肺部感染患者免疫球蛋白、炎性因子检测及病原菌分布和肺炎克雷伯菌耐药基因分析

Distribution of pathogens,detection of immunoglobulin levels,and analysis of resistance genes of Kleb-siella pneumoniae in patients with a pulmonary infection

目的了解肺部感染患者血清免疫球蛋白、炎性因子水平变化及病原菌分布,并检测分析常见肺炎克雷伯菌耐药基因携带情况。方法选择2017年1月1日~2019年9月30日本院收治的肺部感染患者126例,为感染组;选择同期体检健康者126名作为对照组。采用ELISA法检测并比较两组受试对象血清免疫球蛋白及炎症因子水平;采集感染组患者痰标本,采用VITEK-2Compact全自动微生物鉴定药敏系统和ATB自动鉴定分析系统检测病原菌感染种类及耐药情况;采用PCR法检测肺炎克雷伯菌β-内酰胺类耐药基因携带情况。结果感染组患者血清IgA、IgM、IgG水平均显著低于对照组(均P<0.05),IL-6IL-8、IL-10、TNF-α水平均显著高于对照组(均P<0.05);126例肺部感染患者痰液标本中共分离出病原菌102株,其中革兰阴性菌83株,以肺炎克雷伯菌(46.08%)、铜绿假单胞菌(23.53%)为主;革兰阳性菌17株,以金黄色葡萄球菌(11.76%)为主;真菌2株。铜绿假单胞菌对氨苄西林/舒巴坦的耐药率为79.17%,阿米卡星耐药率为8.33%;肺炎克雷伯菌对亚胺培南和美罗培南敏感,耐药率均为0;金黄色葡萄球菌对万古霉素、利奈唑胺、利福平以及呋喃妥因敏感,其中万古霉素、利奈唑胺耐药率均为0。47株耐药肺炎克雷伯菌中31株为耐药肺炎克雷伯菌,TEM-1、CTX-M-8、SHV-12耐药基因携带率分别为41.94%、16.13%和16.13%。结论肺部感染患者存在免疫功能及炎症反应异常,感染病原菌以革兰阴性菌中的肺炎克雷伯菌为主,该菌对万古霉素、利奈唑胺敏感。因此对于肺部感染患者需结合药敏试验及感染病原菌的耐药基因型选择敏感药物治疗。

Objectives To investigate the changes in serum immunoglobulin and inflammatory factors in patients with apulmonary infection and to analyze the distribution of pathogens and the drug resistance genes of Klebsiella pneumoniae. Methods One hundred and twenty-six patients with a pulmonary infection seen at this Hospital from January 1,2017 to September 30,2019 served as patients with an infection.One hundred and twenty-six healthy people served as the control group.ELISA was used to detect and compare the levels of serum immunoglobulin and inflammatory factors between the two groups.Sputum samples were collected from patients with an infection,and the Vitek-2 compact automated microbial identification system and ATB automated identification and analysis system were used to detect the types of infection and drug resistance of pathogens.PCR was used to detect theβ-lactam resistance genes of K.pneumoniae. Results The levels of IgA,IgM,and IgG in patients with an infection were significantly lower than those in the control group(P<0.05),and the levels of IL-6,IL-8,IL-10,and TNF-αin the serum were significantly higher than those in the control group(P<0.05).One hundred and two strains of pathogens were isolated from the sputum samples of 126 patients with a pulmonary infection.Of those,83 were strains of Gram-negative bacteria,which were mainly K.pneumoniae(46.08%)and Pseudomonas aeruginosa(23.53%).Seventeen strains of Gram-positive bacteria were detected,and they were mainly Staphylococcus aureus(11.76%).Two strains of fungi were detected.P.aeruginosa had a resistance to ampicillin/sulbactam of 79.17%and a resistance to amikacin of 8.33%.K.pneumoniae had a resistance to imipenem and meropenem of 0.00%.S.aureus had a resistance to vancomycin,linezolid,rifampicin,and nitrofurantoin of 0.00%.Of47 strains of K.pneumoniae isolated from sputum,31 were drug-resistant.TEM-1 was detected in 41.94% of resistant strains,ctx-m-8 was detected in 16.13%,and SHV-12 was detected in 16.13%. Conclusion Patients with a pulmonary infection had abnormal immune function and an abnormal inflammatory reaction.K.pneumoniae is the main pathogen causing apulmonary infection,and it is sensitive to vancomycin and linezolid.Therefore,a drug sensitivity test and genotyping of drug-resistant pathogens causing an infection should be combined to select sensitive drug treatment for patients with a pulmonary infection.