The goal of the present study was to examine the characteristics of carbapenem-resistant Klebsiella pneumoniae as a cause of neonatal infection. A total of 37 carbapenem-resistant Klebsiella pneumoniae-positive newborns hospitalized in Shandong Provincial Hospital, China between April 2011 and October 2013 were examined. Antibiotic susceptibility testing was performed using the agar dilution method and the Etest. Resistance genes were assessed by polymerase chain reaction (PCR) and sequencing. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were used to determine the genotypes and homology of these isolates. Plasmids were analyzed by PFGE and conjugation experiments. The outer membrane proteins were examined by PCR and SDS-PAGE. All of the isolates were revealed to be resistant to the third and fourth generation cephalosporins and piperacillin-tazobactam. Tigecycline, colistin, levofloxacin and amikacin were successful against all of the isolates. The antibiotic resistance rates of aztreonam, gentamicin, trimethoprim-sulfamethoxazole and fosfomycin were 13.51, 48.64, 78.38 and 86.49%, respectively. Of the 37 cases, 25 isolates (67.57%) were blaNDM-1 positive, 13 isolates (35.14%) were blaIMP-4 positive and 1 isolate (2.70%) was blaIMP-8 positive. Two isolates carried both blaNDM-1 and blaIMP-4. The isolate carrying 2-4 plasmids and blaNDM-1 and blaIMP-4 was transferable between strains. SDS-PAGE data indicated that outer membrane proteins remained present. PFGE revealed 7 distinct clusters, and MLST reported the presence of ST20, ST17, ST54, ST705 and ST290 sequences, which indicated that there was clone and plasmid spread between newborns. The main resistance mechanism of carbapenem-resistant Klebsiella pneumoniae was that the isolates expressed the carbapenemase resistance of blaNDM-1 and blaIMP-4 genes. The current study indicates that early detection of these genes may be helpful in infection prevention and control.

译文

:本研究的目的是检查耐碳青霉烯类肺炎克雷伯菌的特征,以作为新生儿感染的原因。 2011年4月至2013年10月,在中国山东省立医院共住院治疗了37例对碳青霉烯耐药的肺炎克雷伯菌阳性婴儿。使用琼脂稀释法和Etest进行抗生素敏感性测试。通过聚合酶链反应(PCR)和测序评估抗性基因。脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)用于确定这些分离株的基因型和同源性。通过PFGE和缀合实验分析质粒。外膜蛋白通过PCR和SDS-PAGE检查。所有分离株均显示对第三代和第四代头孢菌素和哌拉西林-他唑巴坦有抗药性。替加环素,粘菌素,左氧氟沙星和丁胺卡那霉素对所有分离株均成功。氨曲南,庆大霉素,甲氧苄氨磺胺甲基异恶唑和磷霉素的耐药率分别为13.51%,48.64%,78.38%和86.49%。在这37例病例中,有25株(67.57%)blaNDM-1阳性,13株(35.14%)blaIMP-4阳性,1株(2.70%)blaIMP-8阳性。两种分离株均携带blaNDM-1和blaIMP-4。带有2-4个质粒以及blaNDM-1和blaIMP-4的分离株可在菌株之间转移。 SDS-PAGE数据表明外膜蛋白仍然存在。 PFGE揭示了7个不同的簇,并且MLST报告了ST20,ST17,ST54,ST705和ST290序列的存在,这表明在新生儿之间存在克隆和质粒传播。对碳青霉烯类耐药的肺炎克雷伯菌的主要耐药机制是分离株表达了blaNDM-1和blaIMP-4基因对碳青霉烯酶的耐药性。当前的研究表明,这些基因的早期检测可能有助于预防和控制感染。

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