ST11-KL25型高毒力耐碳青霉烯类肺炎克雷伯菌克隆的基因组流行病学

Genomic epidemiology of ST11-KL25 hypervirulent carbapenem-resistant Klebsiella pneumoniae clones

  • 摘要: 目的 调查医院重症病房耐碳青霉烯类肺炎克雷伯菌(CRKP)的分子流行病学特征及克隆传播情况。方法 收集2022年1月-2025年7月福建中医药大学附属人民医院重症监护病房及呼吸与重症病房住院患者分离的非重复CRKP菌株共60株。采用二代测序技术进行全基因组测序,并综合运用生物信息学方法分析其同源性、耐药基因及毒力基因。结合患者临床信息与流行病学资料进行传播链溯源分析。结果 60株CRKP中发现11株CRKP(11/60,18.33%)携带blaKPC-2碳青霉烯酶基因并同时含有rmpA2和完整的aerobactin(气杆菌素)铁载体系统,其中6株(6/11,54.55%)形成高度同源的ST11-KL25型高毒力耐碳青霉烯类肺炎克雷伯菌(HCKP)克隆簇(核心基因组SNP 差异≤7)。流行病学调查显示,这6例患者在地理位置与时间上存在重叠。核心基因组系统进化树分析显示该暴发克隆与本研究中其他CRKP菌株遗传关系较远,提示为新近引入或独立进化所致。结论 本研究首次报道了医院由兼具blaKPC-2耐药基因与高毒力基因的ST11-KL25型HCKP克隆引起的院内暴发。此“耐药-毒力”融合克隆的出现对临床构成严重威胁,亟须加强院内CRKP的监测与防控。

     

    Abstract: OBJECTIVE To investigate the molecular epidemiological characteristics and clonal transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) in the intensive care units (ICUs). METHODS A total of 60 non-repetitive CRKP strains isolated from hospitalized patients in the ICUs and respiratory ICUs of Fujian University of Traditional Chinese Medicine Affiliated People's Hospital from Jan. 2022 to Jul. 2025 were collected. Whole-genome sequencing was performed with next-generation sequencing technology, and bioinformatics methods were employed to analyze their homology, antimicrobial resistance genes and virulence genes. Transmission chain tracing was conducted by integrating patients' clinical information and epidemiological data.RESULTS Among the 60 CRKP strains, 11 (18.33%) carried the blaKPC-2 carbapenemase gene and simultaneously harbored rmpA2 and a complete aerobactin iron carrier system. Among these strains, 6 (54.55%) formed a highly homologous ST11-KL25 hypervirulent carbapenem-resistant Klebsiella pneumoniae (HCKP) clone cluster (core genome SNP differences ≤7). Epidemiological investigation revealed geographical and temporal overlaps among these 6 cases. Core genome phylogenetic analysis indicated that this outbreak clone was genetically distant from other CRKP strains in the study, suggesting recent introduction or independent evolution. CONCLUSIONS This study is the first to report a hospital-associated outbreak caused by ST11-KL25 HCKP clones co-harboring blaKPC-2 resistance genes and hypervirulence genes. The emergence of this "resistance-virulence" convergent clone poses a serious threat to clinical practice, highlighting the urgent need for strengthened surveillance and infection control measures against CRKP in hospitals.

     

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