2016-2023年江苏省哨点医院耐碳青霉烯铜绿假单胞菌临床分离株耐药及基因特征分析

Analysis on drug-resistance and genome characteristics of clinical isolates of carbapenem-resistant Pseudomonas aeruginosa from sentinel hospitals of Jiangsu,2016−2023

目的 了解江苏省临床分离的耐碳青霉烯铜绿假单胞菌的耐药、血清型及基因特征。方法 收集2016—2023年江苏省各哨点医院临床分离的耐碳青霉烯铜绿假单胞菌,采用肉汤稀释法对分离株进行10类19种抗生素的敏感性测定,将分离株全基因组测序并多位点序列分型,血清型预测,对耐药基因、转座子及可移动元件进行分析。结果 本研究收集患者分离耐碳青霉烯铜绿假单胞菌菌株68株。药敏实验结果显示,全部菌株对氯霉素、复方新诺明、头孢噻肟和头孢唑啉、四环素、氨苄西林和氨苄西林–舒巴坦以及阿莫西林–克拉维酸共计7类9种抗生素全部耐药,检出33种耐药表型,其中2株菌是对所有19种抗生素耐药的泛耐药菌株。所有分离株鉴定出43个序列型(ST),ST235数量最多,聚类图显示,以ST241中心点向两个主要方向发散。共检出8个血清型,以O6、O11和O3血清型为主,占全部菌株的67.65%。共检出8类23种抗生素耐药基因,54.41%(37/68)的菌株存在整合和共轭元件,39.71%(27/68)的菌株存在整合和移动元件,未发现有菌株携带质粒。结论 本研究从基因组水平阐述了江苏省耐碳青霉烯铜绿假单胞菌耐药性、高风险ST型和高耐药性/血清型的特征情况,为有效治疗及防控该菌引起的感染提供了科学依据。

Objective To understand the drug resistance and genome characteristics of clinical isolates of carbapenem-resistant Pseudomonas aeruginosa(CRPA)in Jiangsu province.Methods Clinical CRPA isolates from sentinel hospitals in Jiangsu from 2016 to 2023 were collected.The susceptibility test to 19 antibiotics in 10 classes was conducted by broth dilution method.Whole genome sequencing,multi-site sequence typing and serotype prediction were conducted for the isolates,and their drug resistance genes,transposons and mobile elements were analyzed.Results A total of 68 strains of CRPA isolated from patients were collected.The results of drug susceptibility test showed that all the strains were resistant to 9 antibiotics in 7 classes,i.e.chloramphenicol,cotrimoxazole,cefotaxime,cefazolin,tetracycline,ampicillin,ampicillin/sulbactam and amoxicillin-clavulanate,and 33 drug-resistance phenotypes were found.Two of the strains were pan-drug-resistant to all 19 antibiotics tested.Forty-three sequence types(STs)were identified in all the isolates,ST235 was predominant.The clustering diagram showed that ST241 was in the central of all STs.A total of 8 serotypes were identified,mainly O6,O11 and O3 in 67.65%of all the strains.A total of 23 antibiotic resistance genes to 8 classes of antibiotics were found.In the 68 strains,54.41%had integrated and conjugate elements,39.71%had integrated and mobile elements,and no strains were found to carry plasmid.Conclusion In this study,the characteristics of the drug resistance,high risk ST and high resistance/serotype of carbapenem-resistant P.aeruginosa in Jiangsu were described at genome level,providing scientific evidence for effective treatment and prevention of infection caused by P.aeruginosa.