高黏液型肺炎克雷伯菌耐药性和感染患者临床特征研究

Drug resistance of hypermucoviscous Klebsiella pneumoniae and clinical characteristics of infected patients

目的探讨高黏液型肺炎克雷伯菌(hypermucoviscous Klebsiella pneumoniae,HMKP)的耐药性分布和感染患者临床特征。方法收集临床分离的41株HMKP菌株进行药物敏感性实验,对碳青霉烯类耐药HMKP(carbapenem resistant HMKP,CR-HMKP)菌株进行多位点序列分型(MLST)、荚膜血清学分型(K分型)和碳青霉烯酶基因检测,对HMKP菌株进行毒力因子检测,同时结合患者临床资料进行临床特征分析。结果41株HMKP菌株中碳青霉烯类敏感HMKP(carbapenem susceptible HMKP,CS-HMKP)31株,CR-HMKP菌株10株,CS-HMKP菌株比CRHMKP菌株对抗菌药物更敏感。毒力因子rmp A、uge、kfu、all S、iut A、ent B、iro N、fim H和wab G在HMKP菌株中广泛存在。K57是主要的CR-HMKP菌株荚膜血清型。10株CR-HMKP菌株均携带blaKPC-2基因ST11型。CR-HMKP较CS-HMKP更容易侵犯营养状态低下、有住院病史和有医源性置管患者,感染侵袭性更强,更容易侵袭血液,有更高的死亡率。结论CR-HMKP较CS-HMKP更容易侵犯营养状态低下、有住院病史和有医源性置管患者,对ST11CR-HMKP菌株在全球范围内的流行应引起关注。

Objective To investigate the drug resistance distribution of hypermucoviscous Klebsiella pneumoniae(HMKP)and clinical characteristics of infected patients.Methods 41 clinical isolates of HMKP were collected for drug sensitivity test.Multilocus sequence typing(MLST),capsular serological typing(K typing)and carbapenemase gene detection were performed on carbapenem resistant HMKP(CR-HMKP).The virulence factors of HMKP strains were detected,and the clinical characteristics were analyzed according to the clinical data of patients.Results Among 41 HMKP strains,31 were carbapenem susceptible HMKP(CS-HMKP)and 10 were CR-HMKP.CS-HMKP was more sensitive to antibiotics than CR-HMKP.Virulence factors rmp A,uge,kfu,all S,iut A,ent B,iro N,fim H and wab G were widely distributed in HMKP strains.K57 was the main capsular serotype of CR-HMKP.All ten CR-HMKP strains carried blaKPC-2 gene ST11 type.Compared with CS-HMKP,CR-HMKP was more likely to invade patients with low nutritional status,hospitalization history and iatrogenic catheterization,and was more likely to invade blood and had higher mortality.Conclusions Compared with CS-HMKP,CR-HMKP was more likely to invade patients with low nutritional status,hospitalization history and iatrogenic catheterization.The global epidemic of ST11 CR-HMKP should be concerned.