Epidemiological characteristics and drug resistance of hypervirulent carbapenem-resistant Klebsiella pneumoniae in a hospital,2018-2022
Objective To analyze the epidemiological features and drug resistance of carbapenem-resistant hypervirulent Klebsiella pneumoniae(CR-hvKP)in a hospital from 2018 to 2022.Methods A total of 100 strains of carbapenem-resistant Klebsiella pneumoniae(CR-KP)isolated from the Third Hospital of Shandong Province from January 2018 to December 2022 were collected and screened for CR-hvKP.The K-B paper method was used for drug sensitivity test.Polymerase chain reaction(PCR)was employed to detect the multilocus sequence typing(MLST)and virulence gene of CR-hvKP isolates.Enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction(ERIC-PCR)DNA fingerprinting was applied to detecting the homology of CR-hvKP isolates.Results Fifteen(15.00%)strains of CR-hvKP were isolated from 100 strains of CR-KP.The patients were aged 45-89 years,including 7 males and 8 females.7(46.67%)strains were isolated from the intensive care unit.Except for being more sensitive to colistin,tigecycline and trimethoprim-sulfamethoxazole,the resistance rates of the 15 CR-hvKP isolates to other antibiotics listed in Table 2 were all>70%.MLST typing results displayed that 13 CR-hvKP isolates were ST11,1 CR-hvKP isolate was ST23 and 1 CR-hvKP isolate ST86.Capsular serotyping results revealed that 8 CR-hvKP isolates were K1 type,5 CR-hvKP isolates K2 type,1 CR-hvKP isolate was K64,and 1 CR-hvKP isolate K47.Drug resistance gene detection results showed that 13 CR-hvKP isolates carried KPC-2(86.67%),5 CR-hvKP isolates NDM-1(33.33%),and 1 CR-hvKP isolate IMP-1(6.67%),among which 4 carried both KPC-2 and NDM-1 genes.All 15 CR-hvKP isolates carried entB,fimH,rmpA2,rmpA and iucA genes(100.00%),14 CR-hvKP isolates iroB gene,13 CR-hvKP isolates iroN and mrkD genes,and 3 CR-hvKP isolates aerobactin gene.3 isolates carried 9 virulence genes,9 isolates 8 virulence genes,and 3 isolates 7 virulence genes.After PCR amplification and agarose gel electrophoresis,3-9 DNA fragments appeared.DNA fingerprinting results demonstrated that the 15 CR-hvKP isolates had high polymorphism.Conclusion The detection rate of CR-hvKP in the hospital from 2018 to 2022 was 15.00%,mostly from the intensive care unit.The 15 CR-hvKP isolates detected are resistant to multiple antibiotics and more sensitive to colistin and tigecycline,carry multiple drug resistance genes and virulence genes,and have high polymorphism.