浙江省温州地区肝脓肿患者中肺炎克雷伯菌特征分析

Characteristics of Klebsiella pneumoniae detected in patients with hepatic abscess in Wenzhou

目的探讨肝脓肿患者中高毒力肺炎克雷伯菌微生物学特征、荚膜分型、毒力基因及耐药情况。比较肝脓肿患者中不同毒力肺炎克雷伯菌的区别。方法回顾性分析2015—2017年浙江省温州市中西医结合医院165例肺炎克雷伯菌感染肝脓肿患者的临床资料,采用拉丝试验确定高毒力肺炎克雷伯菌102株。将菌株分为高毒力组和普通组进行研究。采用聚合酶链式反应(PCR)法对血清荚膜进行分型及毒力基因rmpA检测,用VITEK-2 Compact全自动微生物鉴定仪进行药敏试验并对结果进行统计学分析。结果肝脓肿患者中高毒力肺炎克雷伯菌社区获得性感染率更高,83.33%感染的患者没有基础疾病。81.60%肝脓肿病例由肺炎克雷伯菌高毒力株引起,具有高黏液表型,荚膜分型以血清K-1,K-2型为主,携带rmpA基因。普通肺炎克雷伯菌以无黏液为主,荚膜分型为非血清K-1,K-2型为主,极少数携带rmpA基因。高毒力肺炎克雷伯菌对10种常见的抗菌药物的耐药率均较低。共发现3株产超广谱β-内酰胺酶(ESBLs)高毒力肺炎克雷伯菌。未发现耐碳氢酶烯类肺炎克雷伯菌性肝脓肿。结论肝脓肿的主要致病菌为高毒力肺炎克雷伯菌,具有高黏液性、以K-1,K-2血清型为主,在免疫力正常患者的社区获得性感染中出现高毒力肺炎克雷伯菌性肝脓肿的严重感染,对常见抗菌药物的耐药率较低。检出3株产ESBLs的高毒力肺炎克雷伯菌,其耐药性有上升趋势,临床需加强重视。

Objective To investigate the microbiological characteristics,capsule type,virulence gene and drug resistance of Klebsiella pneumoniae detected in patients with hepatic abscess.The differences of K.pneumoniae with different virulence characteristics detected in patients with hepatic abscess were compared.Methods The clinical data of 165 hepatic abscess patients with K.pneumoniae infection in our hospital from 2015 to 2017 were retrospectively analyzed,and 102 strains of K.pneumoniae with high virulence were confirmed by using wire drawing test.The strains were divided into high virulence group and common group.The classification and virulence gene rmpA of serum capsule were detected by using PCR amplification.VITEK 2 Compact automatic microbiological assay instrument was used for drug susceptibility test and the results were statistically analyzed.Results Among patients with hepatic abscess,the community acquired infection rate of K.pneumoniae was higher.Up to 83.33%of the infected patients had no underlying disease and 81.60%of hepatic abscess cases were caused by highly virulent K.pneumoniae strain with high mucous phenotype,and the capsule type were mainly serum K-1 and K-2,which carried rmpA gene.Common K.pneumoniae was mainly mucous free,and the capsule type was non-serum K-1 or K-2 type,a few of them carried rmpA gene.The resistance of K.pneumoniae with high virulence to 10 common used antibiotics was low,and 3 strains of K.pneumoniae with high virulence producing Extended SpectyumβLactamases(ESBLs)were detected.No K.pneumoniae strain resistant to carbapenem was detected.Conclusion The main pathogen of hepatic abscess was K.pneumoniae with high virulence and high level mucous,and mainly with serum type K-1 and K-2,Severe communityacquired infection of highly virulent K.pneumoniae causing liver abscess occurred in patients with normal immunity.The resistance of to common used antibiotics was low.Three strains of K.pneumoniae with high virulence producing ESBLs were detected,and they showed upward trend in drug resistance,to which more attention should be paid in clinical practice.