摘要
目的调查高毒力肺炎克雷伯菌(hypervirulent variant of K.pneumoniae,hvKP)和经典肺炎克雷伯菌(classic Klebsiella pneumoniae,cKP)感染之间的临床特征及分子情况差异。方法对2015年6月至2018年10月在宜宾市第二人民医院接受肺炎克雷伯菌血流感染治疗的35例患者进行回顾性队列研究。对分离的肺炎克雷伯菌进行黏液丝实验以筛查hvKP。采用Mueller-Hinton琼脂上的KirbyBauer纸片扩散法进行抗菌敏感性试验,并利用PCR方法对hvKP和cKP菌株的分子特性进行研究。结果35株肺炎克雷伯菌分离株中,有11株(31.4%)为hvKP,表现为4种血清型(K1、K2、K20和K57);36.4%(4/11)的hvKP感染患者没有潜在疾病,而95.8%(23/24)的cKP感染患者有一种或多种潜在疾病。hvKP感染患者中社区获得性感染(11/11,100.0%)人数显著多于cKP感染(8/24,33.3%)(P<0.05);cKP感染患者对抗菌药物的耐药性明显高于hvKP感染患者(P<0.05);发现1株产生ESBL的hvKP菌株;cKP感染组和hvKP感染组K1、K2和其他血清型的差异有统计学意义(P<0.05);cKP感染组和hvKP感染组pLVPK相关位点和毒力基因rmpA、iroN的差异有统计学意义(P<0.05)。结论hvKP菌株在严重社区获得性感染患者中普遍存在,并且已发现1株产生ESBL的hvKP,因而迫切需要提高临床意识和hvKP感染管理。
Objective To compare the clinical characteristics and molecular conditions between hypervirulent variant of Klebsiella pneumoniae(hvKP)infection and classic Klebsiella pneumoniae(cKP)infection.Methods A retrospective cohort study was conducted on 35 patients treated in our hospital for K.pneumoniae bloodstream infection between June 2015 to October 2018.The string test was performed to screen hvKP from the isolated Klebsiella pneumoniae.Antimicrobial susceptibility test was carried out using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar.The molecular characteristics of hvKP and cKP strains were studied by PCR.Results Of the 35 strains of K.pneumoniae isolated,11(31.4%)were hvKP,which displayed 4 serotypes(K1,K2,K20 and K57).Four(36.4%)of the 11 patients with hvKP infection tended to have no underlying diseases.However,23(95.8%)of the 24 patients with cKP infection had one or more underlying diseases.More hvKP-positive patients(11/11,100.0%)had community-acquired infection than did cKP-positive patients(8/24,33.3%)(P<0.05).The resistance to antimicrobials in cKP-infected patients was greater than that in hvKP-infected patients(P<0.05).One ESBL-producing hvKP strain was found.There were significant differences between hvKP infection group and cKP infection group in K1,K2,non-typeable serotypes,pLVPK-related loci,and virulence genes rmpA and iroN(P<0.05).Conclusion The hvKP strains are prevalent in patients with severe community-acquired infection,and one strain of ESBL-producing hvKP has been found.Therefore,there is an urgent need to improve clinical awareness and hvKP infection management.
作者
张汉冰
ZHANG Han-bing(Department of Respiratory Medicine,the Second People’s Hospital of Yibin,Yibin 644000,China)
出处
《南昌大学学报(医学版)》
CAS
2020年第5期40-44,共5页
Journal of Nanchang University:Medical Sciences
基金
国家自然科学基金(30860323)。
关键词
肺炎克雷伯菌
高毒力
感染
广谱Β-内酰胺酶
Klebsiella pneumoniae
hypervirulence
infection
broad-spectrumβ-lactamase