肺炎克雷伯菌肝脓肿的临床特点及感染菌的分子特征

Clinical features of Klebsiella pneumoniae liver abscess and molecular characteristics of bacterial infection

目的研究肺炎克雷伯菌肝脓肿的临床情况及微生物特点,有助于为临床快速识别,有效控制提供依据。方法收集衢州市人民医院2013年1月至2019年12月符合肝脓肿诊断,由肺炎克雷伯菌引起的完整病例,分析临床特征,微量肉汤稀释法进行药敏试验,PCR方法检测血清荚膜型和毒力基因。结果肺炎克雷伯菌肝脓肿常见于男性,37.83%(14/37)患者有糖尿病史,37.83%(14/37)患者伴胆囊结石伴胆囊炎。脓肿以单发为主,单发脓肿以肝右叶为主,占74.28%(26/35)。40.54%(15/37)患者发生转移性感染,32.43%(12/37)患者发生肺部感染。实验室检查:WBC增高(13.94±6.37)×109/L,CRP显著增高(148.85±56.75)mg/L,对多种抗生素敏感。78.37%(29/37)株肺炎克雷伯菌产高黏液表型。血清荚膜型以K1、K2型为主,携带多种毒力基因,毒力基因检出情况:rmpA+为78.37%(29/37),iroN+为72.97%(27/37),kfu+为64.86%(24/37)。结论肺炎克雷伯菌肝脓肿常见于有肝胆疾病或糖尿病的患者,以单发脓肿为主,多数患者可以发生转移,严重者甚至引起失明、中枢神经系统感染,多以携带多种毒力基因、高黏液表型、血清荚膜型以K1、K2型为主的肺炎克雷伯菌引起。及时了解本地区的菌株分子特点有助于临床医生早期诊断和治疗。

Objective To study the clinical conditions and microbiological characteristics of Klebsiella pneumoniae liver abscess,which is helpful to provide evidence for rapid clinical identification and effective control.Methods Complete cases caused by Klebsiella pneumoniae in line with the diagnosis of liver abscess in Quzhou People′s Hospital from January 2013 to December 2019 were collected.The clinical features were analyzed.The micro broth dilution method was used for drug susceptibility testing.Serum capsule type and virulence genes were detected by PCR Method.Results Klebsiella pneumoniae liver abscess was common in men,37.83%(14/37)of patients had a history of diabetes,and 37.83%(14/37)of patients had gallbladder stones and cholecystitis.The abscess was mainly single,and the single abscess was mainly the right lobe of the liver,accounting for 74.28%(26/35).Metastatic infection occurred in 40.54%(15/37)patients,and lung infection occurred in 32.43%(12/37)patients.Laboratory examination showed that WBC increased(13.94±6.37)×109/L,CRP increased significantly(148.85±56.75)mg/L,and the Klebsiella pneumoniae were sensitive to various antibiotics.78.37%(29/37)strains of Klebsiella pneumoniae produced a high mucus phenotype.Serum capsule types were mainly K1 and K2,which carried multiple virulence genes.The detection of virulence genes showed that rmpA+was 78.37%(29/37),iroN+was 72.97%(27/37),and kfu+was 64.86%(24/37).Conclusion Klebsiella pneumoniae liver abscess is common in patients with liver and gallbladder disease or diabetes.It is mainly a single abscess.Most patients can metastasize.In severe cases,it can even cause blindness and central nervous system infection.It is mostly caused by Klebsiella pneumoniae,which carries a variety of virulence genes,high mucus phenotype,and serum capsule type K1 and K2.A timely understanding of the molecular characteristics of the strains in this region will help clinicians to diagnose and treat early.