Ibiranga ivuriro na molekuline biranga karbapenem-irwanya Hypervi

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Ibiranga ivuriro na molekuline biranga karbapenem-irwanya virusi nyinshi Klebsiella pneumoniae mu bitaro bya kaminuza i Shanghai
Zhou Cong, 1 Wu Qiang, 1 He Leqi, 1 Zhang Hui, 1 Xu Maosuo, 1 Bao Yuyuan, 2 Jin Zhi, 3 Fang Shen 11 Ishami ry’ubuvuzi bwa Laboratoire y’ubuvuzi, ibitaro by’abantu bitanu bya Shanghai, kaminuza ya Fudan, Shanghai, Repubulika y’abaturage Ubushinwa;Ishami rya Shanghai Jiaotong Ishami ry’Ubuvuzi bwa Laboratoire, Ibitaro by’abana bya Shanghai, Shanghai, Repubulika y’Ubushinwa;Ishami rya Neurologiya, Ibitaro bya gatanu by’abaturage bya Shanghai, Kaminuza ya Fudan Umwanditsi wandikirwa: Fang Shen, Ishami ry’Ubuvuzi bwa Laboratwari ya Laboratwari, Ibitaro bya gatanu by’abaturage ba Shanghai, Kaminuza ya Fudan, No 128 Umuhanda wa Ruili, Akarere ka Minhang, Shanghai, Postcode 200240 yo mu BushinwaTel +86 18021073261 Imeri [imeri irinzwe] Amavu n'amavuko: Guhuza karbapenem kurwanya na hypervirulence muri Klebsiella pneumoniae byateje ibibazo bikomeye byubuzima rusange.Mu myaka yashize, hari amakuru menshi kandi menshi yerekeye karbapenem-irwanya virusi nyinshi Klebsiella pneumoniae (CR-hvKP) yigunga.Ibikoresho nuburyo: Isesengura ryisubiramo ryisesengura ryamakuru y’amavuriro y’abarwayi banduye CR-hvKP kuva muri Mutarama 2019 kugeza Ukuboza 2020 mu bitaro bya kaminuza.Kubara umusonga wa Klebsiella, umusonga wa Klebsiella (hmKP), umusonga wa karbapenem wanduye Klebsiella pneumoniae (CR-hmKP) hamwe na karbapenem-irwanya virusi itera virusi yakusanyije mu myaka 2 Umubare w’akato ka Leberella (CR-hvKP).PCR gutahura genes zo kurwanya, genes zijyanye na virusi, capsular serotype genes hamwe na multilocus ikurikirana (MLST) ya CR-hvKP yihariye.Ibisubizo: Ubwinshi bwa 1081 budasubirwamo bwa Klebsiella pneumoniae bwarahawe akato mu bushakashatsi., Harimo amoko 392 ya Klebsiella pneumoniae (36.3%), 39 ya CR-hmKP (3,6%) hamwe na 16 ya CR-hvKP (1.5%).Hafi ya 31.2% (5/16) ya CR-hvKP izahabwa akato muri 2019, naho hafi 68.8% (11/16) ya CR-hvKP izahabwa akato muri 2020. Mubice 16 CR-hvKP, 13 ni ST11 na serotype K64, ubwoko 1 ni serotipi ya ST11 na K47, ubwoko 1 ni serotipi ya ST23 na K1, naho ubwoko 1 ni serotipi ya ST86 na K2.Ingirabuzimafatizo zijyanye na virusi entB, fimH, rmpA2, iutA, na iucA zirahari muri 16 zose za CR-hvKP, zikurikirwa na mrkD (n = 14), rmpA (n = 13), aerobactin (n = 2), AllS ( n = 1).16 CR-hvKP itandukanya byose bitwara karbapenemase gene blaKPC-2 hamwe na spran-yagutse β-lactamase gene blaSHV.Ibisubizo bya ERIC-PCR ADN yo gutunga urutoki byerekanaga ko imirongo 16 CR-hvKP yari polymorphique cyane, kandi imirongo ya buri bwoko yari itandukanye cyane, byerekana leta rimwe na rimwe.Umwanzuro: Nubwo CR-hvKP itangwa rimwe na rimwe, iragenda yiyongera uko umwaka utashye.umwaka.Niyo mpamvu, ivuriro rigomba gukangurwa, kandi hagomba gufatwa ingamba zikenewe kugirango wirinde gukwirakwizwa no gukwirakwiza superbug CR-hvKP.Ijambo ryibanze: Klebsiella pneumoniae, kurwanya karbapenem, virusi nyinshi, mucus nyinshi, epidemiologiya
Klebsiella pneumoniae ni indwara itera indwara ishobora gutera indwara zitandukanye, zirimo umusonga, indwara zifata inkari, bacteremia, na meningite.1 Mu myaka mirongo itatu ishize, bitandukanye na Klebsiella pneumoniae (cKP), umusemburo mushya wa Klebsiella pneumoniae (hvKP) hypermucosal mucus wahindutse indwara ikomeye y’ubuvuzi, ushobora kuboneka mu ndwara zikaze cyane nko kurwara umwijima ziterwa n’ubuzima bwiza n'abantu badakingiwe.2 Birakwiye ko tumenya ko ubusanzwe izo ndwara ziherekezwa nindwara zanduza zikwirakwizwa, harimo endophthalmitis na meningitis.3 Umusemburo wa mucosal mucosal phenotype hvKP mubisanzwe biterwa no kongera umusaruro wa capsular polysaccharide no kuba hari genes yihariye ya virusi, nka rmpA na rmpA2.4.Indwara ya mucus ndende isanzwe igenwa n "ikizamini cyumugozi".Indwara ya Klebsiella pneumoniae ikura ijoro ryose kumasahani ya agar yamaraso irambuye hamwe.Iyo hashyizweho umugozi wijimye ufite uburebure bwa> 5mm, "ikizamini cyumugozi" ni cyiza.5 Ubushakashatsi buherutse gukorwa bwerekanye ko peg-344, iroB, iucA, rmpA rmpA2 na rmpA2 ari biomarkers ishobora kumenya neza hvkp.6 Muri ubu bushakashatsi, umusonga witwa Klebsiella pneumoniae wasobanuwe ko ufite fenotype ya mucus viscous cyane (ibisubizo byikizamini cyiza) no gutwara imbuga zijyanye na virusi ya Klebsiella pneumoniae (rmpA2, iutA, iucA) Mu myaka ya za 1980, raporo z’imanza za Tayiwani zasobanuye bwa mbere abaturage -ibisebe byumwijima byatewe na hvKP, biherekejwe no kwangirika kwingingo zanyuma, nka meningite na endophthalmitis.7,8 hvKP ifite kwanduza rimwe na rimwe mu bihugu byinshi byo muri Aziya, Uburayi na Amerika.Nubwo ibibazo byinshi bya hvKP byagaragaye mu Burayi no muri Amerika, ubwiyongere bwa hvKP bwagaragaye cyane mu bihugu bya Aziya, cyane cyane Ubushinwa.9
Muri rusange, hvKP yunvikana cyane na antibiotike, mugihe karbapenem irwanya Klebsiella umusonga (CRKP) ntabwo ari uburozi.Ariko, hamwe no gukwirakwiza ibiyobyabwenge na virusi ya virusi, CR-hvKP yasobanuwe bwa mbere na Zhang n'abandi.muri 2015, kandi hari raporo nyinshi zo murugo.10 Kubera ko CR-hvKP ishobora gutera indwara zikomeye kandi zigoye-kuvura, mugihe hagaragaye clone yicyorezo, irashobora guhinduka "superbug" itaha.Kugeza ubu, indwara nyinshi ziterwa na CR-hvKP zagiye zibaho rimwe na rimwe, kandi indwara ntoya ni gake.11,12
Kugeza ubu, igipimo cyo kumenya CR-hvKP kiri hasi, kandi hariho ubushakashatsi buke bujyanye.Epidemiologiya ya molekuline ya CR-hvKP iratandukanye mu turere dutandukanye, bityo rero ni ngombwa kwiga ikwirakwizwa ry’amavuriro n’ibiranga epidemiologiya biranga CR-hvKP muri kano karere.Ubu bushakashatsi bwasesenguye byimazeyo genes zo kurwanya, genes zijyanye na virusi na MLST ya CR-hvKP.Twagerageje gukora ubushakashatsi ku byorezo na epidemiologiya ya CR-hvKP mu bitaro bya kaminuza i Shanghai, mu burasirazuba bw'Ubushinwa.Ubu bushakashatsi bufite akamaro kanini mugusobanukirwa ibyorezo bya epidemiologiya ya CR-hvKP muri Shanghai.
Umusonga udasubirwamo Klebsiella pneumoniae witandukanije n’ibitaro bya gatanu by’abaturage bya Shanghai bishamikiye kuri kaminuza ya Fudan kuva muri Mutarama 2019 kugeza Ukuboza 2020 byakusanyirijwe hamwe, kandi ijanisha rya hmKP, CRKP, CR-hmkp na CR-hvKP ryabazwe.Abigunga bose bamenyekanye na VITEK-2 compact yikora mikorobe isesengura (Biomerieux, Marcy L'Etoile, Ubufaransa).Maldi-Tof mass spectrometrie (Bruker Daltonics, Billerica, MA, USA) yakoreshejwe mugusuzuma imiterere ya bagiteri.Indwara ya mucus ndende igenwa n "ikizamini cyumugozi".Iyo imipenem cyangwa meropenem irwanya, kurwanya karbapenem bigenwa hakoreshejwe ikizamini cyo kwanduza ibiyobyabwenge.Indwara ikabije ya Klebsiella pneumoniae isobanurwa ko ifite fenotype yo mu bwoko bwa mucus (ibisubizo byikizamini cyiza) no gutwara Klebsiella pneumoniae virusi virusi ya plasmid (rmpA2, iutA, iucA) 6.
Koloni imwe ya Klebsiella pneumoniae yatewe ku isahani y'amaraso y'intama 5%.Nyuma yo gushira ijoro ryose kuri 37 ° C, kura buhoro buhoro koloni ukoresheje umugozi utera kandi usubiremo inshuro 3.Niba umurongo wa viscous wakozwe inshuro eshatu kandi uburebure bukaba burenze 5mm, "umurongo wumurongo" ufatwa nkibyiza, kandi umutwaro ufite fenotipike ndende.
Mu isesengura rya VITEK-2 ryikora ryisesengura rya mikorobe (Biomerieux, Marcy L'Etoile, mu Bufaransa), kwandura mikorobe kwanduza antibiyotike nyinshi zikoreshwa cyane byagaragaye na mikorobe ya dilution.Ibisubizo bisobanurwa hakurikijwe inyandiko y'ubuyobozi yateguwe n'ikigo gishinzwe ubuziranenge bwa Clinical na Laboratoire (CLSI, 2019).E. coli ATCC 25922 na Klebsiella pneumoniae ATCC 700603 yakoreshejwe nk'igenzura mu gupima virusi itera mikorobe.
ADN ya ADN ya Klebsiella pneumoniae yonyine yakuweho na TIANamp Bacteria Genomic ADN Kit (Tiangen Biotech Co. Ltd., Beijing, Ubushinwa).Ikwirakwizwa ryagutse β-lactamase (blaCTX-M, blaSHV na blaTEM), karbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP na blaOXA-48) hamwe na gen 9 zihagarariye virusi, harimo na pLVPK Plasmid isa na loci (allS, fimHH) , mrkD, entB, iutA, rmpA, rmpA2, iucA, na aerobactin) byongerewe imbaraga na PCR nkuko byasobanuwe mbere.13,14 Ubwoko bwa capsular serotype yihariye (K1, K2, K5, K20, K54, na K57) byongerewe imbaraga na PCR nkuko byasobanuwe haruguru.14 Niba ari bibi, ongera kandi ukurikirane inzige wzi kugirango umenye capsular serotype yihariye.15 Intangiriro zikoreshwa muri ubu bushakashatsi ziri ku mbonerahamwe ya S1.Ibicuruzwa byiza bya PCR byakurikiranwe na NextSeq 500 ikurikirana (Illumina, San Diego, CA, USA).Gereranya urutonde rwa nucleotide ukoresheje BLAST kurubuga rwa NCBI (http://blast.ncbi.nlm.nih.gov/Blast.cgi).
Kwandika kurubuga rwinshi (MLST) byakozwe nkuko byasobanuwe kurubuga rwa Pasteur Institute MLST (https://bigsdb.pasteur.fr/klebsiella/klebsiella.html).Indwi zirindwi zo kubungabunga urugo gapA, infB, mdh, pgi, phoE, rpoB na tonB byongerewe imbaraga na PCR bikurikirana.Ubwoko bwurukurikirane (ST) bugenwa no kugereranya ibisubizo bikurikirana hamwe na MLST base base.
Hasesenguwe homology ya Klebsiella pneumoniae.ADN ya Klebsiella pneumoniae yakuweho nk'icyitegererezo, kandi primers ya ERIC igaragara mu mbonerahamwe S1.PCR yongerera ADN genomic kandi yubaka urutoki rwa ADN genomic.Ibicuruzwa 16 bya PCR byagaragaye na 2% agarose gel electrophorei.Ibisubizo byo gutunga urutoki ADN byagaragaye hakoreshejwe kumenyekanisha bande ya QuantityOne, kandi isesengura rishingiye ku ngirabuzima fatizo ryakozwe hakoreshejwe uburyo bw'amatsinda adafite uburemere (UPGMA) bwo kubara.Kwigunga bifite aho bihuriye> 75% bifatwa nka genotype imwe, naho ibisa <75% bifatwa nka genotypes zitandukanye.
Koresha porogaramu y'ibarurishamibare SPSS ya Windows 22.0 kugirango usesengure amakuru.Ibyatanzwe bisobanurwa nkibisobanuro iation gutandukana bisanzwe (SD).Ibyiciro byahinduwe byasuzumwe na chi-kare cyangwa ikizamini cya Fisher.Ibizamini byose bibarurishamibare ni 2-umurizo, na P agaciro ka <0.05 bifatwa nkibyingenzi.
Ibitaro bya gatanu by’abaturage bya Shanghai bishamikiye kuri kaminuza ya Fudan byakusanyije 1081 Klebsiella pneumoniae yitaruye kuva ku ya 1 Mutarama 2019 kugeza ku ya 31 Ukuboza 2020, kandi hatarimo kwigana kwigana umurwayi umwe.Muri byo, imirongo 392 (36.3%) yari hmKP, 341 (31.5%) ni CRKP, 39 (3,6%) ni CR-hmKP, naho 16 (1.5%) ni CR-hvKP.Birakwiye ko tumenya ko 33.3% (13/39) ya CR-hmKP na 31.2% (5/16) ya CR-hvKP kuva muri 2019, 66.7% (26/39) ya CR-hmKP na 68.8% (11/16 ) CR-hvKP yatandukanijwe guhera muri 2020. Kuva mu gihumyo (17) (1 kwigunga).Ubwoko cumi na butandatu bwa CR-hvKP bwakuwe muri spumum (9 izigunga), inkari (5 izigunga), amaraso (1 wenyine) hamwe na effusion effusion (1 isolate).
Binyuze mu kumenyekanisha amoko, kwipimisha ibiyobyabwenge, gupima umugozi no guterwa na virusi, virusi 16 CR-hvKP.Ibiranga ivuriro ry’abarwayi 16 banduye CR-hvKP yihariye byavuzwe mu mbonerahamwe ya 1. 13 ku barwayi 16 (81.3%) bari abagabo, kandi abarwayi bose bari hejuru y’imyaka 62 (bivuze imyaka: 83.1 ± 10.5).Baturutse mu byumba 8, naho abarenga kimwe cya kabiri baturutse muri ICU rwagati (imanza 9).Indwara z'ibanze zirimo indwara zifata ubwonko (75%, 12/16), hypertension (50%, 8/16), indwara zidakira zifata ibihaha (50%, 8/16), n'ibindi. 16), catheter yinkari (37.5%, 6/16), umuyoboro wigifu (18.8%, 3/16), kubagwa (12.5%, 2/16) na catheter yinjira (6.3%, 1/16).Icyenda ku barwayi 16 barapfuye, abarwayi 7 baratera imbere barasohoka.
39 CR-hmKP yihariye yigabanyijemo amatsinda abiri ukurikije uburebure bwumugozi.Muri bo, 20 CR-hmKP yitaruye ifite uburebure bwumugozi ≤ 25 mm yagabanijwe mu itsinda rimwe, naho 19 CR-hmKP yitaruye ifite uburebure bw’umugozi> mm 25 yagabanijwe mu rindi tsinda.Uburyo bwa PCR bwerekana igipimo cyiza cya genes zijyanye na virusi rmpA, rmpA2, iutA na iucA.Igipimo cyiza cya gen-CR-hmKP kijyanye na virusi mu matsinda yombi cyerekanwe mu mbonerahamwe ya 2. Nta tandukanyirizo ry’imibare ryagaragaye ku gipimo cyiza cy’imiterere ya virusi ya CR-hmKP hagati y’amatsinda yombi.
Imbonerahamwe 3 irerekana ibisobanuro birambuye birwanya imiti igabanya ubukana bwa miti 16.16 CR-hvKP yihariye yerekanye ibiyobyabwenge byinshi.Abigunze bose bavuwe hamwe na ampisilline, ampisilline / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, na meropenem birwanya.Trimethoprim-sulfamethoxazole yari ifite igipimo cyo hasi cyane (43.8%), ikurikirwa na amikacin (62.5%), gentamicin (68.8%) na ciprofloxacin (87.5%).
Ikwirakwizwa rya genes zifitanye isano na virusi, ingirabuzimafatizo zirwanya mikorobe, genoside ya capsular serotype na MLST ya 16 CR-hvKP yitaruye irerekanwa ku gishushanyo cya 1. Ibisubizo bya agarose gel electrophorei ya gen zimwe na zimwe zifitanye isano na virusi, genoside irwanya mikorobe na capsular serotype ni yerekanwe ku gishushanyo cya 1. Ishusho 2. Isesengura rya MLST ryerekana ST zose hamwe, ST11 niyo ST yiganje cyane (87.5%, 14/16), ikurikirwa na ST23 (6.25%, 1/16) na ST86 (6.25%, 1 / 16).Ukurikije ibisubizo byanditse wzi, hamenyekanye serotypes 4 zitandukanye za capsular (Ishusho 1).Muri karbapenem 16 irwanya hvKP yihariye, K64 ni serotype ikunze kugaragara (n = 13), ikurikirwa na K1 (n = 1), K2 (n = 1) na K47 (n = 1).Mubyongeyeho, capsular serotype K1 ubwoko bwa ST23, capsular serotype K2 ubwoko bwa ST86, naho 13 isigaye ya K64 na 1 ya K47 yose ni ST11.Igipimo cyiza cya gen 9 za virusi muri 16 CR-hvKP yihariye zerekanwa ku gishushanyo cya 1., genes zijyanye na virusi entB, fimH, rmpA2, iutA, na iucA ziboneka mumirongo 16 CR-hvKP, ikurikirwa na mrkD (n = 14), rmpA (n = 13), aerobacterin (n = 2), AllS (n = 1).16 CR-hvKP itandukanya byose bitwara karbapenemase gene blaKPC-2 hamwe na spran-yagutse β-lactamase gene blaSHV.16 CR-hvKP yitaruye ntabwo yatwaye genes ya karbapenem blaNDM, blaVIM, blaIMP, blaOXA-48 hamwe na spekiteri yagutse β-lactamase genes blaTEM, itsinda rya blaCTX-M-2, nitsinda rya blaCTX-M-8.Mubice 16 CR-hvKP, imirongo 5 yatwaye umurongo wagutse β-lactamase gene blaCTX-M-1, naho imirongo 6 yatwaye umurongo mugari β-lactamase gene blaCTX-M-9.
Igicapo 1 Ingirabuzimafatizo zifitanye isano na virusi, ingirabuzimafatizo zirwanya mikorobe, genoside ya capsular serotype na MLST ya 16 CR-hvKP yihariye.
Igishushanyo cya 2 Agarose gel electrophorei ya genes zimwe na zimwe zijyanye na virusi, ingirabuzimafatizo zirwanya mikorobe na genoside ya capotype.
Icyitonderwa: M, ikimenyetso cya ADN;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, S yose (508bp);11, mrkD (340bp);12, fimH (609bp).
ERIC-PCR yakoreshejwe mu gusesengura homologiya ya 16 CR-hvKP yihariye.Nyuma yo kongera PCR hamwe na agarose gel electrophorei, hari ibice 3-9 bya ADN.Ibisubizo byo gutunga urutoki byerekanaga ko 16 CR-hvKP yihariye yari polymorphique cyane, kandi hariho itandukaniro rigaragara hagati y’akato (Ishusho 3).
Mu myaka yashize, habaye raporo nyinshi kandi nyinshi kuri CR-hvKP yihariye.Kugaragara kwa CR-hvKP kwigunga birabangamira ubuzima rusange kuko bishobora gutera indwara zikomeye, zigoye-kuvura abantu bafite ubuzima bwiza.Muri ubu bushakashatsi, ubushakashatsi bwakozwe na virusi ya epidemiologiya ya CR-hvKP mu bitaro bya kaminuza i Shanghai kuva 2019 kugeza 2020 byakozwe kugira ngo harebwe niba hari ibyago byo kwandura CR-hvKP ndetse n’iterambere ryayo muri kariya karere.Muri icyo gihe, ubu bushakashatsi burashobora gutanga isuzuma ryimbitse ry’indwara zandura, zifite akamaro kanini mu gukumira ikwirakwizwa ry’izo nyamanswa.
Ubu bushakashatsi bwasesenguye ku buryo bugaragara ikwirakwizwa ry’amavuriro n’imiterere ya CR-hvKP kuva 2019 kugeza 2020. Kuva muri 2019 kugeza 2020, CR-hvKP yihariye yerekanye inzira igenda yiyongera.Hafi ya 31.2% (5/16) ya CR-hvKP yitaruye mu 2019, naho 68.8% (11/16) ya CR-hvKP yitaruye mu 2020, ibyo bikaba bihuye n’izamuka rya CR-hvKP ryavuzwe mu bitabo.Kuva Zhang n'abandi.bwa mbere bwasobanuye CR-hvKP muri 2015,10 n’ibindi byinshi CR-hvKP byavuzwe, 17-20 ahanini mu karere ka Aziya-Pasifika, cyane cyane mu Bushinwa.CR-hvKP ni bagiteri nziza cyane ifite virusi nyinshi kandi irwanya ibiyobyabwenge.Nibyangiza ubuzima bwabantu kandi bifite umubare munini wimpfu.Niyo mpamvu, hagomba kwitabwaho kandi hagafatwa ingamba zo gukumira ikwirakwizwa ryayo.
Isesengura rya antibiyotike yo kurwanya 16 CR-hvKP yerekana ko igipimo kinini cyo kurwanya antibiyotike.Abigunze bose bavuwe hamwe na ampisilline, ampisilline / sulbactam, cefoperazone / sulbactam, piperacillin / tazobactam, cefazolin, cefuroxime, ceftazidime, ceftriaxone, cefepime, Cefoxitin, imipenem, na meropenem birwanya.Trimethoprim-sulfamethoxazole yari ifite igipimo cyo hasi cyane (43.8%), ikurikirwa na amikacin (62.5%), gentamicin (68.8%) na ciprofloxacin (87.5%).Igipimo cyo kurwanya CR-hmkp cyizwe na Lingling Zhan nabandi basa nubu bushakashatsi [12].Abarwayi banduye CR-hvKP bafite indwara nyinshi zibanze, ubudahangarwa buke, nubushobozi buke bwigenga bwo kuboneza urubyaro.Kubwibyo, kuvura mugihe gishingiye kubisubizo byikizamini cya antibicrobial sensitivite ni ngombwa cyane.Bibaye ngombwa, urubuga rwanduye rushobora kuboneka no kuvurwa n'amazi, imyanda n'ubundi buryo.
39 CR-hmKP yihariye yigabanyijemo amatsinda abiri ukurikije uburebure bwumugozi.Muri bo, 20 CR-hmKP yitaruye ifite uburebure bwumugozi ≤ 25 mm yagabanijwe mu itsinda rimwe, naho 19 CR-hmKP yitaruye ifite uburebure bw’umugozi> mm 25 yagabanijwe mu rindi tsinda.Ugereranije ibipimo byiza bya gen-CR-hmKP ziterwa na virusi hagati yaya matsinda yombi, nta tandukanyirizo rishingiye ku mibare ryagaragaye mu mibare myiza ya virusi ya virusi hagati yaya matsinda yombi.Ubushakashatsi bwakozwe na Lin Ze n'abandi.yerekanye ko igipimo cyiza cya virusi ya virusi ya Klebsiella pneumoniae cyari hejuru cyane ugereranije n’umusonga wa Klebsiella pneumoniae.21 Ariko, niba igipimo cyiza cya virusi zifitanye isano neza nuburebure bwurunigi rukomeye ntirurasobanuka neza.Ubundi bushakashatsi bwerekanye ko umusonga wa Klebsiella pneumoniae ushobora nanone kuba umusonga wa Klebsiella pneumoniae ufite umuvuduko ukabije, ufite umuvuduko mwinshi wa gen.22 Ubu bushakashatsi bwerekanye ko virusi ya virusi igipimo cya CR-hmKP ntaho ihuriye neza nuburebure bwa mucus.Ikirongo (cyangwa ntabwo yiyongera hamwe nuburebure bwumugozi ufashe).
ERIC PCR yerekana urutoki rwubu bushakashatsi ni polymorphic, kandi nta clinique ihuza abarwayi, bityo abarwayi 16 banduye CR-hvKP ni indwara rimwe na rimwe.Mu bihe byashize, indwara nyinshi zatewe na CR-hvKP zavuzwe ko ari abantu bonyine cyangwa rimwe na rimwe, 23,24 ndetse n'indwara ntoya ya CR-hvKP ni gake mu bitabo.11,25 ST11 niyo ST11 ikunze kugaragara muri CRKP na CR-hvKP yigunga mubushinwa.26.27 Nubwo ST11 CR-hvKP yari ifite 87.5% (14/16) muri 16 CR-hvKP yitaruye muri ubu bushakashatsi, ntidushobora gutekereza ko imirongo 14 ya ST11 CR-hvKP ikomoka kuri clone imwe, bityo ERIC PCR igikumwe ni ngombwa.Isesengura rya homologiya.
Muri ubu bushakashatsi, abarwayi 16 bose banduye CR-hvKP babazwe igitero.Nk’uko amakuru abitangaza, icyorezo cyahitanye umusonga uterwa na ventilator uterwa na CR-hvKP11 cyerekana ko uburyo bwo gutera bushobora kongera ibyago byo kwandura CR-hvKP.Muri icyo gihe, abarwayi 16 banduye CR-hvKP bafite indwara zifatika, muri zo indwara zifata ubwonko ni zo zikunze kugaragara.Ubushakashatsi bwabanje bwerekanye ko indwara zifata ubwonko ari ikintu gikomeye cyigenga cyanduza CR-hvKP.28 Impamvu yibi bintu ishobora kuba ubudahangarwa bw’ubudahangarwa bw’abarwayi bafite indwara zifata ubwonko, bagiteri zitera indwara ntizishobora kuvaho mu bwigenge, kandi ingaruka zazo ziterwa na bagiteri gusa.Antibiyotike izaganisha ku kurwanya ibiyobyabwenge byinshi na hypervirulence mugihe kirekire.Mu barwayi 16, 9 barapfuye, naho abapfa ni 56.3% (9/16).Umubare w'abapfa uri hejuru ya 10,12 mu bushakashatsi bwabanjirije, naho munsi ya 11.21 byavuzwe mu bushakashatsi bwabanje.Impuzandengo y’abarwayi 16 yari 83.1 ± 10.5, byerekana ko abageze mu zabukuru bakunze kwibasirwa na CR-hvKP.Ubushakashatsi bwibanze bwerekanye ko urubyiruko rushobora kwandura cyane.Virusi ya Klebsiella pneumoniae.29 Ariko, ubundi bushakashatsi bwerekanye ko abageze mu zabukuru bashobora kwandura indwara ya Klebsiella pneumoniae 24,28.Ubu bushakashatsi burahuye nibi.
Mubice 16 CR-hvKP, usibye ST23 CR-hvKP imwe na ST86 CR-hvKP, izindi 14 zose ni ST11 CR-hvKP.Serotype ya capsular ihuye na ST23 CR-hvKP ni K1, naho serotype ihuye na ST86 CR-HVKP ni K2, bisa nubushakashatsi bwabanje.30-32 Abarwayi banduye ST23 (K1) CR-hvKP cyangwa ST86 (K2) CR-hvKP barapfuye, kandi impfu (100%) zari hejuru cyane ugereranije n’abarwayi banduye ST11 CR-hvKP (50%).Nkuko bigaragara ku gishushanyo cya 1, igipimo cyiza cya ST23 (K1) cyangwa ST86 (K2) ubwoko bwa genes zifitanye isano na virusi kirenze icy'ubwoko bwa ST11 (K64).Urupfu rushobora kuba rujyanye nigipimo cyiza cya gen.Muri ubu bushakashatsi, amoko 16 ya CR- hvKP yose atwara karbapenemase gene blaKPC-2 hamwe na spran yagutse β-lactamase gene blaSHV.blaKPC-2 ni gene ya karbapenemase ikunze kugaragara muri CR-hvKP mu Bushinwa.33 Mu bushakashatsi bwakozwe na Zhao nabandi, 25blaSHV niyaguka-spekure β-lactamase gene ifite igipimo cyiza cyane.Indwara ya virusi entB, fimH, rmpA2, iutA, na iucA irahari muri 16 CR-hvKP yonyine, ikurikirwa na mrkD (n = 14), rmpA (n = 13), anaerobicin (n = 2), allS (n = 1), bisa nubushakashatsi bwabanje.34 Ubushakashatsi bumwe bwerekanye ko rmpA na rmpA2 (modulator ya mucus phenotype genes) zishobora guteza imbere ururenda rwa capsular polysaccharide, biganisha kuri hypermucoid phenotypes no kwandura virusi.35 Aerobacterine igizwe na gene ya iucABCD, kandi reseptors zabo zandikirwa na gen iutA, bityo zikaba zifite urwego rwinshi rwa virusi mubibazo byanduye G. mellonella.allS ni ikimenyetso cya K1-ST23, ntabwo kiri muri pLVPK, pLVPK ni plasmid ya virusi yo mu bwoko bwa K2 super virusi.allS ni HTH ubwoko bwimyandikire.Izi genes zizwiho kugira uruhare muri virusi kandi zifite inshingano zo gukoloniza, gutera no gutera indwara.36
Ubu bushakashatsi busobanura ubwiyongere bwa epidemiologiya ya CR-hvKP i Shanghai, mu Bushinwa.Nubwo kwandura biterwa na CR-hvKP rimwe na rimwe, bigenda byiyongera uko umwaka utashye.Ibisubizo bishyigikira ubushakashatsi bwabanje kandi byerekana ko ST11 CR-hvKP ari CR-hvKP izwi cyane mu Bushinwa.ST23 na ST86 CR-hvKP berekanye virusi irenze ST11 CR-hvKP, nubwo bombi ari umusonga Klebsiella pneumoniae.Mugihe ijanisha rya Klebsiella pneumoniae rifite ubukana bwinshi, umuvuduko wo kurwanya umusonga wa Klebsiella urashobora kugabanuka, ibyo bikazana icyizere gihumye mubikorwa byubuvuzi.Niyo mpamvu, birakenewe kwiga virusi no kurwanya ibiyobyabwenge bya Klebsiella pneumoniae.
Ubu bushakashatsi bwemejwe na komite ishinzwe imyitwarire yubuvuzi bwibitaro bya gatanu byabantu (No 104, 2020).Ibyitegererezo byubuvuzi biri mubikorwa bisanzwe bya laboratoire.
Ndashimira abakozi bose ba Laboratoire Nkuru y’ibitaro bya gatanu by’abaturage ba Shanghai kuba baratanze ubuyobozi bwa tekiniki kuri ubu bushakashatsi.
Uyu murimo washyigikiwe na Fondasiyo yubumenyi Kamere yo mu Karere ka Minhang, Shanghai (nimero yemewe: 2020MHZ039).
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