导管相关性血流感染高毒力肺炎克雷伯菌荚膜血清型及多位点序列分型

Capsular serotypes and multilocus sequence typing of hypervirulent Klebsiella pneumoniae causing catheter-related bloodstream infection

目的 探究高毒力肺炎克雷伯菌(hvKP)导致的导管相关性血流感染(CRBSI)的临床特点及其荚膜血清型和多位点序列分型(MLST)。方法 选取2018年8月-2021年8月温州市中医院收治的155例KP感染所致CRBSI患者,根据分离出KP菌株类型分为hvKP组50例、普通肺炎克雷伯菌(cKP)组105例。比较hvKP、cKP菌株对常用抗菌药物的耐药率及检出荚膜血清型分布,并分析hvKP的MLST分布。结果 hvKP菌株对头孢唑林、头孢他啶、头孢曲松、头孢吡肟、哌拉西林、阿莫西林、左氧氟沙星、环丙沙星、磺胺甲噁唑/甲氧苄啶的耐药率均低于cKP菌株(P<0.05);hvKP荚膜血清型K1、K2检出率为52.00%、34.00%,高于cKP(P<0.05);50株hvKP MLST分型以ST23、ST86、ST65为主,分别占32.00%、20.00%、16.00%。结论 引起CRBSI的hvKP菌株相比cKP对多数抗菌药物耐药率较低,其荚膜血清型分布以K1、K2为主,MLST分型以ST23、ST86、ST65为主。

OBJECTIVE To explore the clinical characteristics, capsular serotypes and multilocus sequence typing(MLST) of hypervirulent Klebsiella pneumoniae(hvKP) causing catheter-related bloodstream infection(CRBSI). METHODS A total of 155 patients with KP-induced CRBSI who were treated in Wenzhou Hospital of Traditional Chinese Medicine from Aug 2018 to Aug 2021 were enrolled in the study and were divided into the hvKP group with 50 cases and the common K. pneumoniae(cKP)group with 105 cases according to the types of isolated K. pneumoniae strains. The drug resistance rates to commonly used antibiotics were compared between the hvKP strains and the cKP strains, the capsular serotypes were identified, and the MLST of the hvKP strains was observed. RESULTS The drug resistance rates of the hvKP strains to cefazolin, ceftazidime, ceftriaxone, cefepime, piperacillin, amoxicillin, levofloxacin, ciprofloxacin and sulfamethoxazole-trimethoprim were lower than those of the cKP strains(P<0.05). The detection rates of capsular serotypes K1 and K2 of hvKP were respectively 52.00% and 34. 00%, higher than those of cKP. The MLST for the 50 strains of hvKP showed that ST23, ST86 and ST65 were dominant, accounting for 32.00%, 20.00% and 16.00%, respectively. CONCLUSION The drug resistance rates of the hvKP strains causing CRBSI to most of the antibiotics are lower than those of the cKP strains, K1 and K2 are dominant among the capsular serotypes, and MLST typing shows that ST23, ST86 and ST65 are dominant.