High level quinolone resistance and the mechanisms of resistance in carbapenem-resistant Klebsiella pneumoniae
10.16718/j.1009-7708.2024.03.010
- VernacularTitle:碳青霉烯类耐药肺炎克雷伯菌对喹诺酮类的高度耐药性及其耐药机制
- Author:
Aimaiti ALIMIRE
1
;
Zhewei SUN
;
Qingqing XU
;
Xiaogang XU
;
Minggui WANG
Author Information
1. 复旦大学附属华山医院抗生素研究所,上海 200040
- Keywords:
carbapenem-resistant Klebsiella pneumoniae;
levofloxacin;
ciprofloxacin;
multilocus sequence typing;
quinolone resistance-determining region variation;
qnr;
aac(6)-Ib-cr
- From:
Chinese Journal of Infection and Chemotherapy
2024;24(3):326-331
- CountryChina
- Language:Chinese
-
Abstract:
Objective To examine the quinolone resistance and mechanisms of resistance,including prevalence of transferable mechanisms of quinolone resistance(TMQR)genes in carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods Antimicrobial susceptibility was tested for CRKP isolated from 7 hospitals in China during 2019 by broth microdilution method.Genome sequencing analysis was performed on Illumina HiseqX sequencing platform.The virulence genes,multilocus sequence typing(MLST),chromosome quinolone resistance-determining region(QRDR)variation,and prevalence of TMQR genes in CRKP were analyzed.Results Overall,98.4％and 99.2％of the 481 CRKP strains were non-susceptible to levofloxacin and ciprofloxacin,respectively.ST11(77.8％)and ST15(15.8％)were the dominant clones.Among the 303 CRKP strains carrying virulence gene(CV-CRKP),ST11 type and ST15 type strains accounted for 92.1％and 5.0％,respectively,while ST11 and ST15 type strains accounted for 53.4％and 34.3％in the 178 CRKP strains without the virulence gene(non-CV-CRKP).All of the ST11 and ST 15 type strains were resistant to quinolones associated with gyrA and parC mutation.All of the quinolone-sensitive strains were not ST11 type or not ST15 type.TMQR analysis showed that qnrS1(61.1％,294 strains),qnrB4(10.0％,48 strains)and aac(6)-Ib-cr(18.7％,90 strains)were most prevalent in CRKPs,while qnrB1(4 strains),qnrB2(2 strains),qnrD1(2 strains)and qnrB6(1 strain)were infrequently identified in CRKPs.Specifically,qnrB4 was mainly identified in high-level levofloxacin-resistant strains(MIC≥8 mg/L),while aac(6)-Ib-cr was found mainly in ciprofloxacin-resistant strains(MIC＞8 mg/L).Conclusions Clinical CRKPs were highly resistant to quinolone.The rate of QRDR variation were high in quinolone resistant CRKP strains,with high TMQR gene carriage.
