Astaamaha kiliinikada iyo molecular ee Hypervi u adkaysta karbapenem

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Astaamaha kiliinikada iyo molecular ee carbapenem u adkeysiga fayraska sare ee Klebsiella pneumoniae ee isbitaal jaamacadeed oo ku yaal Shanghai
Zhou Cong 1 Wu Qiang Shiinaha;2 Shanghai Jiaotong Waaxda Daawada Shaybaadhka, Isbitaalka Carruurta ee Shanghai, Shanghai, Jamhuuriyadda Dadka ee Shiinaha;3 Waaxda Neurology, Isbitaalka Shanaad ee Shanghai, Jaamacadda Fudan Qoraaga u dhiganta: Fang Shen, Waaxda Daawada Shaybaarka Clinical, Shanghai Shanaad ee Isbitaalka Dadka, Jaamacadda Fudan, No. 128 Ruili Road, Degmada Minhang, Shanghai, Boostada 200240 ee ChinaTel +86 18021073261 Email [email protected] Asalkii hore: Isku-dhafka iska caabbinta carbapenem iyo hypervirulence ee Klebsiella pneumoniae ayaa horseeday caqabado waaweyn oo caafimaadka bulshada ah.Sanadihii la soo dhaafay, waxaa jiray warbixino badan oo ku saabsan carbapenem u adkeysiga fayraska sare ee Klebsiella pneumoniae (CR-hvKP).Qalabka iyo hababka: Falanqaynta dib-u-eegis ee qiimaynta xogta bukaan-socodka ee bukaannada uu ku dhacay CR-hvKP laga bilaabo Janaayo 2019 illaa Diseembar 2020 ee isbitaal sare.Xisaabi Klebsiella pneumoniae, Klebsiella pneumoniae (hmKP), carbapenem u adkaysta Klebsiella pneumoniae (CR-hmKP) iyo karbapenem u adkaysta oof-wareerka sare ee la ururiyey 2 sano gudahood Tirada go'doomin ee Leberella (CR-hvKP).Ogaanshaha PCR ee hiddo-wadaha iska caabinta, hiddo-wadaha la xidhiidha fayraska, hiddo-wadaha serotype capsular iyo teebaynta isku xigxiga badan (MLST) ee go'doominta CR-hvKP.Natiijooyinka: Wadar dhan 1081 nooc oo Klebsiella oofwareen ah oo aan soo noqnoqon ayaa la go'doomiyay intii daraasaddu socotay., Oo ay ku jiraan 392 nooc oo Klebsiella pneumoniae ah (36.3%), 39 nooc oo CR-hmKP ah (3.6%) iyo 16 nooc oo CR-hvKP ah (1.5%).Qiyaastii 31.2% (5/16) ee CR-hvKP ayaa go'doonsan doona sanadka 2019, qiyaastii 68.8% (11/16) ee CR-hvKP waa la go'doomin doonaa sanadka 2020. 16 ka mid ah noocyada CR-hvKP, 13 nooc ayaa ah ST11 iyo serotype K64, 1 strain is ST11 and K47 serotypes, 1 strain is ST23 and K1 serotypes, iyo 1 strain is ST86 and K2 serotypes.Hidde-yaasha la xidhiidha fayraska entB, fimH, rmpA2, iutA, iyo iucA waxay ku jiraan dhammaan 16 CR-hvKP go'doominta, oo ay ku xigto mrkD (n=14), rmpA (n=13), aerobactin (n=2) , AllS ( n=1).16 CR-hvKP ayaa go'doomiyey dhammaan waxay sido hidda-wadaha carbapenemase blaKPC-2 iyo spectrum-la fidsan ee β-lactamase hidda-wadaha blaSHV.Natiijooyinka sawirka faraha DNA ee ERIC-PCR waxay muujisay in 16 nooc oo CR-hvKP ah ay ahaayeen kuwo aad u sarreeya, iyo xargaha nooc kastaa aad bay u kala duwan yihiin, oo muujinaya xaalad goos goos ah.Gabagabo: Inkasta oo CR-hvKP loo qaybiyo si goos-goos ah, way sii kordhaysaa sannadba sannadka ka dambeeya.sanad.Sidaa darteed, dareenka bukaan-socodka waa in la kiciyaa, waana in la qaado tillaabooyin lagama maarmaanka ah si looga fogaado cloning iyo faafitaanka superbug CR-hvKP.Erayada furaha: Klebsiella pneumoniae, caabbinta carbapenem, fayraska sare, xabka sare, cudurrada faafa
Klebsiella pneumoniae waa cudur-fadeeye fursad ah oo sababi kara caabuqyo kala duwan, oo ay ku jiraan oof-wareen, caabuqyada kaadi mareenka, bakteeriyada, iyo qoorgooyaha.1 Soddonkii sano ee la soo dhaafay, si ka duwan kan caadiga ah ee Klebsiella pneumoniae (cKP), xab cusub oo aadka u fayruska Klebsiella pneumoniae (hvKP) hypermucosal xab ayaa noqday cudur-sidaha caafimaad ahaan muhiim u ah, kaas oo laga heli karo infekshannada aadka u daran sida mabararka beerka ayaa sababa caafimaad qaba. iyo shakhsiyaadka difaaca jirkoodu hooseeyo.Waxaa xusid mudan in infekshannadan ay inta badan la socdaan infekshannada la faafiyo ee wax baabi'iya, oo ay ku jiraan endophthalmitis iyo meningitis.3 Wax soo saarka phenotype xuubka xuubka xuubka sare ee hvKP waxaa badanaa sabab u ah soosaarka kororka ee polysaccharides capsular iyo joogitaanka hidde-sideyaal gaar ah, sida rmpA iyo rmpA2.4.Nooca xab-xabka sare leh waxaa badanaa lagu go'aamiyaa "tijaabada xadhigga".Kolonyada Klebsiella pneumoniae ee ku koray habeen qura taarikada agar ee dhiigga ayaa lagu fidiyay wareeg.Marka la sameeyo xadhig viscous ah oo dhererkiisu yahay>5mm, "tijaabada xadhigga" waa mid togan.5 Daraasad dhowaan la sameeyay ayaa muujisay in peg-344, iroB, iucA, rmpA rmpA2 iyo rmpA2 yihiin biomarkers kuwaas oo si sax ah u aqoonsan kara hvkp.6 Daraasaddan, Klebsiella pneumoniae ee aadka u fayruska ah waxaa lagu qeexay inuu leeyahay xab viscous phenotype aad u sarreeya (natiijooyinka baaritaanka xargaha togan) iyo qaadista Klebsiella pneumoniae virulence plasmid sites (rmpA2, iutA, iucA) 1980-meeyadii, kiiskii bulshada Taiwan ayaa markii ugu horeysay lagu tilmaamay. -cunno beerka ka soo baxa oo uu keeno hvKP, oo ay la socoto dhaawac daran oo xubnaha jirka ah, sida qoorgooyaha iyo endophthalmitis.7,8 hvKP waxay leedahay faafin teel teel ah waddamo badan oo Aasiya, Yurub iyo Ameerika ah.In kasta oo dhowr kiis oo hvKP ah laga soo sheegay Yurub iyo Ameerika, baahsanaanta hvKP waxay inta badan ka dhacday waddamada Aasiya, gaar ahaan Shiinaha.9
Guud ahaan, hvKP aad bay ugu nugul tahay antibiyootiga, halka karbapenem u adkaysta Klebsiella pneumonia (CRKP) ay ka yar tahay sunta.Si kastaba ha noqotee, faafinta caabbinta daroogada iyo plasmids fayrasyada, CR-hvKP ayaa markii ugu horreysay lagu sharraxay Zhang et al.2015, waxaana jira warbixino badan oo gudaha ah.10 Mar haddii CR-hvKP ay sababi karto caabuqyo halis ah oo ay adag tahay in la daweeyo, haddii uu soo baxo clone aafo ah, waxay noqon kartaa "superbug" soo socda.Ilaa hadda, inta badan infekshannada uu keeno CR-hvKP waxay ku dhaceen kiisas goos goos ah, iyo faafitaanno yar yar waa naadir.11,12
Waqtigan xaadirka ah, heerka ogaanshaha CR-hvKP wuu hooseeyaa, waxaana jira daraasado yar oo la xidhiidha.Cudurka faafa ee molecular ee CR-hvKP wuu ka duwan yahay gobollo kala duwan, sidaas darteed waxaa lagama maarmaan ah in la barto qaybinta kiliinikada iyo sifooyinka unugyada unugyada unugyada CR-hvKP ee gobolkan.Daraasadani waxay si buuxda u falanqeysay hiddo-wadaha iska caabinta, hiddo-wadaha la xidhiidha fayraska iyo MLST ee CR-hvKP.Waxaan isku daynay inaan baarno faafitaanka iyo faafitaanka unugyada unugyada ee CR-hvKP ee isbitaal jaamacadeed oo ku yaal Shanghai, bariga Shiinaha.Daraasaddan ayaa muhiimad weyn u leh fahamka cudurrada faafa ee CR-hvKP ee Shanghai.
Klebsiella pneumoniae ee aan soo noqnoqoneynin ayaa ka go'doonsan Isbitaalka Shanaad ee Dadka Shangaani ee ku xiran Jaamacadda Fudan laga bilaabo Janaayo 2019 illaa Diseembar 2020 dib ayaa loo uruuriyay, iyo boqolleyda hmKP, CRKP, CR-hmkp iyo CR-hvKP waa la xisaabiyay.Dhammaan go'doominta waxaa aqoonsaday VITEK-2 is haysta falanqeeyaha microbial-ka (Biomerieux, Marcy L'Etoile, France).Maldi-Tof mass spectrometry (Bruker Daltonics, Billerica, MA, USA) ayaa loo isticmaalay in dib loo eego aqoonsiga noocyada bakteeriyada.Nooca xab-xabku sareeyo waxaa lagu go'aamiyaa "tijaabada xadhkaha".Marka imipenem ama meropenem ay u adkaystaan, iska caabbinta carbapenem waxaa lagu go'aamiyaa baaritaanka nuglaanshaha daroogada.Klebsiella pneumoniae oo aad u fayrus ah waxaa lagu qeexaa inuu leeyahay phenotype xab sare (natiijada tijaabada xargaha togan) iyo qaadista Klebsiella pneumoniae fayraska plasmid ee la xiriira (rmpA2, iutA, iucA)6.
Hal deegaan oo Klebsiella oofwareen ah ayaa lagu tallaalay saxan dhiiga agar 5% ah.Ka dib marka la kariyo habeenkii oo dhan 37°C, si tartiib ah u soo jiid xayndaabka oo ku celi 3 jeer.Haddii laynka viscous la sameeyo saddex jeer oo dhererku ka weyn yahay 5mm, "tijaabada xariiqda" waxaa loo arkaa mid togan, cadaadiskuna wuxuu leeyahay nooc xab ah oo sarreeya.
VITEK-2 is haysta falanqeeyaha microbial-ka tooska ah (Biomerieux, Marcy L'Etoile, France), u nuglaanta antimicrobial ee dhowr antibiyootiko ah oo inta badan la isticmaalo ayaa lagu ogaaday fuuq-baxa yar yar.Natiijooyinka waxaa loo tarjumay si waafaqsan dukumeentiga hagida ee uu sameeyay Machadka Heerarka Clinical iyo Laboratory (CLSI, 2019).E. coli ATCC 25922 iyo Klebsiella pneumoniae ATCC 700603 ayaa loo adeegsaday kontaroolada baaritaanka u nuglaanta ka hortagga jeermiska.
DNA-da genomic ee dhammaan go'doominta Klebsiella pneumoniae waxaa soo saaray TIANamp Bacteria Genomic DNA Kit (Tiangen Biotech Co. Ltd., Beijing, Shiinaha).Hiddo-sidaha β-lactamase-ka-dheeraaday (blaCTX-M, blaSHV iyo blaTEM), hiddo-wadaha carbapenemase (blaKPC, blaNDM, blaVIM, blaIMP iyo blaOXA-48) iyo 9 hiddo-wadaha la xidhiidha fayraska, oo ay ku jiraan pLVPK Plasmid-sida loci (allS, fimH). , mrkD, entB, iutA, rmpA, rmpA2, iucA, iyo aerobactin) waxaa xoojiyay PCR sidii hore loo sharaxay.13,14 Kaabsular serotype-genes-gaar ah (K1, K2, K5, K20, K54, iyo K57) waxaa xoojiyay PCR sida kor lagu sharaxay.14 Hadday taban tahay, kor u qaad oo isku xigxigta wzi locus si aad u go'aamiso hiddo-wadaha u gaarka ah serotype kaabsal.15 Qodobbada loo adeegsaday daraasaddan waxay ku taxan yihiin shaxda S1.Alaabooyinka PCR ee togan waxaa iskuxigay NextSeq 500 ee isku xigxiga (Illumina, San Diego, CA, USA).Is barbar dhig taxanaha nucleotide adiga oo ku ordaya BLAST shabakada NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Qorista isku xigxiga ee gooba badan (MLST) ayaa la sameeyay sida lagu qeexay machadka Pasteur MLST website (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Toddobada hidde-sideyaal guri gapA, infB, mdh, pgi, phoE, rpoB iyo tonB waxaa xoojiyay PCR oo la isku xigxigay.Nooca isku xigxiga (ST) waxaa lagu go'aamiyaa isbarbardhigga natiijooyinka isku xigxiga iyo xogta MLST.
Qaabka isku midka ah ee Klebsiella pneumoniae ayaa la falanqeeyay.Klebsiella pneumoniae genomic DNA waxaa loo soo saaray qaab template ah, iyo aasaasayaasha ERIC waxaa lagu muujiyay shaxda S1.PCR waxay kordhisaa DNA-da genomic waxayna dhistaa faraha DNA-da genomic.16 badeecooyin PCR ah ayaa lagu ogaaday 2% agarose gel electrophoresis.Natiijooyinka faraha DNA-ga waxaa lagu aqoonsaday iyadoo la isticmaalayo aqoonsiga band software ee QuantityOne, iyo falanqaynta hidda-socodka ayaa la sameeyay iyadoo la adeegsanayo habka kooxda lamaanaha ah (UPGMA) ee celceliska xisaabta.Go'doominta isku midka ah> 75% waxaa loo arkaa inay isku mid yihiin genotype, iyo kuwa la mid ah <75% waxaa loo arkaa inay yihiin genotypes kala duwan.
Isticmaal xirmo software xisaabeed SPSS Windows 22.0 si aad u falanqeyso xogta.Xogta waxaa lagu tilmaamay inay tahay celcelis ahaan ± weecasho caadi ah (SD).Doorsoomayaasha kala duwan waxaa lagu qiimeeyay tijaabinta chi-square ama imtixaanka saxda ah ee Fisher.Dhammaan imtixaanada tirakoobka waa 2-dabo, iyo qiimaha P ee <0.05 ayaa loo arkaa mid muhiim ah.
Isbitaalka Shanaad ee Shangaani ee ku xiran Jaamacadda Fudan wuxuu soo aruuriyay 1081 Klebsiella pneumoniae oo go'doomiyay Janaayo 1, 2019 ilaa Diseembar 31, 2020, waxaana laga saaray go'doominno nuqul ka mid ah bukaan isku mid ah.Waxaa ka mid ah, 392 nooc (36.3%) waxay ahaayeen hmKP, 341 nooc (31.5%) waxay ahaayeen CRKP, 39 nooc (3.6%) waxay ahaayeen CR-hmKP, iyo 16 nooc (1.5%) waxay ahaayeen CR-hvKP.Waxaa xusid mudan in 33.3% (13/39) CR-hmKP iyo 31.2% (5/16) ee CR-hvKP ay yihiin laga bilaabo 2019, 66.7% (26/39) CR-hmKP iyo 68.8% (11/16) ) CR-hvKP waxaa laga soocay 2020. Laga soo bilaabo xaakada (17 nooc), kaadida (12 nooc), dareeraha dheecaanka (4 nooc), dhiig (2 nooc), malax (2 nooc), bile (1 go'doomin) iyo xuubka xuubka (1 go'doomin), siday u kala horreeyaan.Lix iyo toban nooc oo CR-hvKP ah ayaa laga soo kabsaday xaakada (9 go'doomin), kaadida (5 go'doomin), dhiig (1 go'doomin) iyo xuubka xuubka (1 go'doomin).
Iyada oo loo marayo aqoonsiga cadaadiska, tijaabada dareenka daroogada, tijaabada xadhigga iyo ogaanshaha hidda-wadaha fayraska, 16 noocyada CR-hvKP ayaa la baadhay.Astaamaha caafimaad ee bukaannada 16 ee uu ku dhacay go'doominta CR-hvKP ayaa lagu soo koobay Shaxda 1. 13 ka mid ah bukaannada 16 (81.3%) waxay ahaayeen rag, dhammaan bukaannada ayaa ka weyn da'da 62 (da'da celceliska: 83.1 ± 10.5 sano).Waxay ka kala yimaadeen 8 waaxood, in ka badan kala badhna waxay ka yimaadeen ICU-da dhexe (9 xaaladood).Cudurada aasaasiga ah waxaa ka mid ah cudurrada maskaxda ee maskaxda (75%, 12/16), hypertension (50%, 8/16), cudurrada sambabada ee joogtada ah (50%, 8/16), iwm. 16), tuubada kaadi mareenka (37.5%, 6/16), tuubada caloosha (18.8%, 3/16), qaliin (12.5%, 2/16) iyo tuubada xididka (6.3%, 1/16).Sagaal ka mid ah 16 bukaan ayaa dhintay, 7 bukaanna way fiicnaadeen oo waa laga saaray.
Go'doominta 39 CR-hmKP ayaa loo qaybiyay laba kooxood iyadoo loo eegayo dhererka xadhigga dhegdhegaysan.Waxaa ka mid ah, 20 CR-hmKP go'doomin leh dhererka xargaha viscous ≤ 25 mm ayaa loo qaybiyay hal koox, iyo 19 CR-hmKP go'doomin leh dhererka xargaha viscous> 25 mm ayaa loo qaybiyay koox kale.Habka PCR wuxuu ogaadaa heerka togan ee hiddo-wadaha la xiriira fayraska rmpA, rmpA2, iutA iyo iucA.Heerarka togan ee CR-hmKP hiddo-wadaha la xidhiidha fayraska ee labada kooxood ayaa lagu muujiyey Shaxda 2. Ma jirin farqi tirakoob oo u dhexeeya heerka togan ee CR-hmKP hiddo-wade la xidhiidha fayraska ee u dhexeeya labada kooxood.
Shaxda 3 waxa ay taxaysaa muuqaalada iska caabbinta antimicrobial ee faahfaahsan ee 16ka dawo.16 go'doominta CR-hvKP waxay muujisay iska caabin dawooyin badan.Dhammaan go'doominta waxaa lagu daaweeyay ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, iyo meropenem ayaa u adkaysta.Trimethoprim-sulfamethoxazole waxay lahayd heerka iska caabbinta ugu hooseeya (43.8%), waxaa ku xiga amikacin (62.5%), gentamicin (68.8%) iyo ciprofloxacin (87.5%).
Qaybinta hiddo-wadaha la xidhiidha fayraska, hiddaha iska caabbinta antimicrobial, genes serotype capsular iyo MLST ee 16 CR-hvKP go'doominta ayaa lagu muujiyay Jaantuska 1. Natiijooyinka agarose gel electrophoresis ee qaar ka mid ah hiddo-wadaha la xidhiidha fayraska, hiddaha iska caabbinta antimicrobial iyo genes serotype capsular waa lagu muujiyey Jaantuska 1. Jaantuska 2. Falanqaynta MLST waxay muujinaysaa wadar ahaan 3 STs, ST11 waa ST-da ugu badan (87.5%, 14/16), oo ay ku xigto ST23 (6.25%, 1/16) iyo ST86 (6.25%, 1) /16).Marka loo eego natiijooyinka wzi-qorista, 4 serotypes kaabsal ah oo kala duwan ayaa la aqoonsaday (Jaantuska 1).Ka mid ah 16 ka karbapenem u adkaysta hvKP go'doominta, K64 waa serotype-ka ugu caansan (n=13), oo ay ku xigto K1 (n=1), K2 (n=1) iyo K47 (n=1).Intaa waxaa dheer, cadaadiska serotype K1 capsular waa ST23, kaabsular serotype K2 strain waa ST86, iyo 13 nooc ee soo hadhay ee K64 iyo 1 nooc ee K47 dhamaantood waa ST11.Heerarka togan ee 9 hiddo-wadaha fayraska ee 16 CR-hvKP go'doominta ayaa lagu muujiyay sawirka 1. 14), rmpA (n = 13), aerobacterin (n = 2) , AllS (n=1).16 CR-hvKP ayaa go'doomiyey dhammaan waxay sido hidda-wadaha carbapenemase blaKPC-2 iyo spectrum-la fidsan ee β-lactamase hidda-wadaha blaSHV.16 CR-hvKP go'doominta ma aysan qaadin hiddo-wadaha carbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 iyo xayndaabka β-lactamase blaTEM, kooxda blaCTX-M-2, iyo kooxda blaCTX-M-8.Ka mid ah noocyada 16 CR-hvKP, noocyada 5 waxay qaadeen kooxda β-lactamase ee blaCTX-M-1, iyo noocyada 6 waxay qaadeen kooxda blaCTX-M-9.
Jaantuska 1 Hidde-yaasha la xidhiidha fayraska, hidde-sideyaasha iska caabbinta antimicrobial, hiddo-wadaha serotype capsular iyo MLST ee 16 CR-hvKP.
Jaantuska 2 Agarose gel electrophoresis ee qaar ka mid ah hiddo-wadaha la xidhiidha fayraska, hidde-sideyaasha iska caabbinta jeermiska iyo hiddo-wadaha serotype capsular.
Fiiro gaar ah: M, DNA calaamade;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, dhammaan S (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR waxaa loo isticmaalay in lagu falanqeeyo isu-ekaanta 16 CR-hvKP.Ka dib kordhinta PCR iyo agarose gel electrophoresis, waxaa jira 3-9 jajab DNA ah.Natiijooyinka sawir-qaadista ayaa muujiyay in 16 CR-hvKP go'doomintu ay ahaayeen kuwo aad u sarreeya, waxaana jiray farqi muuqda oo ka dhex jira go'doominta (Jaantus 3).
Sanadihii la soo dhaafay, waxaa soo badanayay warbixino ku saabsan go'doominta CR-hvKP.Muuqashada go'doominta CR-hvKP waxay khatar weyn ku tahay caafimaadka bulshada sababtoo ah waxay u keeni karaan caabuqyo halis ah, oo ay adag tahay in laga daweeyo dadka caafimaadka qaba.Daraasaddan, faafitaanka iyo astaamaha unugyada unugyada unugyada ee CR-hvKP ee cisbitaalka sare ee Shanghai laga bilaabo 2019 ilaa 2020 ayaa la darsay si loo qiimeeyo haddii ay jirto halista dillaaca CR-hvKP iyo isbeddelka horumarka ee aaggan.Isla mar ahaantaana, daraasaddan ayaa bixin karta qiimeyn aad u ballaaran oo ku saabsan caabuqa bukaan-socodka, taas oo muhiimad weyn u leh ka hortagga faafitaanka dheeraadka ah ee go'doonnadaas.
Daraasaddan ayaa si tartiib tartiib ah u falanqeysay qaybinta bukaan-socodka iyo isbeddelka CR-hvKP laga bilaabo 2019 illaa 2020. Laga bilaabo 2019 illaa 2020, go'doominta CR-hvKP waxay muujisay isbeddel sii kordhaya.Qiyaastii 31.2% (5/16) ee CR-hvKP ayaa la go'doomiyay sanadka 2019, iyo 68.8% (11/16) ee CR-hvKP ayaa la go'doomiyay sanadka 2020, taasoo la socota kor u kaca CR-hvKP ee lagu sheegay suugaanta.Tan iyo Zhang et al.Markii ugu horreysay ee lagu sharraxay CR-hvKP 2015,10 in ka badan iyo in ka badan ayaa la soo sheegay suugaanta CR-hvKP, 17-20 inta badan gobolka Aasiya-Pacific, gaar ahaan Shiinaha.CR-hvKP waa bakteeriya aad u wanaagsan oo leh fayras sare iyo iska caabin dawooyin badan leh.Waxay dhibaato ku tahay caafimaadka dadka waxayna leedahay heer dhimasho oo sarreeya.Sidaa darteed, waa in fiiro gaar ah loo yeesho oo la qaado tallaabooyin looga hortagayo faafitaankiisa.
Falanqaynta iska caabbinta antibiyootiga ee 16 CR-hvKP go'doominta waxay muujisay heer sare oo iska caabin antibiyootik ah.Dhammaan go'doominta waxaa lagu daaweeyay ampicillin, ampicillin/sulbactam, cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, iyo meropenem ayaa u adkaysta.Trimethoprim-sulfamethoxazole waxay lahayd heerka iska caabbinta ugu hooseeya (43.8%), waxaa ku xiga amikacin (62.5%), gentamicin (68.8%) iyo ciprofloxacin (87.5%).Heerka iska caabinta CR-hmkp ee uu bartay Lingling Zhan iyo kuwa kale waxay la mid tahay daraasaddan [12].Bukaannada uu ku dhacay CR-hvKP waxay qabaan cudurro badan oo asaasi ah, difaacooda oo hooseeya, iyo awoodda nadiifinta madax-bannaanida oo daciif ah.Sidaa darteed, daawaynta waqtiga ku salaysan ee ku salaysan natiijooyinka baaritaanka dareenka antimicrobial waa mid aad muhiim u ah.Haddii loo baahdo, goobta cudurka waxaa laga heli karaa oo lagu daaweeyaa biyo-mareenka, nadiifinta iyo habab kale.
Go'doominta 39 CR-hmKP ayaa loo qaybiyay laba kooxood iyadoo loo eegayo dhererka xadhigga dhegdhegaysan.Waxaa ka mid ah, 20 CR-hmKP go'doomin leh dhererka xargaha viscous ≤ 25 mm ayaa loo qaybiyay hal koox, iyo 19 CR-hmKP go'doomin leh dhererka xargaha viscous> 25 mm ayaa loo qaybiyay koox kale.Marka la barbardhigo heerarka togan ee CR-hmKP hiddo-wadaha la xidhiidha fayraska ee u dhexeeya labada kooxood, ma jirin farqi weyn oo tirakoob ah oo u dhexeeya heerarka togan ee hiddo-wadaha fayraska ee u dhexeeya labada kooxood.Cilmi-baaris uu sameeyay Lin Ze et al.waxay muujisay in heerka togan ee hiddo-wadaha fayraska ee Klebsiella pneumoniae uu aad uga sarreeyo kan caadiga ah ee Klebsiella pneumoniae.21 Si kastaba ha ahaatee, haddii heerka togan ee hiddo-wadaha fayraska uu si togan ula xidhiidho dhererka silsiladda dhegdheggu weli ma cadda.Daraasado kale ayaa muujiyay in pneumoniae-ka caadiga ah ee Klebsiella uu sidoo kale noqon karo Klebsiella oof-wareenka oo aad u daran, oo leh heer sare oo togan oo ah hiddo-wadaha fayraska.22 Daraasadani waxay ogaatay in heerka togan ee hiddo-wadaha fayraska ee CR-hmKP aanu si togan ula xidhiidhin dhererka xabka.Xarig (ama kuma korodho dhererka xadhigga dhegdhegaysan).
Sawirada faraha ee ERIC PCR ee daraasaddan waa polymorphic, mana jirto wax isdhaafsi bukaan oo u dhexeeya bukaanada, markaa 16 bukaan oo qaba caabuqa CR-hvKP waa kiisas goos goos ah.Waagii hore, inta badan infekshannada uu keeno CR-hvKP waxaa loo soo sheegay inay yihiin kiisas go'doon ah ama goos goos ah, 23,24 iyo faafitaanno yar yar oo CR-hvKP ah ayaa ku yar suugaanta.11,25 ST11 waa kan ugu caansan ST11 ee go'doominta CRKP iyo CR-hvKP ee Shiinaha.26,27 Inkasta oo ST11 CR-hvKP ay ku xisaabtameen 87.5% (14/16) ee 16 CR-hvKP ee daraasaddan, looma qaadan karo in 14 ST11 CR-hvKP ay ka soo jeedaan isku mid ah, markaa ERIC PCR far. ayaa loo baahan yahay.Falanqaynta Homology.
Daraasaddan, dhammaan bukaannada 16 ee uu ku dhacay CR-hvKP ayaa lagu sameeyay qalliin qallafsan.Sida laga soo xigtay warbixinnada, dillaaca dilaaga ah ee sambabada la xidhiidha hawo-mareenka ee uu keeno CR-hvKP11 waxay muujinaysaa in hababka wax-soo-saarka ay kordhin karaan khatarta caabuqa CR-hvKP.Isla mar ahaantaana, 16 bukaan oo qaba CR-hvKP waxay qabaan cudurro hoose, kuwaas oo cudurada maskaxda ay yihiin kuwa ugu badan.Daraasad hore ayaa muujisay in cudurka cerebrovascular uu yahay arrin khatar ah oo madax-bannaan oo khatar ah oo ku saabsan caabuqa CR-hvKP.28 Sababta dhacdadani waxay noqon kartaa difaaca daciifka ah ee bukaanka qaba cudurrada maskaxda, bakteeriyada pathogenic si madax-bannaan lagama saari karo, kaliya saameyntooda bakteeriyada ayaa lagu tiirsan yahay.Antibiyootiga waxay u horseedi doontaa isku darka caabbinta daawooyinka badan iyo hypervirulence mustaqbalka fog.16 ka bukaan, 9 ayaa dhintay, heerka dhimashaduna waxay ahayd 56.3% (9/16).Heerka dhimashadu waxa uu ka sarreeyaa 10,12 daraasadihii hore, iyo in ka yar 11,21 ayaa lagu sheegay daraasadihii hore.Celceliska da'da bukaanada 16 waxay ahayd 83.1 ± 10.5 sano, taas oo muujinaysa in waayeelka ay aad ugu nugul yihiin CR-hvKP.Daraasado hore ayaa muujiyay in dhallinyaradu aad ugu nugul yihiin caabuqa.Fayraska Klebsiella pneumoniae.29 Si kastaba ha ahaatee, daraasado kale ayaa muujiyay in dadka waayeelka ah ay u nugul yihiin Klebsiella pneumoniae24,28 ee aadka u daran.Daraasadani waxay la socotaa tan.
Ka mid ah 16ka nooc ee CR-hvKP, marka laga reebo hal ST23 CR-hvKP iyo hal ST86 CR-hvKP, 14ka nooc ee kale waa ST11 CR-hvKP.Serotype capsular u dhiganta ST23 CR-hvKP waa K1, iyo serotype capsular u dhigma ee ST86 CR-HVKP waa K2, oo la mid ah daraasadihii hore.30-32 Bukaannada qaba ST23 (K1) CR-hvKP ama ST86 (K2) CR-hvKP ayaa dhintay, heerka dhimashaduna (100%) aad ayuu uga sarreeyaa bukaannada qaba ST11 CR-hvKP (50%).Sida ku cad Jaantuska 1, heerka togan ee noocyada ST23 (K1) ama ST86 (K2) ee noocyada hidde-sideyaasha fayraska ayaa ka sarreeya noocyada ST11 (K64).Dhimashada waxaa laga yaabaa inay la xiriirto heerka togan ee hiddo-wadaha la xiriira fayraska.Daraasaddan, 16 nooc oo CR-hvKP ah dhamaantood waxay wataan hidda-wadaha carbapenemase blaKPC-2 iyo spectrum-la fidsan ee β-lactamase gene blaSHV.blaKPC-2 waa hiddo-wadaha carbapenemase ee ugu caansan CR-hvKP ee Shiinaha.33 Daraasadda Zhao et al., 25blaSHV waa hidda-wadaha β-lactamase-dheeraad ah oo leh heerka ugu sarreeya ee togan.Hidde-yaasha fayraska entB, fimH, rmpA2, iutA, iyo iucA waxay ku jiraan dhammaan 16 CR-hvKP go'doomin, oo ay ku xigto mrkD (n=14), rmpA (n=13), anaerobicin (n=2), allS (n = 1), oo la mid ah daraasaddii hore.34 Daraasadaha qaarkood ayaa muujiyay in rmpA iyo rmpA2 (modulators of phenotype hiddo-wadaha) ay kor u qaadi karaan dheecaanka polysaccharides capsular, taasoo keenta phenotypes hypermucoid iyo kororka fayraska.35 Aerobacterins waxaa lagu calaamadeeyay hidda-wadaha iucABCD, iyo reseptors-kooda isku midka ah waxaa lagu dhejiyay hidda-wadaha iutA, sidaas darteed waxay leeyihiin heer sare oo fayraska ah ee baaritaanka caabuqa G. mellonella.allS waa calaamade K1-ST23, oo aan ku jirin pLVPK, pLVPK waa plasmid fayraska ah oo ka yimid nooca K2 super virulence.allS waa hawl-galiyaha qoraalka nooca HTH.Hidde-sideyaashan fayrasku waxa ay caan ku yihiin in ay ka qaybqaataan fayraska waxayna mas’uul ka yihiin gumeysiga, duullaanka iyo cudur-sidaha.36
Daraasadani waxay sharraxaysaa baahsanaanta iyo cudurrada faafa ee CR-hvKP ee Shanghai, Shiinaha.In kasta oo caabuqa uu keeno CR-hvKP uu yahay mid teel-teel ah, haddana sannadba sannadka ka dambeeya wuu sii kordhayaa.Natiijooyinka waxay taageerayaan cilmi-baaris hore waxayna muujinayaan in ST11 CR-hvKP uu yahay CR-hvKP ugu caansan Shiinaha.ST23 iyo ST86 CR-hvKP waxay muujiyeen fayraska ka sarreeya ST11 CR-hvKP, in kasta oo ay labadooduba yihiin kuwo aad u daran oo Klebsiella pneumoniae ah.Marka boqolleyda Klebsiella pneumoniae ee aadka u fayruska ah ay korodho, heerka iska caabbinta ee Klebsiella pneumoniae ayaa laga yaabaa inay yaraato, taas oo u horseedi doonta rajo indho la'aan ah oo ku saabsan waxqabadka kiliinikada.Sidaa darteed, waa lagama maarmaan in la barto fayraska iyo caabbinta daawada ee Klebsiella pneumoniae.
Daraasadan waxaa ansixiyay Guddiga Anshaxa Caafimaadka ee Isbitaalka Shanaad ee Shangaani (Lambar. 104, 2020).Shaybaarada caafimaadku waa qayb ka mid ah hababka shaybaadhka ee caadiga ah ee cusbitaalka.
Waad ku mahadsan tahay dhammaan shaqaalaha Shaybaadhka Dhexe ee Cisbitaalka Shanaad ee Shanghai sida aad u bixisay hagitaan farsamo daraasaddan.
Shaqadan waxaa taageeray Aasaaska Sayniska Dabiiciga ah ee Degmada Minhang, Shanghai (lambarka oggolaanshaha: 2020MHZ039).
1. Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: isha ugu weyn ee caalamiga ah iyo shuttle loogu talagalay iska caabbinta antibiyootiga.Daabacaadda FEMS Microbiology oo dib loo eegay 2017;41 (3): 252-275.doi:10.1093/femsre/fux013
2. Prokesch BC, TeKippe M, Kim J, iwm. Lafo-beelka aasaasiga ah ee ay keento sunta sareLancet waxa uu ku dhacay Dis.2016;16(9):e190–e195.doi:10.1016/S1473-3099(16)30021-4
3. Shon AS, Bajwa RPS, Russo TA.Fayras sare (xab sare).Klebsiella pneumoniae fayraska.2014;4 (2): 107-118.doi:10.4161/virus.22718
4. Paczosa MK, Mecsas J. Klebsiella pneumoniae: Ku sii wad dembiga difaac adag.Microbiol Mol Biol Rev. 2016;80 (3): 629-661.doi:10.1128/MMBR.00078-15
5. Fang C, Chuang Y, Shun C, iyo al.Hiddo-sidaha fayraska cusub ee Klebsiella pneumoniae oo keena nabar beerka aasaasiga ah iyo dhibaatooyinka dheef-shiid kiimikaadka ee sepsis.J Exp Med.2004;199(5):697–705.doi:10.1084/jem.20030857
6. Russo TA, Olson R, Fang CT, iwm. Aqoonsiga J Clin Microbiol, biomarker loo isticmaalo in lagu kala saaro Klebsiella pneumoniae ee aadka u fayraska ah iyo Klebsiella pneumoniae caadiga ah.2018;56(9):e00776.
7. YCL, Cheng DL, Lin CL.Klebsiella pneumoniae naasaha beerka ee la xidhiidha caabuqa endophthalmitis.Arch intern doctor.1986;146(10):1913-1916.doi:10.1001/archinte.1986.00360220057011
8. Chiu C, Lin D, Liaw Y. Metastatic septic endophthalmitis ee malaxda beerka ee purulent.J Clinical Gastroenterology.1988;10(5):524–527.doi:10.1097/00004836-198810000-00009
9. Guo Yan, Wang Shun, Zhan Li, iwm. Sifooyinka microbiological iyo kiliinikada ee Klebsiella pneumoniae mucinous sare oo go'doomin ah oo la xidhiidha caabuqyada faafa ee Shiinaha.Unugyadii hore waxaa ku dhacay jeermisyo.2017;7.
10. Zhang Yi, Zeng Jie, Liu Wei, iwm. Soo ifbaxa nooca aadka u fayraska ah ee kaarbapenem u adkaysta Klebsiella pneumoniae ee caabuqyada kiliinikada ee Shiinaha[J].caabuqa j2015;71 (5): 553-560.doi:10.1016/j.jinf.2015.07.010
11. Gu De, Dong Nan, Zheng Zhong, iwm. Dilaaca dilaaga ah ee ST11 carbapenem u adkaysta fayraska sare ee Klebsiella oof wareenka cusbitaalka Shiinaha: daraasad molecular epidemiological.Lancet waxa uu ku dhacay Dis.2018;18 (1):37–46.doi:10.1016/S1473-3099(17)30489-9
12. Zhan Li, Wang S, Guo Yan, iyo al.Ka dillaacay nooca carbapenem u adkaysta ST11 hypermucoid Klebsiella pneumoniae ee cisbitaalka sare ee Shiinaha.Unugyadii hore waxaa ku dhacay jeermisyo.2017;7.
13. FRE, Messai Y, Alouache S, iwm. Klebsiella pneumoniae fayraska spectrum iyo qaabka dareenka daroogada oo laga soocay shaybaar caafimaad oo kala duwan[J].Pathophysiology.2013;61 (5):209-216.doi:10.1016/j.patbio.2012.10.004
14. Turton JF, Perry C, Elgohari S, iwm. Sifada PCR iyo qorista Klebsiella pneumoniae iyadoo la isticmaalayo nooca kaabsal gaar ah, tirada doorsooma ee soo noqnoqda tandem iyo bartilmaameedyada hidda-socodka fayraska [J].J Med Microbiology.2010;59 (Cutubka 5): 541-547.doi:10.1099/jmm.0.015198-0
15. Brisse S, Passet V, Haugaard AB iwmJ Clinical Microbiology.2013;51 (12):4073-4078.doi:10.1128/JCM.01924-13
16. Ranjbar R, Tabatabaee A, Behzadi P, iwmIran J Pathol.2017;12 (1): 25–34.doi:10.30699/ijp.2017.21506