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医院内高黏液性肺炎克雷伯菌的流行分布、毒力基因及临床特征分析 被引量:36

Epidemiological distribution, virulent genes and clinical characteristics of hypermucoviscous Klebsiella pneumonia in a Hospital
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摘要 目的·了解上海交通大学医学院附属瑞金医院高黏液性肺炎克雷伯杆菌(hv KP)的流行分布、耐药性、毒力基因特点及检出患者的临床特征。方法·收集该院2014年9月—2016年3月由住院患者各种标本分离的肺炎克雷伯菌作为实验菌株。拉丝试验阳性的菌株确定为hv KP,用聚合酶链反应(PCR)检测相关荚膜血清型及毒力基因。回顾性分析检出hv KP患者的临床资料。结果·①研究期间临床标本分离的不重复肺炎克雷伯菌共872株,其中hv KP 128株,检出率为14.7%。脓肿液标本检出率最高,为44.1%(15/34)。hv KP中呼吸道标本构成比最高,达70.3%(90/128)。②hv KP整体耐药性不高,但是出现2株对亚胺培南耐药的菌株。③hv KP荚膜血清型以K1型和K2型为主,其中K1型占31.3%(40/128),K2型占32.0%(41/128)。95.2%(20/21)的K57型hv KP来自呼吸道标本。所有hv KP均含fi m H、wab G和ure A基因,p-Rmp A和p-Rmp A2基因的检出率分别为91.4%(117/128)和82.8%(106/128)。kfu BC和all S基因的检出率分别为41.4%(53/128)和27.3%(35/128),与K1型相关。不同标本类型间荚膜血清型及毒力基因检出率比较,差异无统计学意义。④检出hv KP的患者中28.9%(37/128)合并糖尿病,44.5%(57/128)合并肿瘤或者使用过长时间的免疫抑制剂。引起明确临床感染者占60.9%(78/128),其中社区获得性感染占47.4%(37/78)。感染组与非感染组、医院获得性感染组和社区获得性感染组菌株的荚膜分型及毒力基因检出率比较,差异无统计学意义。结论·瑞金医院hv KP检出率不高,主要为呼吸道标本,存在一定比例的呼吸道定植。荚膜血清型以K1型和K2型为主,K57型主要见于呼吸道标本。荚膜血清型和毒力基因与标本类型、是否感染及感染来源无明显相关性。hv KP感染逐步由社区获得向医院获得转变,值得临床医师关注。 Objective·To investigate the epidemiological distribution,antibiotic resistance and virulent genes of the hypermucoviscous Klebsiellapneumonia(hvKP)strains isolated from Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and the clinical characteristicsof these patients.Methods·Klebsiella pneumonia isolates were collected from hospitalized patients between September2014and March2016.hvKPisolates were identified by string test.Capsular serotypes and virulent genes were detected using polymerase chain reaction(PCR).Clinical data of thehvKP-detected patients were retrospectively studied.Results·①Of the872non-repetitive Klebsiella pneumonia strains,the prevalence of hvKP was14.7%(128/872),and the highest prevalence of hvKP was44.1%(15/34)from pus.Respiratory tract specimen was the most prevailing specimen of hvKP(70.3%,90/128).②Vast majority of the hvKP strains were susceptible to main antimicrobial agents,but two carbapenem-resistant hvKP strains werefound.③Most of hvKP strains belonged to K1(31.3%,40/128)or K2(32.0%,41/128)capsular serotypes.95.2%(20/21)of K57serotype hvKP strainswere isolated from respiratory tract.All hvKP strains were fimH,wabG and ureA positive.The incidences of p-RmpA and p-RmpA2were91.4%(117/128)and82.8%(106/128)respectively,while the incidences of kfuBC and allS were41.4%(53/128)and27.3%(35/128)respectively,related to K1serotype.The prevalence of capsular serotypes and virulent genes displayed no significant difference among different specimen types.④hvKP isolates occurredcommonly in patients with diabetes mellitus(28.9%,37/128)and cancer/immunosuppression(44.5%,57/128).60.9%(78/128)of the hvKP isolates couldcause an infection,among which47.4%(37/78)were community-acquired infection.The prevalence of capsular serotypes and virulent genes of hvKPalso displayed no significant difference between infection group and non-infection group,as well as community-acquired infection group and hospitalacquiredinfection group.Conclusion·The prevalence of hvKP in Ruijin hospital was not high,and the dominant specimen of hvKP was respiratory tractspecimen,some of which were colonization bacteria.K1/K2capsular serotypes were the predominant serotypes,and almost all K57capsular serotypehvKP strains were isolated from respiratory tract.The prevalence of capsular serotypes and virulent genes of hvKP was not significantly associated withspecimen type,infection and source of infection.It is noteworthy that hvKP infection shows a convert from community-acquired to hospital-acquired.
作者 田李均 王晓丽 肖淑珍 孙景勇 刘嘉琳 瞿洪平 TIAN Li-jun;WANG Xiao-li;LIU Jia-lin;QU Hong-ping;XIAO Shu-zhen;SUN Jing-yong(Department of Critical Care Medicine,Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
出处 《上海交通大学学报(医学版)》 CAS CSCD 北大核心 2017年第1期43-48,共6页 Journal of Shanghai Jiao tong University:Medical Science
基金 上海市科学技术委员会项目(124119a6100) 上海交通大学"医工交叉基金"项目(YG2014MS57)~~
关键词 肺炎克雷伯菌 高黏液性 毒力基因 临床特征 Klebsiella pneumonia hypermucoviscous virulent gene clinical characteristic
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