聚酮合酶基因岛在肺炎克雷伯菌临床分离株中的流行研究

Prevalence of Polyketide Synthase Gene Islands in Clinical Isolates of Klebsiella pneumoniae

目的 研究肺炎克雷伯菌(Klebsiella pneumoniae)的聚酮合酶(PKS)基因岛的临床分布情况,探讨PKS基因岛与肺炎克雷伯菌感染的关系。方法 收集234株肺炎克雷伯菌,根据有、无PKS基因岛分为PKS+组和PKS-组。采用聚合酶链式反应(PCR)检测PKS基因岛,并结合肺炎克雷伯菌感染患者的临床资料,分析其在临床样本中的分布情况。结果 234例感染者中,PKS+组感染者占37.6%(88/234)。菌株主要来源于痰液(70.1%,164/234)、血液(7.3%,17/234)、腹水(5.6%,13/234)和脓液(4.3%,10/234)。PKS+菌株感染者中患有肝脓肿的比例较PKS-菌株感染者多[(13.6%,12/88)vs(1.4%,2/146),P<0.001]。药敏实验发现,PKS+菌株在氨曲南、亚胺培南、美罗培南、阿米卡星、妥布霉素、环丙沙星、左氧氟沙星和复方新诺明的药物敏感性更高(P<0.001)。结论 PKS+感染者数量有进一步上升的趋势,肝病患者更易感染PKS+肺炎克雷伯菌,而PKS+菌株对多种抗生素的敏感性较PKS-菌株高。应高度重视PKS基因在肺炎克雷伯菌流行的可能性,并进一步发掘PKS基因在肺炎克雷伯菌感染中的诊疗价值。

Objective To study the clinical distribution of polyketide synthase(PKS)gene islands of Klebsiella pneumoniae,and investigate the relationship between PKS gene islands and the characteristics of Klebsiella pneumoniae infection.Methods 234 strains of Klebsiella pneumoniae isolated from clinical specimens were collected.They were divided into a PKS+group and a PKS-group based on the presence or absence of the PKS gene islands.The PKS gene islands were detected by polymerase chain reaction(PCR),and their distribution in clinical samples was analyzed by combining the relevant infection indexes and infection types of patients with Klebsiella pneumoniae infection.Results Among 234 patients with Klebsiella pneumoniae infection,37.6%(88/234)were infected in the PKS+group.PKS strain sources were mainly from sputum(70.1%,164/234),blood(7.3%,17/234),ascites(5.6%,13/234)and pus(4.3%,10/234).PKS+strain infected patients had liver abscess(13.6%,12/88)than those infected with PKS-strains(1.4%,2/146)(P<0.01).In drug sensitivity assays,PKS+strains were found to have higher drug susceptibility to amineptine,imipenem,meropenem,amikacin,tobramycin,ciprofloxacin,levofloxacin,and cotrimoxazole(P<0.001).Conclusion The number of PKS+infections is on the rise,and patients with liver abscess are more likely to be infected with PKS+Klebsiella pneumoniae,and PKS+strains are more sensitive to a variety of antibiotics than PKS-strains.The possibility of PKS gene islands in the prevalence of Klebsiella pneumoniae should be highly valued,and the diagnostic value of PKS gene islands in Klebsiella pneumoniae infection needs to be further explored.