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已发表论文
中国东部重症监护病房中高风险产 KPC 酶 ST463 型铜绿假单胞菌的环境持久性
Authors Shi W, Zhang P, Feng H, Ge T, Chen Y , Jiang Y, Shen P, Ni L, Yu C, Qu T
Received 26 May 2025
Accepted for publication 2 October 2025
Published 21 October 2025 Volume 2025:18 Pages 5379—5390
DOI https://doi.org/10.2147/IDR.S531973
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 5
Editor who approved publication: Dr Hemant Joshi
Weixiao Shi,1,* Piaopiao Zhang,1,* Haiting Feng,2,* Tianxiang Ge,2 Yunbo Chen,1 Yan Jiang,3 Ping Shen,1 Lingmei Ni,2 Chengbo Yu,1 Tingting Qu1,2
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 3Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tingting Qu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email qutingting@zju.edu.cn Chengbo Yu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email yuchengbo1974@zju.edu.cn
Purpose: This study aimed to investigate the distribution and characteristics of high-risk, difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) sequence type (ST) 463 in intensive care units (ICUs) in East China.
Patients and Methods: This 11-month study investigated Carbapenem-resistant Pseudomonas aeruginosa (CRPA) in patients and environments across four ICUs in a large teaching hospital in East China. It involved whole-genome sequencing, antibiotic susceptibility testing, and biofilm-forming ability testing of all the isolates. Molecular epidemiology and phylogenetic relationships were assessed using multi-locus sequence typing (MLST) and core genome multi-locus sequence typing (cgMLST). Bacterial virulence was evaluated using Galleria mellonella infection model.
Results: A total of 54 CRPA were isolated from the environment and inpatients in ICUs and classified into 25 STs, with ST463 identified as the predominant ST (13/54, 24.07%). All 13 ST463 PA isolates belonged to DTR-PA, including 4 from patients and 9 from environments primarily from wastewater dumping pools. All ST463-DTR-PA isolates carried blaKPC-2 and exhibited exoU+/exoS+ virulence genotype. There were 3 KPC-ST463-DTR-PA additionally carried blaAFM-1, resulting in resistance to last-resort antibiotics. ST463-DTR-PA had higher biofilm-forming ability and mortality in infected larvae than non-ST463-DTR-PA. Both clinical and environmental strains showed high virulence. CgMLST results revealed that several ST463-DTR-PA isolated from different ICUs were genetically related.
Conclusion: KPC-ST463-DTR-PA can widely colonize in ICU environment. Contamination and incomplete disinfection in humid environments may provide evolutionary opportunities for ST463-DTR-PA. Hence, it’s worth our vigilance about the growing prevalence of ST463-DTR-PA in East China’s ICUs. Meanwhile, it is important to strengthen the management of the ICU environment, especially water reservoirs, and even to promote the management of patients without water.
Keywords: difficult-to-treat resistant Pseudomonas aeruginosa, ST463, virulence, resistance, ICU, transmission
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 3Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Tingting Qu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email qutingting@zju.edu.cn Chengbo Yu, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China, Email yuchengbo1974@zju.edu.cn
Purpose: This study aimed to investigate the distribution and characteristics of high-risk, difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) sequence type (ST) 463 in intensive care units (ICUs) in East China.
Patients and Methods: This 11-month study investigated Carbapenem-resistant Pseudomonas aeruginosa (CRPA) in patients and environments across four ICUs in a large teaching hospital in East China. It involved whole-genome sequencing, antibiotic susceptibility testing, and biofilm-forming ability testing of all the isolates. Molecular epidemiology and phylogenetic relationships were assessed using multi-locus sequence typing (MLST) and core genome multi-locus sequence typing (cgMLST). Bacterial virulence was evaluated using Galleria mellonella infection model.
Results: A total of 54 CRPA were isolated from the environment and inpatients in ICUs and classified into 25 STs, with ST463 identified as the predominant ST (13/54, 24.07%). All 13 ST463 PA isolates belonged to DTR-PA, including 4 from patients and 9 from environments primarily from wastewater dumping pools. All ST463-DTR-PA isolates carried blaKPC-2 and exhibited exoU+/exoS+ virulence genotype. There were 3 KPC-ST463-DTR-PA additionally carried blaAFM-1, resulting in resistance to last-resort antibiotics. ST463-DTR-PA had higher biofilm-forming ability and mortality in infected larvae than non-ST463-DTR-PA. Both clinical and environmental strains showed high virulence. CgMLST results revealed that several ST463-DTR-PA isolated from different ICUs were genetically related.
Conclusion: KPC-ST463-DTR-PA can widely colonize in ICU environment. Contamination and incomplete disinfection in humid environments may provide evolutionary opportunities for ST463-DTR-PA. Hence, it’s worth our vigilance about the growing prevalence of ST463-DTR-PA in East China’s ICUs. Meanwhile, it is important to strengthen the management of the ICU environment, especially water reservoirs, and even to promote the management of patients without water.
Keywords: difficult-to-treat resistant Pseudomonas aeruginosa, ST463, virulence, resistance, ICU, transmission