某三甲医院肺炎克雷伯菌毒力基因分布、耐药性及患者临床特征分析

Analysis of Virulence Genes Distribution,Drug Resistance and Clinical Characteristics of Klebsiella pneumoniae in a Tertiary A Hospital

目的 分析某三级甲等医院临床分离的肺炎克雷伯菌毒力基因分布、耐药性及患者临床特征,为临床诊治提供依据。方法 收集临床分离的107株肺炎克雷伯菌进行毒力基因检测和药敏试验,并收集患者的临床资料,采用iucA基因和peg-344基因阳性区分高毒力肺炎克雷伯菌(hvKP)和经典肺炎克雷伯菌(cKP),比较分析hvKP和cKP的毒力基因携带率、药敏结果以及患者临床特征。结果 107株肺炎克雷伯菌中共检出hvKP 57株,占比53.3%,hvKP组的毒力基因iucA、iroB、rmpA、rmpA2、peg-344基因携带率明显高于cKP组,与cKP相比,hvKP对头孢唑林、头孢呋辛、环丙沙星、复方磺胺甲恶唑耐药率较低;hvKP及cKP主要分离自痰标本,与hvKP相比,年龄大于75岁的患者更易引起cKP感染。结论 本院hvKP临床分离率较高,但老年人更易引起cKP感染。与cKP相比,hvKP对临床常用抗菌药物耐药率较低,临床医生应根据菌株特性和患者临床特征,制定合理的诊治方案。

Objective The virulence genes distribution,drug resistance and clinical characteristics of Klebsiella pneumoniae isolated from a tertiary A hospital were analyzed in order to provide basis for clinical diagnosis and treatment.Methods 107 strains of Klebsiella pneumoniae isolated clinically were collected for virulence gene detection and drug sensitivity test,and the clinical data of the patients were collected.Hypervirulent Klebsiella pneumoniae and Classic Klebsiella pneumoniae are distinguished by positive iucA gene and peg-344 gene.The virulence gene carrying rate,drug sensitivity and clinical characteristics of hvKP and cKP were compared and analyzed.Results A total of 57 strains of hvKP were detected in 107strains of Klebsiella pneumoniae,accounting for 53.3%.The carrying rate of virulence genes iucA,iroB,rmpA,rmpA2 and peg-344 in hvKP group was significantly higher than that in cKP group,compared with cKP,the resistance rates of hvKP to cefazolin,cefuroxime,ciprofloxacin and sulfamethoxazole were lower.HvKP and cKP were mainly isolated from sputum samples.Compared with hvKP,patients older than 75 years old were more likely to cause cKP infection.Conclusion The clinical isolation rate of hvKP in our hospital is high,but the elderly are more likely to cause cKP infection.Compared with cKP,the resistance rates of hvKP to common clinical antibiotics are lower.Clinicians should make reasonable diagnosis and treatment plans according to the characteristics of strains and clinical characteristics of patients.