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一株罕见不携带rmpA、rmpA2的多药耐药高毒力肺炎克雷伯菌临床分离株

An abnormal multidrug-resistant and hypervirulent Klebsiella pneumoniae clinical isolate without rmpA or rmpA2

  • 摘要: 肺炎克雷伯菌(Klebsiella pneumoniae)是一种臭名昭著的机会致病菌,尤以高毒力肺炎克雷伯菌(Hypervirulent K. pneumoniae, hvKp)为重。幸运的是,多数hvKp对抗生素敏感。然而,近年来,多药耐药hvKp (Multidrug-resistant hvKp, MDR-hvKp)引发病症的报告剧增,威胁着全世界人民的健康和安全。本研究报告了一例感染了不携带rmpA和rmpA2的MDR-hvKp的92岁慢性阻塞性肺疾病患者的病例。患者在住院后第7天去世。对患者痰液中分离得到的肺炎克雷伯菌21072329进行表型实验和全基因组测序,结果显示,21072329属于ST11-KL47 MDR- hvkp,该菌株对大蜡螟具有较高的致死率。同时,21072329有着较强的粘性,难以将其完全离心。21072329携带ESBL(Extended spectrum beta-lactamase)基因(blaCTX-M-65, blaSHV-158, 和blaTEM-1)和碳青霉烯酶基因(blaKPC-2),其对碳青霉烯类抗生素和第三代、第四代头孢菌素耐受。21072329虽具有hvKp的特征,但在其基因组中未发现rmpA和rmpA2。此外,它只携带了一种铁载体耶尔森菌素(yersinabactin)。这表明可能存在其他促进hvKp形成的高毒力因子。MDR-hvKp已经给全球医疗保健带来了巨大负担,携带未知高毒力因子的肺炎克雷伯菌则带来了新的威胁,因此迫切需要进行预防和深入研究。

     

    Abstract: Klebsiella pneumoniae is a notorious opportunistic pathogen, especially hypervirulent K. pneumoniae (hvKp). Fortunately, most classical hvKp strains are antibiotic-susceptible. However, in recent years, reports of multidrug-resistant hvKp (MDR-hvKp) have increased dramatically, threatening the health and safety of people worldwide. Here, we report the discovery of MDR-hvKp without rmpA and rmpA2 in a 92-year-old patient with chronic obstructive pulmonary disease. The patient died on the eighth day of hospitalization. Phenotyping experiments and whole-genome sequencing of K. pneumoniae isolate 21072329 isolated from the patient’s sputum were performed. Moreover, 21072329 belongs to ST11-KL47 MDR-hvKp, which was highly lethal to Galleria mellonella. Meanwhile, 21072329 had a strong viscosity, and it was difficult to completely centrifuge it; 21072329 carried ESBL genes (blaCTX-M-65, blaSHV-158, and blaTEM-1) and a carbapenemase gene (blaKPC-2), and it was resistant to carbapenem antibiotics and third- and fourth-generation cephalosporins. Although 21072329 had the characteristics of hvKp, rmpA and rmpA2 could not be found in its genome; it also only carried a siderophore of yersiniabactin. This may indicate that other hypervirulence factors promote the formation of hvKp. MDR-hvKp has already brought an enormous burden to global medical care, and those carrying unknown hypervirulence factors are new threats, so urgent prevention and control with research are urgently needed.

     

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