重症肺炎住院患者多药耐药肺炎克雷伯菌高毒力特征

A. E. Goncharov, D. Azarov, A. Mokhov, A. Pochtovyi, D. D. Kustova, V. Gushchin, E. Lebedeva, V. Kolodzhieva, A. Kireeva, L. Kraeva, S. Dolinny, O. Burgasova, A.R. Goncharova, E. Belková, A. Dmitriev
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引用次数: 0

摘要

住院患者的COVID-19严重病程可由多种原因引起,包括病毒和细菌的重复感染。抗生素的经验性使用以及不良的感染控制刺激了多重耐药细菌的出现和传播。肺炎克雷伯菌是引起医院感染的最常见的产碳青霉烯酶细菌病原体。这些毒株在COVID-19大流行期间变得非常普遍。目标。目的:分析重症监护病房重症COVID-19患者中优势病原菌肺炎克雷伯菌的表型和遗传特征。患者和方法。本研究纳入了2020年7月至2020年12月期间在莫斯科和圣彼得堡医院重症监护室接受传染病治疗的38例COVID-19患者(包括6例重症患者)。所有患者均签署知情同意书参与研究;患者数据是匿名的。收集以下样本:痰液、支气管肺泡灌洗液和鼻咽拭子。对分离菌株进行细菌学鉴定、药敏试验和肺炎克雷伯菌全基因组测序。结果。从重症COVID-19患者中分离的大多数肺炎克雷伯菌菌株在基因中含有有氧肌动蛋白和肠杆菌簇。然而,其中一些菌株(菌株90和124)也含有耶尔斯尼abactin基因簇。这些基因与高毒力和形成生物膜的能力有关。分离到的菌株属于ST874、ST395、ST147、ST15 4种序列型,具有较高的毒力和耐药性。这些肺炎克雷伯菌菌株可被认为是导致严重和致命的COVID-19的主要原因之一。结论。我们的研究结果表明,在大流行期间,COVID-19患者的肺炎克雷伯菌检出率从30%上升到70%。表型测试表明,超过80%的菌株对复杂性COVID-19患者使用的大多数抗生素具有耐药性。超毒力和抗生素耐药性的结合对于这些菌株的医院传播及其对疾病结局的影响至关重要。高耐药病原体的出现需要在俄罗斯医院,特别是重症监护病房进行定期流行病学监测和强有力的感染控制。关键词:COVID-19,重症,肺炎克雷伯菌,基因组测序,碳青霉烯酶,高毒力,抗生素耐药性
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Characteristics of hypervirulent multi-drug resistant Klebsiella pneumoniae strains in inpatients with severe COVID-19
Severe course of COVID-19 in inpatients can be caused by a number of reasons, including viral and bacterial superinfections. Empirical use of antibiotics, as well as poor infectious control stimulate the emergence and spread of multidrug-resistant bacteria. Klebsiella pneumoniae is the most common carbapenemase-producing bacterial pathogen causing nosocomial infections. These strains became significantly widespread during the COVID-19 pandemic. Objective. To analyze phenotypic and genetic characteristics of K. pneumoniae strains as the dominant bacterial pathogen in severe COVID-19 patients in the intensive care unit. Patients and methods. This study included 38 COVID-19 patients (including 6 patients with severe disease) treated in the intensive care units of Moscow and Saint Petersburg hospitals for infectious diseases between July 2020 and December 2020. All patients signed an informed consent to participate in the study; patient data was anonymized. The following samples were collected: sputum, bronchoalveolar lavage, and nasopharyngeal swabs. We performed bacteriological identification of isolated bacterial strains, drug susceptibility testing, and whole genome sequencing of K. pneumoniae strains. Results. The majority of K. pneumoniae strains isolated from patients with severe COVID-19 contained clusters of aerobactin and enterobacterin genes. However, some of them (strains 90 and 124) also contained clusters of yersiniabactin genes. These genes are associated with high virulence and ability to form biofilms. The isolated strains belonged to four sequence types (ST874, ST395, ST147, ST15) that are characterized by high virulence and antibiotic resistance. These K. pneumoniae strains can be considered as one of the major causes of severe and lethal COVID-19. Conclusion. Our findings suggest that the detection rate of K. pneumoniae in COVID-19 patients increased from 30% to 70% during the pandemic. Phenotypic tests demonstrated that more than 80% of the strains were resistant to most antibiotics used in patients with complicated COVID-19. The combination of gypervirulence and antibiotic resistance is crucial for nosocomial transmission of these strains and their effect on the disease outcome. The emergence of hyper-resistant pathogens necessitates regular epidemiological monitoring and robust infection control in Russian hospitals, especially in intensive care units. Key words: COVID-19, severe disease, Klebsiella pneumoniae, genome sequencing, carbapenemases, hypervirulence, antibiotic resistance
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来源期刊
Infektsionnye Bolezni
Infektsionnye Bolezni Medicine-Infectious Diseases
CiteScore
1.30
自引率
0.00%
发文量
15
期刊介绍: The journal publishes original research works, reviews of literature, lectures, methodological recommendations, clinical observations. Main topics: problems of etiology, pathogenesis, clinical manifestations of infectious diseases, new techniques and methods of their diagnosis, prevention and treatment; special attention is paid to the problems of antibacterial and antiviral therapy, the use of immunoglobulins and interferons, and also to intensive therapy of critical states. The journal is in the List of leading scientific journals and periodicals of the Supreme Attestation Committee, where the principal results of doctoral dissertations should be published.
期刊最新文献
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