上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (2): 235-.doi: 10.3969/j.issn.1674-8115.2020.02.015

• 论著·临床研究 • 上一篇    下一篇

分离自血培养肺炎克雷伯菌的毒力基因及患者临床特征分析

管红艳，刘婧娴，刘 瑛   

  1. 上海交通大学医学院附属新华医院检验科，临床微生物室，上海 200092
  • 出版日期:2020-02-28 发布日期:2020-03-20
  • 通讯作者: 刘 瑛，电子信箱：liuying01@xinhuamed.com.cn。
  • 作者简介:管红艳（1993—），女，住院医师，硕士；电子信箱：ghy0704@126.com。

Virulence genes of Klebsiella pneumoniae isolated blood cultures and clinical characteristics of the patients

GUAN Hong-yan, LIU Jing-xian, LIU Ying   

  1. Department of Clinical Microbiology, Clinical Laboratory, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • Online:2020-02-28 Published:2020-03-20

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摘要： 目的·检测分离自血培养的肺炎克雷伯菌的毒力基因，以及分析高毒力肺炎克雷伯菌（hypervirulent Klebsiella pneumoniae，hvKP）和经典肺炎克雷伯菌（classic Klebsiella pneumoniae，cKP）感染患者的临床特征。方法·收集上海交通大学医学院附属新华医院2016年10月—2018年3月分离自血培养的肺炎克雷伯菌80株。采用黏液丝试验筛选高黏液性肺炎克雷伯菌（hypermucoviscous Klebsiella pneumoniae，HMKP），通过扩增wzi基因的方法进行荚膜血清分型，PCR方法检测hvKP常见的rmpA、magA、aerobactin等22种毒力基因，采用多位点序列分型方法对菌株进行基因分型，收集并分析患者的相关临床资料。结果·黏液丝试验结果显示，80株肺炎克雷伯菌中有9株为HMKP；毒力基因检测结果显示，10株为hvKP，magA、allS、iucA、iroN、kfu、wcaG、rmpA2、iutA、pLVPK、terW、silS基因在hvKP中检出率均显著高于cKP，差异具有统计学意义（均P结论·上海交通大学医学院附属新华医院分离自血培养的肺炎克雷伯菌以cKP为主，大部分cKP为K14.K64/ST11型，且多为医院获得性感染；hvKP感染患者合并肝脓肿的比例较高。

关键词: 肺炎克雷伯菌, 血培养, 毒力基因, 临床特征

Abstract:

Objective · To detect the virulence genes of Klebsiella pneumoniae isolated blood cultures, and analyze the clinical characteristics of the patients infected with hypervirulent Klebsiella pneumoniae (hvKP) or classic Klebsiella pneumoniae (cKP). Methods · A total of 80 Klebsiella pneumoniae strains isolated blood cultures in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine Oct. 2016 to Mar. 2018 were collected. String test was performed to determine hypermucoviscous Klebsiella pneumoniae (HMKP). The capsular serotypes were confirmedwzi sequencing. The 22 virulence genes, such as rmpA, magA, and aerobactin, were identifiedPCR. Multilocus sequence typing (MLST) was used to determine sequence type of these isolates. The clinical records were collected to analyze the characteristics of Klebsiella pneumoniae-infected patients. Results · The results of string test showed that 9 out of 80 Klebsiella pneumoniae strains were HMKP. The results of virulence gene detection showed that 10 strains were hvKP. Significant difference was found between hvKP and cKP in the detection rates of magA, allS, iucA, iroN, kfu, wcaG, rmpA2, iutA, pLVPK, silS and terW genes (PConclusion · cKP is the dominant type of the Klebsiella pneumoniae strains isolated blood cultures in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine. Most cKPs are K14.K64/ST11 and the infections are mainly hospital-acquired. The proportion of hvKP infected patients with liver abscess is high.

Key words: Klebsiella pneumoniae, blood culture, virulence gene, clinical characteristic