2022-2023年华北地区住院患者鼻咽部携带肺炎克雷伯菌的耐药特征分析

Analysis of drug resistance characteristics of Klebsiella pneumoniae in the nasopharynx of hospitalized patients in North China from 2022 to 2023

目的:分析2022-2023年华北地区住院患者鼻咽部携带肺炎克雷伯菌的耐药特征。方法:于2022年11月至2023年7月,采集华北理工大学附属医院100例住院患者的鼻咽拭子并进行肺炎克雷伯菌分离培养。同时收集患者的临床资料,包括性别、年龄、科室、临床诊断的疾病类型等。使用全自动细菌药敏系统检测菌株的最低抑菌浓度,通过全基因组测序和数据分析对菌株的耐药基因、ST型、荚膜血清型以及种群结构进行分析。结果:100例住院患者中,共计从55名住院患者鼻咽拭子中分离出肺炎克雷伯菌,占比55.00%。55名鼻咽部携带肺炎克雷伯菌的住院患者中以男性患者为主(70.91%,39/55),年龄分布集中在61~80岁(58.18%,32/55),科室分布集中在重症监护室(50.91%,28/55),患者基础疾病类型以神经系统疾病为主(49.09%,27/55)。药敏结果显示55株肺炎克雷伯菌对头孢菌素类、喹诺酮类、氨曲南、呋喃妥因的不敏感率均>80.00%;共检出碳青霉烯类耐药肺炎克雷伯菌28株(50.91%),产超广谱β-内酰胺酶47株(85.45%),多重耐药菌48株(87.27%);共检出碳青霉烯类(携带率76.36%)、超广谱β-内酰胺酶类(携带率96.36%)等11类抗生素耐药基因。55株菌可分为17种ST型别,ST11型最多(25.45%)。55株菌可分为18种荚膜血清型,K102型最多(23.64%)。OXA-1_ST307_K102(21.82%)和KPC-2_ST5492_K125(18.18%)为优势克隆群,分别分布于神经外科和重症监护室。全基因组序列分析显示55株菌中有4个同源性较高的簇,来源于重症监护室的菌株组成2个独立的簇,又分别与神经内科重症监护室和神经外科的菌株各组成1个簇。结论:住院患者鼻咽部肺炎克雷伯菌的携带率较高,菌株耐药情况严重,携带耐药基因种类多。

ObjectiveTo analyze the drug resistance characteristics of Klebsiella pneumoniae in the nasopharynx of hospitalized patients in North China from 2022 to 2023.MethodsFrom November 2022 to July 2023,nasopharyngeal swabs were collected from 100 inpatients in Affiliated Hospital of North China University of Science and Technology,and Klebsiella pneumoniae was isolated and cultured.At the same time,the clinical data of the patients were collected,including gender,age,department,clinical diagnosis of disease type,etc.The minimum inhibitory concentration of strains was detected by an automatic bacterial drug sensitivity system.The drug resistance genes,ST types,capsule serotypes and population structure of the strains were analyzed by whole genome sequencing and data analysis.Results Klebsiella pneumoniae was isolated from 55 nasopharyngeal swabs of 100 inpatients(55.00%).Among the 55 inpatients with Klebsiella pneumoniae in the nasopharynx,70.91%(39/55)were male,with an age distribution concentrated between 61 and 80 years old(58.18%,32/55),and 50.91%(28/55)were in intensive care units(ICU).The main underlying disease type was nervous system disease(49.09%,27/55).The results of drug sensitivity showed that the non-susceptibility rates of 55 strains of Klebsiella pneumoniae to cephalosporins,quinolones,aztreonam and nitrofurantoin were all more than 80.00%.Twenty-eight carbapenem-resistant Klebsiella pneumoniae strains(50.91%),47 extended-spectrumβ-lactamase producing strains(85.45%),and 48 multi-drug-resistant strains(87.27%)were detected.A total of 11 antibiotic resistance genes were detected,including carbapenems(carrying rate 76.36%)and extended-spectrumβ-lactamase(carrying rate 96.36%).The 55 strains could be divided into 17 ST types,and the most common type was ST11(25.45%).The 55 strains were divided into 18 capsular serotypes,among which K102 was the most prevalent(23.64%).OXA-1_ST307_K102(21.82%)and KPC-2_ST5492_K125(18.18%)were the dominant clones,distributed in the Department of Neurosurgery and ICU.The result of whole genome sequence analysis showed that there were four clusters with high homology among the 55 strains.The strains from the ICU formed two independent clusters,and strains from the Neurology ICU and Neurosurgery department formed one cluster respectively.ConclusionThe carrying rate of Klebsiella pneumoniae in the nasopharynx of inpatients is high,and the drug resistance of the strains is serious.There are many types of drug-resistant genes.