Halayen asibiti da kwayoyin halitta na Hypervi mai jurewa carbapenem

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Halayen asibiti da kwayoyin halitta na Klebsiella pneumoniae mai jurewa carbapenem a wani babban asibiti a 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 Sashen Kula da Dakunan gwaje-gwaje na Clinical Medicine, Asibitin Jama'ar Shanghai na biyar, Jami'ar Fudan, Shanghai, Jamhuriyar Jama'ar Jama'a Sin;2 Ma'aikatar Lafiya ta Shanghai Jiaotong, Asibitin Yara na Shanghai, Shanghai, Jamhuriyar Jama'ar Sin;3 Sashen Nazarin Jiki, Asibitin Jama'a na biyar na Shanghai, Jami'ar Fudan Mawallafin Mawallafi: Fang Shen, Ma'aikatar Lafiya ta Lafiya, Asibitin Jama'a na Shanghai, Jami'ar Fudan, No. 128 Ruili Road, gundumar Minhang, Shanghai, lambar waya 200240 na ChinaTel +86 18021073261 Imel [email protected] Fage: Haɗin juriya na carbapenem da hypervirulence a cikin Klebsiella pneumoniae ya haifar da manyan ƙalubalen lafiyar jama'a.A cikin 'yan shekarun nan, an sami ƙarin rahotanni game da ƙananan ƙwayoyin cuta na Klebsiella pneumoniae (CR-hvKP).Kayayyaki da hanyoyin: Binciken baya na kimanta bayanan asibiti na marasa lafiya da suka kamu da CR-hvKP daga Janairu 2019 zuwa Disamba 2020 a cikin babban asibiti.Yi lissafin Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem-resistant Klebsiella pneumoniae (CR-hmKP) da carbapenem-resistant high-virulence ciwon huhu da aka tattara a cikin shekaru 2 Yawan ware Leberella (CR-hvKP).Gano PCR na kwayoyin juriya, kwayoyin da ke da alaƙa, kwayoyin serotype capsular da nau'in nau'in nau'in nau'in nau'i (MLST) na CR-hvKP.Sakamako: Jimillar 1081 nau'in cutar pneumoniae na Klebsiella mara maimaitawa an ware su yayin binciken., Ciki har da nau'ikan 392 na Klebsiella pneumoniae (36.3%), nau'ikan 39 na CR-hmKP (3.6%) da nau'ikan 16 na CR-hvKP (1.5%).Kusan 31.2% (5/16) na CR-hvKP za a ware a cikin 2019, kuma kusan 68.8% (11/16) na CR-hvKP za a ware a cikin 2020. Daga cikin nau'ikan 16 CR-hvKP, nau'ikan 13 sune ST11 da serotype K64, 1 iri ne ST11 da K47 serotypes, 1 iri ne ST23 da K1 serotypes, da kuma 1 iri ne ST86 da K2 serotypes.Kwayoyin da ke da alaƙa da ƙwayoyin cuta entB, fimH, rmpA2, iutA, da iucA suna nan a cikin 16 CR-hvKP ware, sannan mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).16 CR-hvKP ya keɓance duk yana ɗaukar ƙwayar carbapenemase blaKPC-2 da tsawaita-bakan β-lactamase gene blaSHV.Sakamakon zanen yatsan yatsa na ERIC-PCR DNA ya nuna cewa nau'ikan nau'ikan CR-hvKP guda 16 sun kasance polymorphic sosai, kuma makada na kowane nau'in sun bambanta sosai, suna nuna yanayin ɗan lokaci.Kammalawa: Kodayake ana rarraba CR-hvKP kai tsaye, yana ƙaruwa kowace shekara.shekara.Sabili da haka, ya kamata a tada hankali na asibiti, kuma yakamata a ɗauki matakan da suka dace don guje wa cloning da yaduwar superbug CR-hvKP.Mahimman kalmomi: Klebsiella pneumoniae, juriya na carbapenem, babban ƙwayar cuta, babban ƙwayar cuta, ilimin cututtuka
Klebsiella pneumoniae cuta ce mai fa'ida wacce zata iya haifar da cututtuka iri-iri, gami da ciwon huhu, cututtukan urinary fili, bacteremia, da sankarau.1 A cikin shekaru talatin da suka gabata, sabanin classic Klebsiella pneumoniae (cKP), wani sabon mai saurin kamuwa da cutar Klebsiella pneumoniae (hvKP) hypermucosal mucus ya zama kwayar cuta mai mahimmanci na asibiti, wanda za'a iya samuwa a cikin cututtuka masu tsanani kamar su abscesses na hanta suna haifar da lafiya. da kuma mutanen da ba su da rigakafi.2 Ya kamata a lura cewa waɗannan cututtuka yawanci suna tare da cututtuka masu lalacewa masu lalacewa, ciki har da endophthalmitis da meningitis.3 Samar da babban mucosal mucosal phenotype hvKP yawanci saboda haɓakar haɓakar polysaccharides capsular da kasancewar takamaiman ƙwayoyin cuta, kamar rmpA da rmpA2.4.Babban phenotype na gamsai yawanci ana ƙaddara ta “gwajin kirtani”.Ƙungiyoyin Klebsiella pneumoniae mazaunan da ke girma a cikin dare a kan faranti na agar jini suna shimfiɗa tare da madauki.Lokacin da igiya danko mai tsayi> 5mm aka kafa, "gwajin igiya" yana da kyau.5 Wani bincike na baya-bayan nan ya nuna cewa peg-344, iroB, iucA, rmpA rmpA2 da rmpA2 sune alamomin halitta waɗanda zasu iya tantance hvkp daidai.6 A cikin wannan binciken, an bayyana Klebsiella pneumoniae mai cutarwa sosai a matsayin yana da nau'in phenotype mai ɗanɗano sosai (sakamakon gwajin kirtani mai kyau) kuma yana ɗauke da rukunin yanar gizo na Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA) A cikin 1980s, rahoton al'ummar Taiwan na farko ya bayyana. -haɓakar hanta da aka samu ta hanyar hvKP, tare da mummunar lalacewar sassan jiki, irin su meningitis da endophthalmitis.7,8 hvKP yana da watsa watsa shirye-shirye a cikin ƙasashe da yawa a Asiya, Turai da Amurka.Ko da yake an sami rahoton bullar cutar ta hvKP da dama a Turai da Amurka, yawan cutar ta hvKP ya fi faruwa a kasashen Asiya, musamman kasar Sin.9
Gabaɗaya, hvKP ya fi kula da maganin rigakafi, yayin da ƙwayar huhu ta Klebsiella mai jure wa carbapenem (CRKP) ba ta da guba.Koyaya, tare da yaduwar juriya na miyagun ƙwayoyi da plasmids virulence, CR-hvKP ya fara bayyana ta Zhang et al.a cikin 2015, kuma ana samun rahotannin cikin gida da yawa.10 Tun da CR-hvKP na iya haifar da cututtuka masu tsanani da wuyar magance cututtuka, idan ƙwayar cuta ta bayyana, yana iya zama "superbug" na gaba.Ya zuwa yau, yawancin cututtuka da CR-hvKP ke haifarwa sun faru ne a lokuta na lokaci-lokaci, kuma ƙananan cututtuka ba su da yawa.11,12
A halin yanzu, adadin gano CR-hvKP ya yi ƙasa kaɗan, kuma akwai ƙananan binciken da ke da alaƙa.Kwayoyin cututtuka na kwayoyin halitta na CR-hvKP ya bambanta a yankuna daban-daban, don haka wajibi ne a yi nazarin rarrabawar asibiti da kuma kwayoyin cututtukan cututtuka na CR-hvKP a wannan yanki.Wannan binciken ya yi nazari sosai akan kwayoyin juriya, kwayoyin da ke da alaƙa da virulence da MLST na CR-hvKP.Mun yi ƙoƙari mu bincika yaɗuwar ƙwayar cuta da ƙwayoyin cuta na CR-hvKP a wani babban asibiti a Shanghai, gabashin China.Wannan binciken yana da ma'ana mai girma don fahimtar ilimin ƙwayoyin cuta na CR-hvKP a Shanghai.
Klebsiella pneumoniae da ba mai maimaitawa ba daga Asibitin Jama'a na biyar na Shanghai wanda ke da alaƙa da Jami'ar Fudan daga Janairu 2019 zuwa Disamba 2020 an sake tattara su a baya, kuma an ƙididdige kaso na hmKP, CRKP, CR-hmkp da CR-hvKP.An gano duk keɓancewar ta VITEK-2 ƙaramin mai binciken ƙananan ƙwayoyin cuta ta atomatik (Biomerieux, Marcy L'Etoile, Faransa).An yi amfani da Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, Amurka) don sake duba gano nau'ikan ƙwayoyin cuta.Babban phenotype na gamsai an ƙaddara ta “gwajin kirtani”.Lokacin da imipenem ko meropenem ke da juriya, ana ƙayyade juriya na carbapenem ta hanyar gwajin kamuwa da ƙwayoyi.Klebsiella pneumoniae mai saurin kamuwa da cuta ana bayyana shi azaman yana da babban ƙwayar ƙwayar cuta (sakamakon gwajin kirtani mai kyau) kuma yana ɗauke da rukunin yanar gizo na Klebsiella pneumoniae virulence plasmid (rmpA2, iutA, iucA)6.
An yi allurar rigakafi guda ɗaya na Klebsiella pneumoniae a kan farantin jinin tumaki 5%.Bayan dasawa da daddare a zazzabi na 37 ° C, a hankali cire yankin tare da madauki na inoculating kuma maimaita sau 3.Idan layin viscous ya yi sau uku kuma tsayin ya fi 5mm, ana ɗaukar "gwajin layin" tabbatacce, kuma nau'in yana da nau'in ƙwayar cuta mai girma.
A cikin m VITEK-2 m atomatik microbial analyzer (Biomerieux, Marcy L'Etoile, Faransa), da antimicrobial mai saukin kamuwa zuwa da yawa da aka saba amfani da maganin rigakafi da aka gano ta broth micro-dilution.Ana fassara sakamakon bisa ga takaddun jagora wanda Cibiyar Ka'idodin Clinical da Laboratory (CLSI, 2019) ta haɓaka.E. coli ATCC 25922 da Klebsiella pneumoniae ATCC 700603 an yi amfani da su azaman sarrafawa don gwajin kamuwa da ƙwayoyin cuta.
DNA na genomic na duka Klebsiella pneumoniae keɓe an cire su ta TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, China).Extended-bakan β-lactamase kwayoyin halitta (blaCTX-M, blaSHV da blaTEM), carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP da blaOXA-48) da kuma 9 wakilci virulence genes, ciki har da pLVPK Plasmid-like loci (allS, fimH). , mrkD, entB, iutA, rmpA, rmpA2, iucA, da aerobactin) PCR ne ya inganta su kamar yadda aka bayyana a baya.13,14 Capsular-takamaiman kwayoyin halittar serotype (K1, K2, K5, K20, K54, da K57) an ƙara su ta PCR kamar yadda aka bayyana a sama.14 Idan mara kyau, ƙara ƙara da jeri wzi locus don tantance takamaiman ƙwayoyin halittar serotype na capsular.15 Abubuwan da aka yi amfani da su a cikin wannan binciken an jera su a cikin Tebura S1.Ingantattun samfuran PCR an tsara su ta hanyar dandamalin jerin abubuwan NextSeq 500 (Illumina, San Diego, CA, Amurka).Kwatanta jerin nucleotide ta hanyar gudanar da BLAST akan gidan yanar gizon NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
An yi buga jeri mai yawa (MLST) kamar yadda aka bayyana a cikin gidan yanar gizon Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Kwayoyin kula da gida bakwai gapA, infB, mdh, pgi, phoE, rpoB da tonB an haɓaka su ta PCR kuma an jera su.Ana ƙayyade nau'in jeri (ST) ta hanyar kwatanta sakamakon jeri tare da bayanan MLST.
An yi nazari akan homology na Klebsiella pneumoniae.An fitar da Klebsiella pneumoniae genomic DNA a matsayin samfuri, kuma ana nuna abubuwan ERIC a cikin Tebura S1.PCR yana haɓaka DNA na genomic kuma yana gina hoton yatsa na DNA na genomic.An gano samfuran PCR 16 ta hanyar 2% agarose gel electrophoresis.An gano sakamakon hoton yatsa na DNA ta amfani da ƙididdige band ɗin software na QuantityOne, kuma an gudanar da nazarin kwayoyin halitta ta hanyar hanyar rukuni mara nauyi (UPGMA) na ma'anar lissafi.Wadanda ke da kamanceceniya> 75% ana ɗaukar su iri ɗaya ne, kuma waɗanda ke da kama <75% ana ɗaukar su nau'ikan genotypes daban-daban.
Yi amfani da fakitin software na ƙididdiga na SPSS don Windows 22.0 don nazarin bayanan.An bayyana bayanan azaman ma'anar ± daidaitaccen karkata (SD).An ƙididdige sauye-sauyen nau'i ta gwajin chi-square ko ainihin gwajin Fisher.Duk gwaje-gwajen ƙididdiga suna da wutsiya 2, kuma ana ɗaukar ƙimar P na <0.05 a ƙididdiga.
Asibitin mutane na biyar na Shanghai da ke da alaƙa da Jami'ar Fudan ya tattara 1081 Klebsiella pneumoniae keɓe daga Janairu 1, 2019 zuwa Disamba 31, 2020, kuma an cire keɓancewar kwafi daga majiyyaci iri ɗaya.Daga cikin su, nau'ikan 392 (36.3%) sun kasance hmKP, nau'ikan 341 (31.5%) CRKP, nau'ikan 39 (3.6%) sun kasance CR-hmKP, kuma nau'ikan 16 (1.5%) sune CR-hvKP.Ya kamata a lura cewa 33.3% (13/39) na CR-hmKP da 31.2% (5/16) na CR-hvKP daga 2019, 66.7% (26/39) na CR-hmKP da 68.8% (11/16) ) An raba CR-hvKP daga 2020. Daga sputum (17 damuwa), fitsari (12 damuwa), ruwa mai zubar da ruwa (4 damuwa), jini (2 damuwa), mujiyar (2 damuwa), bile ( warewar 1) da kuma zubar da jini. (1 kadaici), bi da bi.An dawo da nau'ikan CR-hvKP goma sha shida daga sputum ( warewar 9), fitsari ( warewar 5), jini ( warewar 1) da zubar da jini (1 ware).
Ta hanyar gano nau'i, gwajin jiyya na miyagun ƙwayoyi, gwajin kirtani da gano kwayar cutar da ke da alaƙa, an duba nau'ikan CR-hvKP 16.Abubuwan halayen asibiti na marasa lafiya na 16 da suka kamu da cutar CR-hvKP an taƙaita su a cikin Table 1. 13 na marasa lafiya na 16 (81.3%) maza ne, kuma duk marasa lafiya sun girmi shekaru 62 (ma'anar shekaru: 83.1 ± 10.5 shekaru).Sun fito ne daga gundumomi 8, kuma fiye da rabi sun fito daga tsakiyar ICU (la'o'i 9).Cututtuka na asali sun haɗa da cututtukan cerebrovascular (75%, 12/16), hauhawar jini (50%, 8/16), cututtukan huhu na yau da kullun (50%, 8/16), da sauransu. 16), catheter na fitsari (37.5%, 6/16), bututun ciki (18.8%, 3/16), tiyata (12.5%, 2/16) da catheter na jini (6.3%, 1/16).Tara daga cikin marasa lafiya 16 sun mutu, kuma marasa lafiya 7 sun inganta kuma an sallame su.
An raba keɓancewar CR-hmKP 39 zuwa rukuni biyu gwargwadon tsayin kirtani mai ɗaure.Daga cikin su, 20 CR-hmKP keɓancewa tare da tsayin igiya mai tsayi ≤ 25 mm an raba su zuwa rukuni ɗaya, kuma 19 CR-hmKP keɓaɓɓu tare da tsayin kirtani na viscous> 25 mm an raba zuwa wani rukuni.Hanyar PCR tana gano ingantacciyar ƙimar ƙwayoyin cuta masu alaƙa da rmpA, rmpA2, iutA da iucA.An nuna ma'auni mai kyau na CR-hmKP da ke da alaka da kwayoyin halitta a cikin ƙungiyoyin biyu a cikin Table 2. Babu wani bambanci na ƙididdiga a cikin ma'auni mai kyau na CR-hmKP kwayoyin da ke da alaka da ƙwayoyin cuta a tsakanin ƙungiyoyin biyu.
Tebu na 3 ya lissafa cikakkun bayanan martabar juriyar ƙwayoyin cuta na magungunan 16.16 CR-hvKP keɓewa sun nuna juriya na ƙwayoyi da yawa.An bi da duk warewa tare da ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, da meropenem suna da juriya.Trimethoprim-sulfamethoxazole yana da mafi ƙarancin juriya (43.8%), sai amikacin (62.5%), gentamicin (68.8%) da ciprofloxacin (87.5%).
Rarraba kwayoyin da ke da alaka da kwayar cutar, kwayoyin maganin antimicrobial, capsular serotype genes da MLST na 16 CR-hvKP keɓance an nuna su a cikin Hoto 1. Sakamakon agarose gel electrophoresis na wasu kwayoyin da ke da alaka da kwayar cutar, kwayoyin antimicrobial resistance genes da capsular serotype genes. wanda aka nuna a cikin Hoto 1. Hoto 2. Binciken MLST yana nuna jimlar 3 STs, ST11 shine mafi rinjaye ST (87.5%, 14/16), sannan ST23 (6.25%, 1/16) da ST86 (6.25%, 1) /16).Dangane da sakamakon buga wzi, an gano nau'ikan serotypes 4 daban-daban (Hoto 1).Daga cikin 16 carbapenem-resistant hvKP ware, K64 shine mafi yawan serotype (n=13), sannan K1 (n=1), K2 (n=1) da K47 (n=1).Bugu da kari, nau'in capsular serotype K1 shine ST23, nau'in serotype K2 na capsular shine ST86, sauran nau'ikan nau'ikan 13 na K64 da nau'in 1 na K47 duk ST11 ne.An nuna ma'auni mai kyau na 9 virulence genes a cikin 16 CR-hvKP keɓewa an nuna su a cikin Hoto 1. . 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n=1).16 CR-hvKP ya keɓance duk yana ɗaukar ƙwayar carbapenemase blaKPC-2 da tsawaita-bakan β-lactamase gene blaSHV.16 CR-hvKP keɓancewa ba su ɗauke da ƙwayoyin carbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 da ƙarin bakan β-lactamase genes blaTEM, ƙungiyar blaCTX-M-2, da ƙungiyar blaCTX-M-8.Daga cikin nau'ikan nau'ikan 16 CR-hvKP, nau'ikan 5 sun ɗauki rukunin β-lactamase gene blaCTX-M-1 mai tsayi, kuma nau'ikan 6 sun ɗauki rukunin β-lactamase gene blaCTX-M-9.
Hoto 1 Kwayoyin da ke da alaƙa da ƙwayoyin cuta, ƙwayoyin rigakafin ƙwayoyin cuta, ƙwayoyin serotype capsular da MLST na 16 CR-hvKP keɓe.
Hoto 2 Agarose gel electrophoresis na wasu kwayoyin halittar da ke da alaka da kwayar cutar, kwayoyin juriya na antimicrobial da kwayoyin serotype capsular.
Lura: M, alamar 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, duk S (508bp);11, mrkD (340bp);12, fimH (609bp).
An yi amfani da ERIC-PCR don nazarin ƙayyadaddun ƙayyadaddun CR-hvKP 16.Bayan haɓakawa na PCR da agarose gel electrophoresis, akwai gutsuttsuran DNA guda 3-9.Sakamakon zanen yatsa ya nuna cewa keɓancewar 16 CR-hvKP sun kasance polymorphic sosai, kuma akwai bambance-bambance a bayyane tsakanin keɓancewar (Hoto 3).
A cikin 'yan shekarun nan, an sami ƙarin rahotanni game da warewar CR-hvKP.Bayyanar keɓancewar CR-hvKP yana haifar da babbar barazana ga lafiyar jama'a saboda suna iya haifar da mummuna, masu wahalar magance cututtuka a cikin mutane masu lafiya.A cikin wannan binciken, an yi nazari game da yaɗuwar ƙwayoyin cuta da halayen ƙwayoyin cuta na CR-hvKP a wani babban asibiti a Shanghai daga 2019 zuwa 2020 don tantance ko akwai haɗarin fashewar CR-hvKP da yanayin ci gabanta a wannan yanki.A lokaci guda, wannan binciken na iya ba da ƙarin kimantawa game da kamuwa da cuta na asibiti, wanda ke da mahimmanci don hana ci gaba da yaduwar irin waɗannan keɓe.
Wannan binciken ya sake nazarin rarrabawar asibiti da yanayin CR-hvKP daga 2019 zuwa 2020. Daga 2019 zuwa 2020, keɓancewar CR-hvKP ya nuna haɓakar haɓaka.Kusan 31.2% (5/16) na CR-hvKP an ware shi a cikin 2019, kuma 68.8% (11/16) na CR-hvKP an keɓe shi a cikin 2020, wanda ya yi daidai da haɓakar yanayin CR-hvKP da aka ruwaito a cikin wallafe-wallafe.Tun da Zhang et al.Da farko an bayyana CR-hvKP a cikin 2015,10 an ba da rahoton wallafe-wallafen CR-hvKP da yawa, 17-20 galibi a yankin Asiya da tekun Pasifik, musamman a kasar Sin.CR-hvKP ƙwaya ce mai ƙarfi tare da ƙwaƙƙwaran ƙwayar cuta da juriya mai yawa.Yana da illa ga lafiyar mutane kuma yana da yawan mace-mace.Don haka ya kamata a mai da hankali tare da daukar matakan hana yaduwarsa.
Binciken juriya na ƙwayoyin cuta na 16 CR-hvKP keɓance ya nuna babban adadin juriya na ƙwayoyin cuta.An bi da duk warewa tare da ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, da meropenem suna da juriya.Trimethoprim-sulfamethoxazole yana da mafi ƙarancin juriya (43.8%), sai amikacin (62.5%), gentamicin (68.8%) da ciprofloxacin (87.5%).Adadin juriya na CR-hmkp da Lingling Zhan yayi da sauransu yayi kama da wannan binciken [12].Marasa lafiya da suka kamu da CR-hvKP suna da cututtuka na asali da yawa, ƙarancin rigakafi, da raunin haifuwa mai zaman kansa.Sabili da haka, jiyya na lokaci bisa ga sakamakon gwajin ji na ƙwayoyin cuta yana da mahimmanci.Idan ya cancanta, za'a iya samun wurin da cutar ta kamu da ita ta hanyar magudanar ruwa, tarwatsawa da sauran hanyoyin.
An raba keɓancewar CR-hmKP 39 zuwa rukuni biyu gwargwadon tsayin kirtani mai ɗaure.Daga cikin su, 20 CR-hmKP keɓancewa tare da tsayin igiya mai tsayi ≤ 25 mm an raba su zuwa rukuni ɗaya, kuma 19 CR-hmKP keɓaɓɓu tare da tsayin kirtani na viscous> 25 mm an raba zuwa wani rukuni.Kwatanta ma'auni mai kyau na CR-hmKP kwayoyin da ke da alaka da ƙwayoyin cuta a tsakanin ƙungiyoyin biyu, babu wani bambanci mai mahimmanci a cikin ma'auni mai kyau na ƙwayoyin cuta a tsakanin ƙungiyoyin biyu.Binciken Lin Ze et al.ya nuna cewa ingantacciyar adadin kwayoyin cutar huhu na Klebsiella pneumoniae ya kasance mafi girma fiye da na Klebsiella pneumoniae na gargajiya.21 Duk da haka, ko ingantaccen adadin ƙwayoyin ƙwayoyin cuta yana da alaƙa da alaƙa da tsayin sarkar mai ɗako ya kasance ba a sani ba.Sauran binciken sun nuna cewa Klebsiella pneumoniae na al'ada na iya zama cutar huhu ta Klebsiella, tare da mafi girman ƙimar ƙwayoyin cuta.22 Wannan binciken ya gano cewa ƙwayar ƙwayar ƙwayar cuta ta CR-hmKP ba ta da alaƙa da tsayin ƙwayar cuta.Iri (ko baya karuwa tare da tsawon kirtani mai ɗaki).
Hanyoyin yatsan hannu na ERIC PCR na wannan binciken sune polymorphic, kuma babu wani rikici na asibiti tsakanin marasa lafiya, don haka marasa lafiya 16 tare da kamuwa da cutar CR-hvKP sune lokuta na lokaci-lokaci.A baya, yawancin cututtuka da CR-hvKP ke haifarwa an ba da rahoton a matsayin keɓe ko lokuta na lokaci-lokaci, 23,24 da ƙananan fashewa na CR-hvKP ba su da yawa a cikin wallafe-wallafe.11,25 ST11 shine mafi yawan ST11 a cikin keɓancewar CRKP da CR-hvKP a China.26,27 Ko da yake ST11 CR-hvKP ya lissafta 87.5% (14/16) na 16 CR-hvKP keɓewa a cikin wannan binciken, ba za a iya ɗauka cewa nau'in 14 ST11 CR-hvKP daga nau'in clone iri ɗaya ne, don haka ERIC PCR yatsa. ake bukata.Binciken Homology.
A cikin wannan binciken, duk majinyata 16 da suka kamu da cutar ta CR-hvKP sun yi aikin tiyata.A cewar rahotanni, mummunar barkewar cutar ciwon huhu da ke da alaƙa da iska wanda CR-hvKP11 ke haifarwa ya nuna cewa hanyoyin da za su iya ƙara haɗarin kamuwa da cutar CR-hvKP.A lokaci guda kuma, marasa lafiya 16 da suka kamu da cutar ta CR-hvKP suna da cututtukan da ke da alaƙa, waɗanda cututtukan cerebrovascular sun fi yawa.Wani binciken da aka yi a baya ya nuna cewa cutar cerebrovascular shine muhimmiyar haɗari mai zaman kanta don kamuwa da cutar CR-hvKP.28 Dalilin wannan sabon abu na iya zama rashin ƙarfi na rigakafi na marasa lafiya tare da cututtuka na cerebrovascular, ƙwayoyin cuta ba za a iya cire su da kansu ba, kuma kawai tasirin su na bactericidal sun dogara.Magungunan rigakafi za su haifar da haɗuwa da juriya na ƙwayoyi da yawa da hypervirulence a cikin dogon lokaci.Daga cikin marasa lafiya 16, 9 sun mutu, kuma adadin mace-mace ya kasance 56.3% (9/16).Yawan mace-mace ya fi 10,12 a cikin binciken da suka gabata, kuma ƙasa da 11,21 da aka ruwaito a cikin binciken da suka gabata.Matsakaicin shekarun marasa lafiya na 16 shine 83.1 ± 10.5 shekaru, yana nuna cewa tsofaffi sun fi dacewa da CR-hvKP.Binciken da aka yi a baya ya nuna cewa matasa sun fi kamuwa da kamuwa da cuta.Kwayar cutar Klebsiella pneumoniae.29 Duk da haka, wasu nazarin sun nuna cewa tsofaffi suna iya kamuwa da cutar Klebsiella pneumoniae24,28.Wannan binciken ya yi daidai da wannan.
Daga cikin nau'ikan nau'ikan CR-hvKP guda 16, ban da ST23 CR-hvKP ɗaya da ST86 CR-hvKP ɗaya, sauran nau'ikan 14 duk ST11 CR-hvKP ne.The capsular serotype m ST23 CR-hvKP ne K1, kuma daidai capsular serotype na ST86 CR-HVKP ne K2, kama da baya karatu.30-32 Marasa lafiya da suka kamu da ST23 (K1) CR-hvKP ko ST86 (K2) CR-hvKP sun mutu, kuma yawan mace-mace (100%) ya fi na marasa lafiya da suka kamu da ST11 CR-hvKP (50%).Kamar yadda aka nuna a cikin Hoto 1, madaidaicin ƙimar ST23 (K1) ko ST86 (K2) nau'ikan ƙwayoyin cuta masu alaƙa sun fi na ST11 (K64).Matukar mace-mace na iya kasancewa da alaƙa da ingantacciyar ƙimar ƙwayoyin cuta masu alaƙa.A cikin wannan binciken, nau'ikan 16 na CR-hvKP duk suna ɗauke da ƙwayar carbapenemase blaKPC-2 da tsawaita-bakan β-lactamase gene blaSHV.blaKPC-2 shine mafi yawan kwayoyin carbapenemase a cikin CR-hvKP a kasar Sin.33 A cikin binciken Zhao et al., 25blaSHV shine tsararren β-lactamase gene tare da mafi girman ƙimar inganci.Kwayoyin halittar virulence entB, fimH, rmpA2, iutA, da iucA suna nan a cikin 16 CR-hvKP ware, sannan mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), wanda yayi kama da binciken da ya gabata.34 Wasu nazarin sun nuna cewa rmpA da rmpA2 (masu canza launin mucus phenotype genes) na iya inganta siginar polysaccharides na capsular, wanda ke haifar da hypermucoid phenotypes da karuwa mai yawa.35 Aerobacterins an ɓoye su ta hanyar iucABCD gene, kuma masu karɓa na homologous ana sanya su ta hanyar iutA gene, don haka suna da matsayi mafi girma na virulence a cikin G. mellonella kamuwa da cuta.allS alama ce ta K1-ST23, ba a cikin pLVPK ba, pLVPK plasmid virulence ne daga nau'in K2 super virulence.allS shine mai kunnawa nau'in HTH mai kunnawa.Wadannan kwayoyin halittun da aka sani suna ba da gudummawa ga virulence kuma suna da alhakin mulkin mallaka, mamayewa da pathogenicity.36
Wannan binciken ya bayyana yaɗuwar ƙwayar cuta da ƙwayoyin cuta na CR-hvKP a Shanghai, China.Ko da yake kamuwa da cutar da CR-hvKP ke haifarwa ba ta wuce lokaci ba, tana ƙaruwa kowace shekara.Sakamakon ya goyi bayan binciken da ya gabata kuma ya nuna cewa ST11 CR-hvKP shine mashahurin CR-hvKP a China.ST23 da ST86 CR-hvKP sun nuna haɓakar ƙwayar cuta mafi girma fiye da ST11 CR-hvKP, kodayake duka biyun suna da tsananin cutar Klebsiella pneumoniae.Yayin da yawan masu kamuwa da ciwon huhu na Klebsiella ke ƙaruwa, ƙimar juriya na Klebsiella pneumoniae na iya raguwa, wanda zai haifar da kyakkyawan fata a cikin aikin asibiti.Saboda haka, wajibi ne a yi nazarin virulence da juriya na miyagun ƙwayoyi na Klebsiella pneumoniae.
Kwamitin da'a na likita na Asibitin Jama'a na biyar na Shanghai ya amince da wannan binciken (Lamba 104, 2020).Samfurori na asibiti wani bangare ne na hanyoyin gwajin asibiti na yau da kullun.
Godiya ga dukan ma'aikatan Cibiyar Nazarin Tsakiyar Tsakiya na Asibitin Mutane na biyar na Shanghai don ba da jagorar fasaha don wannan binciken.
Gidauniyar Kimiyyar Halitta ta Gundumar Minhang, Shanghai ta tallafa wa wannan aikin (lambar amincewa: 2020MHZ039).
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