokoana-hloko ea bohlokoa ea bophelo bo botle, e ka fumanoang ho mafu a matla a kang sebete a bakoang ke bophelo bo botle. le batho ba nang le immunocompromised.2 Ke habohlokoa ho hlokomela hore mafu ana hangata a tsamaisana le tšoaetso e senyang e hasang, ho akarelletsa endophthalmitis le meningitis.3 Ho hlahisoa ha li-mucosal mucosal phenotype hvKP hangata ho bakoa ke ho eketseha ha tlhahiso ea capsular polysaccharides le ho ba teng ha liphatsa tsa lefutso tse khethehileng, tse kang rmpA le rmpA2.4.The mucus phenotype e phahameng hangata e khethoa ke "teko ea likhoele".Likolone tsa Klebsiella pneumoniae tse hōlileng ka bosiu bo le bong holim'a lipoleiti tsa mali tsa agar li otlolloa ka loop.Ha thapo ea viscous e bolelele ba> 5mm e thehoa, "teko ea thapo" e ntle.5 Phuputso ea morao tjena e bontšitse hore peg-344, iroB, iucA, rmpA rmpA2 le rmpA2 ke li-biomarker tse ka khethollang hvkp ka nepo.6 Phuputsong ena, Klebsiella pneumoniae e kotsi haholo e hlalositsoe e na le mucus viscous phenotype (sephetho se setle sa tlhahlobo ea khoele) le ho jara libaka tse amanang le Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA) Lilemong tsa bo-1980, nyeoe ea Taiwan e tlaleha pele ho hlalosa sechaba. - li-abscesses tse fumanoeng sebeteng tse bakoang ke hvKP, tse tsamaeang le tšenyo e matla ea setho sa ho qetela, tse kang meningitis le endophthalmitis.7,8 hvKP e na le phetiso ea nakoana linaheng tse ngata tsa Asia, Europe le Amerika.Le hoja ho tlalehiloe linyeoe tse 'maloa tsa hvKP Europe le Amerika, ho ata ha hvKP haholo-holo ho etsahetse linaheng tsa Asia, haholo-holo Chaena.9
Ka kakaretso, hvKP e ameha haholo ho lithibela-mafu, athe Klebsiella pneumonia (CRKP) e hanyetsanang le carbapenem ha e na chefo e fokolang.Leha ho le joalo, ka ho ata ha ho hanyetsa lithethefatsi le li-plasmids tsa virulence, CR-hvKP e qalile ho hlalosoa ke Zhang et al.ka 2015, mme ho na le litlaleho tse ngata tsa lehae.10 Kaha CR-hvKP e ka baka mafu a tebileng le ao ho leng thata ho a phekola, haeba lefu la seoa le hlaha, e ka ba "superbug" e latelang.Ho fihlela joale, mafu a mangata a bakoang ke CR-hvKP a hlahile maemong a nakoana, 'me ho qhoma ha likokoana-hloko tse nyenyane ha hoa tloaeleha.11,12
Hajoale, sekhahla sa ho lemoha CR-hvKP se tlase, 'me ho na le lithuto tse fokolang tse amanang.Epidemiology ea limolek'hule ea CR-hvKP e fapane libakeng tse fapaneng, kahoo hoa hlokahala ho ithuta kabo ea bongaka le litšobotsi tsa lefu la limolek'hule tsa CR-hvKP sebakeng sena.Phuputso ena e hlahlobile ka botlalo mefuta ea ho hanyetsa, liphatsa tsa lefutso tse amanang le likokoana-hloko le MLST ea CR-hvKP.Re lekile ho batlisisa ka ho ata le lefu la seoa la limolek'hule tsa CR-hvKP sepetleleng sa thuto e phahameng Shanghai, ka bochabela ho China.Thuto ena e bohlokoa haholo bakeng sa ho utloisisa lefu la seoa la limolek'hule tsa CR-hvKP Shanghai.
Klebsiella pneumoniae e sa iphetang e itšehla thajana ho tsoa Sepetleleng sa Bohlano sa Batho sa Shanghai se ikopantseng le Univesithi ea Fudan ho tloha Pherekhong 2019 ho fihlela ka Tšitoe 2020 li ile tsa bokelloa ka morao, 'me liperesente tsa hmKP, CRKP, CR-hmkp le CR-hvKP li ile tsa baloa.Li-isolates kaofela li ile tsa khetholloa ke VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France).Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) e ne e sebelisetsoa ho hlahloba bocha ho khetholla mefuta ea baktheria.The mucus phenotype e phahameng e khethoa ke "teko ea likhoele".Ha imipenem kapa meropenem e hanyetsa, khanyetso ea carbapenem e khethoa ka tlhahlobo ea ho ba le lithethefatsi.Klebsiella pneumoniae e kotsi haholo e hlalosoa e le ho ba le mucus phenotype e phahameng (sephetho se setle sa tlhahlobo ea khoele) le ho jara libaka tse amanang le plasmid tsa Klebsiella pneumoniae (rmpA2, iutA, iucA)6.
Kolone e le 'ngoe ea Klebsiella pneumoniae e ne e entiloe holim'a poleiti ea mali ea linku ea 5%.Ka mor'a hore u emise bosiu bo le bong ka 37 ° C, ka bonolo u hule kolone ka loop ea inoculating 'me u phete makhetlo a 3.Haeba mohala oa viscous o etsoa ka makhetlo a mararo 'me bolelele bo feta 5mm, "teko ea mohala" e nkoa e le ntle,' me khatello e na le phenotype e phahameng ea mucus.
Ho VITEK-2 compact automatic microbial analyzer (Biomerieux, Marcy L'Etoile, France), ts'oaetso ea antimicrobial ho lithibela-mafu tse 'maloa tse sebelisoang hangata e ile ea bonoa ka ho hlapolloa ha moro.Liphetho li hlalosoa ho latela tokomane ea tataiso e ntlafalitsoeng ke Clinical and Laboratory Standards Institute (CLSI, 2019).E. coli ATCC 25922 le Klebsiella pneumoniae ATCC 700603 li ile tsa sebelisoa e le taolo bakeng sa tlhahlobo ea ts'oaetso ea likokoana-hloko.
Genomic DNA ea li-isolates tsohle tsa Klebsiella pneumoniae li ile tsa ntšoa ke TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, Chaena).Liphatsa tsa lefutso tsa β-lactamase tse atolositsoeng (blaCTX-M, blaSHV le blaTEM), liphatsa tsa lefutso tsa carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP le blaOXA-48) le liphatsa tsa lefutso tse 9 tse amanang le virulence, ho kenyeletsoa pLVPK Plasmid-like fimHS, ka kakaretso. , mrkD, entB, iutA, rmpA, rmpA2, iucA, le aerobactin) li ile tsa matlafatsoa ke PCR joalokaha ho hlalositsoe pele.Liphatsa tsa lefutso tsa 13,14 Capsular serotype-specific (K1, K2, K5, K20, K54, le K57) li ile tsa phahamisoa ke PCR joalokaha ho hlalositsoe ka holimo.14 Ha e le mpe, holisa le ho hlophisa sebaka sa wzi ho fumana hore na ke liphatsa tsa lefutso tse khethehileng tsa serotype.15 Litlhaku tse sebelisitsoeng thutong ena li thathamisitsoe ho Lethathamo la S1.Lihlahisoa tse ntle tsa PCR li ne li hlophisitsoe ke sethala sa tatellano sa NextSeq 500 (Illumina, San Diego, CA, USA).Bapisa tatellano ea li-nucleotide ka ho sebelisa BLAST webosaeteng ea NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Ho ngola ka tatellano ea libaka tse ngata (MLST) ho entsoe joalo ka ha ho hlalositsoe webosaeteng ea Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Liphatsa tsa lefutso tse supileng tsa ho boloka ntlo gapA, infB, mdh, pgi, phoE, rpoB le tonB li ile tsa holisoa ke PCR le ho latellana.Mofuta oa tatelano (ST) o khethoa ka ho bapisa liphetho tsa tatelano le polokelong ea MLST.
Homology ea Klebsiella pneumoniae e ile ea hlahlojoa.Klebsiella pneumoniae genomic DNA e ile ea ntšoa e le template, 'me li-primer tsa ERIC li bontšoa ho Lethathamo la S1.PCR e holisa genomic DNA mme e etsa monoana oa DNA ea genomic.Lihlahisoa tse 16 tsa PCR li ile tsa fumanoa ke 2% ea agarose gel electrophoresis.Liphetho tsa menoana ea DNA li ile tsa khetholloa ho sebelisoa QuantityOne software band recognition, 'me tlhahlobo ea liphatsa tsa lefutso e ile ea etsoa ho sebelisoa mokhoa oa sehlopha se se nang boima ba 'mele (UPGMA) oa lipalo tsa lipalo.Li-isolates tse nang le ho tšoana> 75% li nkoa e le liphatsa tsa lefutso tse tšoanang, 'me tse nang le ho tšoana <75% li nkoa e le li-genotype tse fapaneng.
Sebelisa sephutheloana sa software ea lipalo SPSS bakeng sa Windows 22.0 ho sekaseka lintlha.Lintlha li hlalosoa e le ± kheloha e tloaelehileng (SD).Likarolo tse fapaneng li ile tsa hlahlobjoa ka tlhahlobo ea chi-square kapa tlhahlobo e nepahetseng ea Fisher.Liteko tsohle tsa lipalo li na le mehatla e 2, 'me boleng ba P ba <0.05 bo nkuoa bo le bohlokoa ho latela lipalo.
Sepetlele sa Shanghai sa Bohlano sa Batho se ikopantseng le Univesithi ea Fudan se ile sa bokella tse 1081 tsa Klebsiella pneumoniae ho tloha ka la 1 Pherekhong 2019 ho fihlela la 31 Tšitoe 2020, 'me tsa qhelela ka thoko likheo tse qotsitsoeng ho tsoa ho mokuli a le mong.Har'a bona, mefuta ea 392 (36.3%) e ne e le hmKP, mefuta ea 341 (31.5%) e ne e le CRKP, mefuta ea 39 (3.6%) e ne e le CR-hmKP, le mefuta ea 16 (1.5%) e ne e le CR-hvKP.Ho bohlokoa ho hlokomela hore 33.3% (13/39) ea CR-hmKP le 31.2% (5/16) ea CR-hvKP e tsoa ka 2019, 66.7% (26/39) ea CR-hmKP le 68.8% (11/16). ) CR-hvKP e ne e arohane le 2020. Ho tloha ho sekhohlela (lihlopha tse 17), moroto (li-12 strains), mokelikeli oa metsi (4 strains), mali (2 strains), pus (2 strains), bile (1 isolation) le pleural effusion. (1 ho itšehla thajana), ka ho latellana.Mefuta e leshome le metso e tšeletseng ea CR-hvKP e ile ea fumanoa ho tsoa ho sekhohlela (9 isolates), moroto (5 isolate), mali (1 isolate) le pleural effusion (1 isolate).
Ka ho tsebahatsa mathata, tlhahlobo ea kutloisiso ea lithethefatsi, tlhahlobo ea likhoele le ho lemoha liphatsa tsa lefutso tse amanang le likokoana-hloko, mefuta e 16 ea CR-hvKP e ile ea hlahlojoa.Litšobotsi tsa kliniki tsa bakuli ba 16 ba tšoaelitsoeng ke li-isolate tsa CR-hvKP li akaretsoa ho Lethathamo la 1. 13 ea bakuli ba 16 (81.3%) e ne e le banna, 'me bakuli bohle ba ne ba le lilemo li 62 (lilemo tse bolelang: 83.1 ± 10.5 lilemo).Ba tsoa mabaleng a 8, mme ba fetang halofo ba tsoa ICU e bohareng (linyeoe tse 9).Mafu a mantlha a kenyelletsa lefu la cerebrovascular (75%, 12/16), khatello ea mali (50%, 8/16), lefu le sa foleng la pulmonary (50%, 8/16), joalo-joalo. 16), catheter ea moroto (37.5%, 6/16), gastric tube (18.8%, 3/16), opereishene (12.5%, 2/16) le catheter ea methapo (6.3%, 1/16).Bakuli ba robong ho ba 16 ba ile ba hlokahala, ’me bakuli ba 7 ba ile ba ntlafala ’me ba lokolloa sepetlele.
Likarolo tsa 39 CR-hmKP li ne li arotsoe ka lihlopha tse peli ho ea ka bolelele ba khoele e khomarelang.Har'a bona, li-20 CR-hmKP tse arohaneng tse nang le bolelele ba khoele ea viscous ≤ 25 mm li arotsoe ka sehlopha se le seng, 'me 19 CR-hmKP e itšehla thajana e nang le khoele ea viscous> 25 mm e arotsoe ka sehlopha se seng.Mokhoa oa PCR o lemoha sekhahla se nepahetseng sa liphatsa tsa lefutso tse amanang le kokoana-hloko rmpA, rmpA2, iutA le iucA.Litefiso tse ntle tsa liphatsa tsa lefutso tse amanang le kokoana-hloko ea CR-hmKP lihlopheng tse peli li bontšoa ho Lethathamo la 2. Ho ne ho se na phapang ea lipalo-palo ka tekanyo e ntle ea liphatsa tsa lefutso tse amanang le CR-hmKP pakeng tsa lihlopha tse peli.
Lethathamo la 3 le thathamisa lintlha tse qaqileng tsa antimicrobial resistance tsa litlhare tse 16.Likarolo tse 16 tsa CR-hvKP li bontšitse khanyetso ea lithethefatsi tse ngata.Li-isolate tsohle li ne li phekoloa ka ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem le meropenem.Trimethoprim-sulfamethoxazole e na le tekanyo e tlaase ka ho fetisisa ea ho hanyetsa (43.8%), e lateloa ke amikacin (62.5%), gentamicin (68.8%) le ciprofloxacin (87.5%).
Kabo ea liphatsa tsa lefutso tse amanang le kokoana-hloko, liphatsa tsa lefutso tse thibelang likokoana-hloko, liphatsa tsa lefutso tsa capsular serotype le MLST ea 16 CR-hvKP isolates e bontšoa ho Setšoantšo sa 1. Liphello tsa agarose gel electrophoresis ea liphatsa tse ling tse amanang le likokoana-hloko, liphatsa tsa lefutso tsa antimicrobial resistance le capsular serotype genes ke e bontšitsoeng ho Setšoantšo sa 1. Setšoantšo sa 2. Tlhahlobo ea MLST e bontša kakaretso ea 3 STs, ST11 ke ST e hlahelletseng ka ho fetisisa (87.5%, 14/16), e lateloa ke ST23 (6.25%, 1/16) le ST86 (6.25%, 1). /16).Ho ea ka liphello tsa ho thaepa ha wzi, li-serotype tsa 4 tse fapaneng tsa capsular li ile tsa khetholloa (Setšoantšo sa 1).Har'a li-hvKP tse 16 tse hanyetsanang le carbapenem, K64 ke serotype e tloaelehileng haholo (n=13), e lateloa ke K1 (n=1), K2 (n=1) le K47 (n=1).Ho feta moo, mofuta oa capsular serotype K1 ke ST23, mofuta oa capsular serotype K2 ke ST86, 'me mefuta e 13 e setseng ea K64 le 1 ea K47 kaofela ke ST11.Litekanyetso tse ntle tsa liphatsa tsa lefutso tsa 9 ho li-isolates tsa 16 CR-hvKP li bontšoa ho Setšoantšo sa 1. 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n = 1).16 CR-hvKP e itšehla thajana kaofela e na le mofuta oa carbapenemase blaKPC-2 le mofuta o atolositsoeng oa β-lactamase blaSHV.16 CR-hvKP isolates ha ea ka ea jara liphatsa tsa lefutso tsa carbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 le liphatsa tsa lefutso tsa β-lactamase tse atolositsoeng tsa blaTEM, sehlopha sa blaCTX-M-2, le sehlopha sa blaCTX-M-8.Har'a mefuta e 16 ea CR-hvKP, mefuta e 5 e nkile sehlopha se atolositsoeng sa β-lactamase gene blaCTX-M-1, 'me mefuta e 6 e nkile sehlopha se atolositsoeng sa β-lactamase blaCTX-M-9.
Setšoantšo sa 1 Liphatsa tsa lefutso tse amanang le kokoana-hloko, liphatsa tsa lefutso tse thibelang likokoana-hloko, liphatsa tsa lefutso tsa capsular serotype le MLST ea 16 CR-hvKP isolates.
Setšoantšo sa 2 Agarose gel electrophoresis ea liphatsa tse ling tse amanang le likokoana-hloko, liphatsa tsa lefutso tsa antimicrobial resistance le capsular serotype genes.
Ela hloko: M, lesupa la 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, kaofela S (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR e ne e sebelisetsoa ho hlahloba homology ea 16 CR-hvKP isolates.Kamora ho matlafatsa PCR le electrophoresis ea gel ea agarose, ho na le likaroloana tsa 3-9 tsa DNA.Liphetho tsa menoana li bontšitse hore li-isolates tsa 16 CR-hvKP li ne li le polymorphic haholo, 'me ho ne ho e-na le phapang e totobetseng har'a batho ba ikhethileng (Setšoantšo sa 3).
Lilemong tsa morao tjena, ho 'nile ha e-ba le litlaleho tse ngata le tse ngata mabapi le li-isolates tsa CR-hvKP.Ponahalo ea li-isolates tsa CR-hvKP e baka tšokelo e kholo ho bophelo bo botle ba sechaba hobane e ka baka mafu a tebileng, ao ho leng thata ho a phekola ho batho ba phelang hantle.Thutong ena, ho ile ha ithutoa ho ata le litšoaneleho tsa lefu la limolek'hule tsa CR-hvKP sepetleleng sa thuto e phahameng sa Shanghai ho tloha 2019 ho isa 2020 ho lekola hore na ho na le kotsi ea ho phatloha ha CR-hvKP le mokhoa oa eona oa nts'etsopele sebakeng sena.Ka nako e ts'oanang, thuto ena e ka fana ka tlhahlobo e felletseng ea ts'oaetso ea bongaka, e leng bohlokoa bo boholo ho thibela ho ata ho eketsehileng ha libaka tse ka thoko.
Boithuto bona bo ile ba hlahlobisisa kabo ea bongaka le mokhoa oa CR-hvKP ho tloha ka 2019 ho isa ho 2020. Ho tloha ka 2019 ho isa ho 2020, likarohano tsa CR-hvKP li bonts'itse mokhoa o ntseng o eketseha.Hoo e ka bang 31.2% (5/16) ea CR-hvKP e khethiloe ka 2019, 'me 68.8% (11/16) ea CR-hvKP e ile ea aroloa ka 2020, e tsamaellanang le boemo bo holimo ba CR-hvKP bo tlalehiloeng libukeng.Ho tloha ha Zhang et al.e hlalositsoe ka lekhetlo la pele ka CR-hvKP ka 2015,10 lingoliloeng tse ngata tsa CR-hvKP li tlalehiloe, 17-20 haholo-holo sebakeng sa Asia-Pacific, haholo-holo Chaena.CR-hvKP ke baktheria e kholo e nang le ts'oaetso e kholo le e hanyetsanang le lithethefatsi tse ngata.E kotsi bophelong ba batho mme e na le sekhahla se phahameng sa ho shoa.Ka hona, tlhokomelo e lokela ho lefshoa 'me mehato e lokela ho nkoa ho thibela ho ata ha eona.
Tlhahlobo ea lithibela-mafu e hanyetsanang le li-isolates tse 16 tsa CR-hvKP e bontšitse sekhahla se phahameng sa ho hanyetsa lithibela-mafu.Li-isolate tsohle li ne li phekoloa ka ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem le meropenem.Trimethoprim-sulfamethoxazole e na le tekanyo e tlaase ka ho fetisisa ea ho hanyetsa (43.8%), e lateloa ke amikacin (62.5%), gentamicin (68.8%) le ciprofloxacin (87.5%).Sekhahla sa ho hanyetsa CR-hmkp se ithutoang ke Lingling Zhan le ba bang se tšoana le thuto ena [12].Bakuli ba tšoaelitsoeng ke CR-hvKP ba na le mafu a mangata a mantlha, ho itšireletsa mafung ho fokolang, le matla a fokolang a ikemetseng a ho thibela likokoana-hloko.Ka hona, kalafo e nakong e thehiloeng ho liphetho tsa tlhahlobo ea kutlo ea antimicrobial e bohlokoa haholo.Haeba ho hlokahala, sebaka se nang le tšoaetso se ka fumanoa 'me sa phekoloa ka drainage, debridement le mekhoa e meng.
Likarolo tsa 39 CR-hmKP li ne li arotsoe ka lihlopha tse peli ho ea ka bolelele ba khoele e khomarelang.Har'a bona, li-20 CR-hmKP tse arohaneng tse nang le bolelele ba khoele ea viscous ≤ 25 mm li arotsoe ka sehlopha se le seng, 'me 19 CR-hmKP e itšehla thajana e nang le khoele ea viscous> 25 mm e arotsoe ka sehlopha se seng.Ho bapisa litekanyetso tse ntle tsa liphatsa tsa lefutso tse amanang le kokoana-hloko ea CR-hmKP pakeng tsa lihlopha tse peli, ho ne ho se na phapang e kholo ea lipalo-palo ea litekanyetso tse ntle tsa liphatsa tsa lefutso pakeng tsa lihlopha tse peli.Lipatlisiso tsa Lin Ze et al.e bontšitse hore tekanyo e ntle ea liphatsa tsa lefutso tsa kokoana-hloko ea Klebsiella pneumoniae e ne e phahame haholo ho feta ea Klebsiella pneumoniae ea khale.21 Leha ho le joalo, hore na sekhahla se setle sa liphatsa tsa lefutso tsa kokoana-hloko se amana hantle le bolelele ba ketane e khomarelang e ntse e sa hlaka.Liphuputso tse ling li bontšitse hore Klebsiella pneumoniae ea khale e ka 'na ea boela ea e-ba Klebsiella pneumoniae e kotsi haholo, e nang le tekanyo e phahameng e ntle ea liphatsa tsa lefutso tsa varulence.22 Phuputso ena e fumane hore tekanyo e ntle ea liphatsa tsa lefutso tsa CR-hmKP ha e amane hantle le bolelele ba mucus.Khoele (kapa ha e eketsehe ka bolelele ba khoele e khomarelang).
Lintlha tsa menoana tsa ERIC PCR tsa thuto ena li na le polymorphic, 'me ha ho na crossover ea kliniki pakeng tsa bakuli, kahoo bakuli ba 16 ba nang le tšoaetso ea CR-hvKP ke linyeoe tsa nakoana.Nakong e fetileng, mafu a mangata a bakoang ke CR-hvKP a tlalehiloe e le linyeoe tse ka thōko kapa tse fokolang, tse 23,24 le tse nyenyane tsa CR-hvKP li fumaneha ka seoelo libukeng.11,25 ST11 ke ST11 e tloaelehileng ka ho fetisisa libakeng tse ka thōko tsa CRKP le CR-hvKP Chaena.26,27 Le hoja ST11 CR-hvKP e ikarabella bakeng sa 87.5% (14/16) ea 16 CR-hvKP e itšehla thajana thutong ena, ho ke ke ha nahanoa hore mefuta ea 14 ST11 CR-hvKP e tsoa ho clone e le 'ngoe, kahoo khatiso ea menoana ea ERIC PCR. e a hlokahala.Tlhahlobo ea Homology.
Phuputsong ena, bakuli bohle ba 16 ba tšoaelitsoeng ke CR-hvKP ba ile ba etsoa opereishene e hlaselang.Ho ea ka litlaleho, ho qhoma ho bolaeang ha pneumonia e amanang le ventilator e bakoang ke CR-hvKP11 e bontša hore mekhoa e hlaselang e ka eketsa kotsi ea tšoaetso ea CR-hvKP.Ka nako e ts'oanang, bakuli ba 16 ba tšoaelitsoeng ke CR-hvKP ba na le mafu a ka sehloohong, ao mafu a cerebrovascular a atileng haholo.Phuputso e fetileng e bontšitse hore lefu la cerebrovascular ke kotsi e ikemetseng e ikemetseng bakeng sa tšoaetso ea CR-hvKP.28 Lebaka la ketsahalo ena e ka 'na ea e-ba tšireletso e fokolang ea bakuli ba nang le lefu la cerebrovascular, baktheria ea pathogenic e ke ke ea qheleloa ka thōko,' me ho itšetlehile feela ka phello ea bona ea bactericidal.Lithibela-mafu li tla lebisa ho motsoako oa ho hanyetsa lithethefatsi tse ngata le hypervirulence ka nako e telele.Har'a bakuli ba 16, ba 9 ba ile ba shoa, 'me palo ea batho ba shoang e ne e le 56.3% (9/16).Palo ea batho ba shoang e phahame ho feta 10,12 lithutong tse fetileng, 'me e ka tlaase ho 11,21 e tlalehiloeng lithutong tse fetileng.Karolelano ea lilemo tsa bakuli ba 16 e ne e le lilemo tse 83.1±10.5, e leng se bontšang hore batho ba hōlileng ba kotsing ea ho tšoaroa ke CR-hvKP.Liphuputso tse fetileng li bontšitse hore bacha ba kotsing ea ho tšoaetsoa.Boloetse ba Klebsiella pneumoniae.29 Leha ho le joalo, liphuputso tse ling li bontšitse hore batho ba hōlileng ba hlaseloa habonolo ke Klebsiella pneumoniae24,28 e kotsi haholo.Phuputso ena e lumellana le sena.
Har'a mefuta e 16 ea CR-hvKP, ntle le ST23 CR-hvKP e le 'ngoe le ST86 CR-hvKP e le' ngoe, mefuta e meng e 14 kaofela ke ST11 CR-hvKP.Serotype ea capsular e lumellanang le ST23 CR-hvKP ke K1, 'me serotype e tšoanang ea capsular ea ST86 CR-HVKP ke K2, e tšoanang le lithuto tse fetileng.Bakuli ba 30-32 ba tšoaelitsoeng ke ST23 (K1) CR-hvKP kapa ST86 (K2) CR-hvKP ba shoele, 'me palo ea batho ba shoang (100%) e ne e phahame haholo ho feta ea bakuli ba tšoaelitsoeng ke ST11 CR-hvKP (50%).Joalokaha ho bontšitsoe setšoantšong sa 1, tekanyo e ntle ea mefuta ea ST23 (K1) kapa ST86 (K2) ea mefuta e amanang le likokoana-hloko e phahame ho feta ea mefuta ea ST11 (K64).Ho shoa ho ka amana le sekhahla se nepahetseng sa liphatsa tsa lefutso tse amanang le vaerase.Phuputsong ena, mefuta e 16 ea CR- hvKP kaofela e na le lefutso la carbapenemase blaKPC-2 le blaSHV e atolositsoeng ea β-lactamase.blaKPC-2 ke mofuta o tsebahalang haholo oa carbapenemase ho CR-hvKP naheng ea China.33 Thutong ea Zhao et al., 25blaSHV ke mofuta o atolositsoeng oa β-lactamase o nang le sekhahla se phahameng ka ho fetisisa se nepahetseng.Liphatsa tsa lefutso tsa entB, fimH, rmpA2, iutA, le iucA li teng likarolong tsohle tsa 16 tsa CR-hvKP, li lateloa ke mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), e ts'oanang le thuto e fetileng.34 Liphuputso tse ling li bontšitse hore rmpA le rmpA2 (li-modulator tsa liphatsa tsa lefutso tsa mucus phenotype) li ka khothalletsa secretion ea capsular polysaccharides, e lebisang ho hypermucoid phenotypes le ho eketseha ha kokoana-hloko.35 Aerobacterin e kentsoe ke mofuta oa iucABCD, 'me li-receptor tsa tsona tse homologous li kentsoe ke mofuta oa iutA, kahoo li na le boemo bo phahameng ba ts'oaetso tekong ea ts'oaetso ea G. mellonella.allS ke lesupa la K1-ST23, eseng ho pLVPK, pLVPK ke plasmid ea virulence e tsoang ho mofuta oa K2 super virulence.allS ke mofuta oa HTH o kenyang mongolo oa mongolo.Liphatsa tsa lefutso tsena tsa virulence li tsejoa ka ho kenya letsoho ho kokoana-hloko 'me li ikarabella bakeng sa bokolone, tlhaselo le pathogenicity.36
Phuputso ena e hlalosa ho ata le lefu la seoa la limolek'hule tsa CR-hvKP Shanghai, China.Le hoja ts'oaetso e bakoang ke CR-hvKP e etsahala hang-hang, e ntse e eketseha selemo le selemo.Liphetho li tšehetsa lipatlisiso tse fetileng mme li bontša hore ST11 CR-hvKP ke CR-hvKP e tsebahalang haholo Chaena.ST23 le ST86 CR-hvKP li bontšitse varulence e phahameng ho feta ST11 CR-hvKP, leha ka bobeli li le kotsi haholo Klebsiella pneumoniae.Ha peresente ea Klebsiella pneumoniae e kotsi haholo e ntse e eketseha, sekhahla sa ho hanyetsa Klebsiella pneumoniae se ka 'na sa fokotseha, e leng se tla lebisa tšepong ea bofofu tšebetsong ea bongaka.Ka hona, hoa hlokahala ho ithuta ka likokoana-hloko le ho hanyetsa lithethefatsi tsa Klebsiella pneumoniae.
Boithuto bona bo amohetsoe ke Komiti ea Boitšoaro ba Bongaka ea Sepetlele sa Bohlano sa Batho sa Shanghai (No. 104, 2020).Mehlala ea kliniki ke karolo ea mekhoa e tloaelehileng ea laboratori ea sepetlele.
Re leboha basebetsi bohle ba Central Laboratori ea Sepetlele sa Bohlano sa Batho sa Shanghai bakeng sa ho fana ka tataiso ea botekgeniki bakeng sa phuputso ena.
Mosebetsi ona o ne o tšehetsoa ke Motheo oa Saense ea Tlhaho oa Setereke sa Minhang, Shanghai (nomoro ea tumello: 2020MHZ039).
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