中国2017—2019年耐碳青霉烯类肺炎克雷伯菌耐药基因及流行克隆特征

 目的 探讨耐碳青霉烯类肺炎克雷伯菌（CRKP）在我国流行的克隆及分子流行病学特征，为临床追踪、实时监控CRKP医院感染及防控提供实际数据支持。方法 通过文献检索收集2017—2019年全国CRKP菌株相关文献，纳入可提供菌株采集地，采用聚合酶链反应（PCR）方法检测耐药基因和多位点序列分型（MLST）分析得出ST型别的文献进行回顾分析，并使用BioNumerics创建最小生成树。结果 最终纳入40篇文献，共2 094株CRKP菌株，分布在全国6个地区（东北、华北、华东、华南、华中、西南）共15个省市，其中1 631株（77.89%） CRKP携带产KPC酶耐药基因，检出亚型主要为KPC-2型（1 014株，62.17%）。2 094株CRKP共检出12种耐药基因，其中KPC耐药基因在6个地区的检出占比均超过50%。859株CRKP经MLST，主要优势序列型别为ST11型（659/859，76.72%），且在全国6个地区均有分布。产KPC-2酶的ST11型菌株（581/659，88.16%）为我国流行的最主要类型。结论 携带耐药基因的CRKP菌株在全国散播流行迅速，目前已遍布全国6个地区，应建立应对CRKP的综合防控措施，避免CRKP在医院内暴发流行。

Resistance genes and prevalence clone characteristics of carbapenem-resis-tant Klebsiella pneumoniae in China from 2017 to 2019

Objective To explore the prevalence clone and molecular epidemiological characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) in China, provide practical data support for clinical trace as well as real-time monitoring on prevention and control of CRKP healthcare-associated infection. Methods Literatures related to CRKP strains in China from 2017 to 2019 were collected through literature retrieval, places where strains could be collected were included in analysis, literatures on drug resistance genes detected with polymerase chain reaction (PCR) and sequence type (ST) detected with multilocus sequence typing (MLST) were analyzed, BioNumerics was used to create minimum spanning tree. Results A total of 40 literatures were included in analysis, involving 2 094 CRKP strains, these strains distributed in 15 provinces and cities in 6 regions (northeast, north, east, south, central and southwest China), 1 631 (77.89%) CRKP strains carried KPC resistance genes; the main detected subtype was KPC-2 (n=1 014, 62.17%). 12 drug resistance genes were detected from 2 094 CRKP strains, of which KPC drug resistance genes accounted for more than 50% in 6 regions.Through MLST analysis on 859 CRKP strains, the dominant sequence type was ST11 (659/859, 76.72%), and distributed in 6 regions of China. KPC-2-producing ST11 strain (581/659, 88.16%) was the most prevalence type in China. Conclusion CRKP strains carrying drug resistance genes spread rapidly throughout the country, they have spread all over 6 regions of the country at pre-sent, comprehensive prevention and control measures against CRKP should be established to avoid the outbreak of CRKP in hospitals.