肝脓肿高毒力肺炎克雷伯菌耐药性及毒力基因型流行性分析

Antimicrobial resistance and virulence genotypes epidemiological analysis of hypermucoviscous Klebsiella pneumoniae isolates in the liver abscess disease

目的了解肝脓肿分离的高毒力肺炎克雷伯菌耐药性及毒力基因分型流行性分析,为临床治疗提供参考依据。方法选择2011年-2015年医院肝脓肿患者穿刺液和确诊为肝脓肿患者血液分离112株高毒力肺炎克雷伯菌(hvKP),采用PCR及其产物测序了解上述hvKP菌株毒力基因型。结果 112株高毒力肺炎克雷伯菌临床菌株经过拉丝试验检测,结果显示阳性提示均为高毒力株;ESBLs阳性26株,阳性率为23.2%;除亚胺培南与美洛培南之外,抗菌药物在ESBLs阳性耐药率显著高于ESBLs阴性,差异有统计学意义(P<0.05);112株高毒力中102株检出毒力基因,其余10株未检出,102株高毒力基因中以K1+rmpA+wcaG基因携带为主,共34株占33.3%。结论肝脓肿分离肺炎克雷伯菌均为高毒力菌株;rmpA、wcaG和K1基因是医院分离hvKP所携带的主要毒力基因型,而K1+rmpA+wcaG为优势毒力基因型携带模式。

OBJECTIVE To investigate the antimicrobial resistance and virulence genotypes epidemiology of hypermucoviscous Klebsiella pneumoniae（hvKP）isolates in the liver abscess disease,so as to procide evidence for clinical treatment.METHODS One hundred and twelve strains of hvKP were isolated from puncture fluid and blood separation of patients with diagnosis of the liver abscess in our hospital from Jan.2011 to Dec.2015.The major virulence genotypes in the hvKP isolates were detected by PCR.RESULTS All the 112 strains of hvKP were hypervirulent isolates by the string test.There were 26 ESBLs positive strains,with the positive rate of 23.2%.Except imipenem and meropenem,the antimicrobial resistant rates of ESBLs positive strains to antimicrobial agents were significantly higher than those of ESBLs negative strains（P〈0.05）.Virulence genes were detected from91.1%（102/112）of the isolates,and were not detected from 10 isolates.The K1＋rmpA＋wcaG（33.3%,34/102）acted as the predominant virulence genotypes carrying mode.CONCLUSION K.pneumoniae strains isolated from the liver abscess are all hypervirulent isolates.The rmpA,wcaGand K1 are the major genotypes carried by the hvKP from our hospital,and K1 plus rmpA plus wcaG（K1＋rmpA＋wcaG）is the predominant carrying mode of the virulence genotypes.