呼伦贝尔地区HvKp分子流行病学特征及其感染的危险因素分析

Molecular epidemiological characteristics and risk factors of HvKp infection in Hulunbuir area

目的探讨高毒力肺炎克雷伯菌(HvKp)的分子流行病学特征与其感染发生的独立危险因素,为抗感染治疗提供研究依据。方法收集2020年1月至2022年12月内蒙古林业总医院鉴定为肺炎克雷伯菌的519株菌株。采用拉丝试验区分高黏菌株(HMV-Kp)与非HMV-Kp,普通PCR琼脂糖凝胶电泳法进行rmpA、rmpA2、iutA基因的检测并筛选出HvKp菌株,对其中60株HvKp菌株进行多位点序列分型分析并绘制最小生成树,采用多因素Logistic回归分析HvKp感染发生的危险因素。结果HMV-Kp检出率为39.69%,HvKp检出率为37.19%,HvKp中HMV-Kp占76.68%。科室中普外科HvKp检出率最高,标本中脓液标本HvKp检出率最高。经ST分型比对,60株HvKp菌株共检出18种分型,ST23型最常见,占50.00%,其次为ST86型占8.33%。多因素Logistic回归分析结果显示,男性、肝脓肿、其他组织器官感染或化脓、近3个月使用大环内酯类抗菌药物为HvKp感染发生的独立危险因素(P<0.05)。结论HvKp与HMV-Kp菌株存在较强的关联,ST23型为本研究的优势分型,男性、肝脓肿、其他组织器官感染或化脓、近3个月使用大环内酯类抗菌药物为HvKp感染发生的独立危险因素。

Objective To investigate the molecular epidemiology of hypervirulent Klebsiella pneumoniae(HvKp)and its independent risk factors for infection,and to provide research basis for anti-infection treatment.Methods A total of 519 Klebsiella pneumoniae strains were collected from Inner Mongolia Forestry General Hospital from January 2020 to December 2022.String test was used to distinguish hypermyxoid strains(HMV-Kp)and non-HMV-KP.The rmpA,rmpA2,and iutA genes were detected by common PCR agarose gel electrophoresis to screen the HvKp strains.Multilocus sequence typing analysis was performed on 60 HvKp strains and the minimum spanning tree was drawn.Multivariate Logistic regression was used to analyze the risk factors of HvKp infection.Results The positive rate of HMV-Kp was 39.69%,the positive rate of HvKp was 37.19%,and HMV-Kp accounted for 76.68%of HvKp.The detection rate of HvKp in general surgery department was the highest,and the detection rate of HvKp in pus specimens was the highest.By ST typing comparison,a total of 18 types of 60 HvKp strains were detected,ST23 type was the most common type(50.00%),followed by ST86 type(8.33%).Multivariate Logistic regression analysis showed that male,liver abscess,infection or suppuration of other tissues and organs,and use of macrolide antibiotics in the past 3 months were independent risk factors for HvKp infection(P<0.05).Conclusion There is a strong association between HvKp and HMV-Kp strains,and ST23 type is the dominant type in this study.Male,liver abscess,infection or suppuration of other tissues and organs,and use of macrolide antibiotics in the past 3 months are independent risk factors for HvKp infection.