儿童肺炎克雷伯菌感染分子流行病学特征

doi:10.3969/j.issn.1674-8115.2025.08.010

摘要/Abstract

摘要：

目的·分析临床分离的儿童肺炎克雷伯菌的分子流行病学特征，包括血清型分布、耐药基因及毒力基因特征，为儿童肺炎克雷伯菌感染的防控及治疗策略提供科学依据。方法·收集2023年4月至2024年4月上海交通大学医学院附属儿童医院临床分离的133株非重复肺炎克雷伯菌株。采用Vitek-2 Compact系统进行抗菌药物敏感性检测，通过荚膜合成相关外膜蛋白（wzy-dependent initiator，wzi）基因测序确定荚膜多糖K抗原血清型（K型），利用胶体金法检测碳青霉烯酶耐药基因，并采用PCR方法鉴定毒力基因及脂多糖O抗原血清型。结果·在133株肺炎克雷伯菌株中，共检出50株碳青霉烯类耐药肺炎克雷伯菌（carbapenem-resistant Klebsiella pneumoniae，CRKP），主要分布于新生儿病房（39株，78.00%）和重症监护病房（intensive care unit，ICU）。CRKP对多数抗菌药物呈现高度耐药性，其主要携带的碳青霉烯酶基因类型为bla_NDM（34/50，68.00%），其次为携带bla_NDM+bla_OXA-48双酶（10/50，20.00%）和bla_KPC（6/50，12.00%）。血清型分析显示，50株CRKP可分为8种K型和6种O型。最常见的K型是KL17（30/50，60.00%），其次是KL105（10/50，20.00%）和KL47（5/50，10.00%）；最常见的O型为O4（30/50，60.00%），其次是O3b（7/50，14.00%）、O3/O3a（6/50，12.00%）以及OL101（5/50，10.00%）。进而发现KL47与OL101血清型（KL47：OL101）、KL17与O4血清型（KL17：O4）、KL1/KL2与O1血清型（KL1/KL2：O1）存在强烈的关联性。结论·儿童感染CRKP的菌株主要携带bla_NDM型碳青霉烯酶基因，与感染CRKP的成人存在显著差异。新生儿病房CRKP检出率显著高于其他科室，提示需加强该病区的感染防控措施。

关键词: 碳青霉烯类耐药肺炎克雷伯菌, 荚膜多糖K抗原, 脂多糖O抗原, 儿童

Abstract:

Objective ·To analyze the molecular epidemiological characteristics of Klebsiella pneumoniae isolated from children, including the distribution of serotypes, resistance genes, and virulence genes, to provide a scientific basis for the prevention and treatment strategies of Klebsiella pneumoniae infections in children. Methods ·A total of 133 non-duplicate strains of Klebsiella pneumoniae clinically isolated from Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, from April 2023 to April 2024, were collected. Antimicrobial susceptibility testing was performed by using the Vitek-2 Compact system. Capsular polysaccharide K antigen serotypes (K types) were determined by wzy-dependent initiator (wzi) gene sequencing. Resistance genes were detected by the colloidal gold method. Virulence genes and lipopolysaccharide O antigen serotypes (O types) were identified by PCR method. Results ·Among the 133 strains of Klebsiella pneumoniae, a total of 50 strains of carbapenem-resistant Klebsiella pneumoniae (CRKP) were detected, mainly distributed in the neonatal ward and intensive care unit (ICU). CRKP exhibited high resistance to most antimicrobial agents, and the main type of carbapenemase gene was bla_NDM (34/50, 68.00%), followed by co-carriage of bla_NDM+bla_OXA-48 (10/50, 20.00%) and bla_KPC (6/50, 12.00%). Serotype analysis revealed that the 50 CRKP strains could be divided into 8 K types and 6 O types. The most common K type was KL17 (30/50, 60.00%), followed by KL105 (10/50, 20.00%) and KL47 (5/50, 10.00%). The most common O type was O4 (30/50, 60.00%), followed by O3b (7/50, 14.00%, ), O3/O3a (6/50, 12.00% ), and OL101 (5/50, 10.00%). Significant correlations were identified between KL47 and OL101 serotypes (KL47:OL101), between KL17 and O4 serotypes (KL17:O4), and between KL1/KL2 and O1 serotypes (KL1/KL2:O1). Conclusion ·The CRKP strains infecting children primarily carry bla_NDM-type carbapenemase genes, showing a significant difference compared to CRKP-infected adults. The detection rate of CRKP in the neonatal ward is significantly higher than those in other departments, suggesting that infection prevention and control measures in this ward need to be strengthened.

Key words: carbapenem-resistant Klebsiella pneumoniae, capsular polysaccharide K antigen, lipid polysaccharide O antigen, child

中图分类号:

R378

蒋婕, 张泓, 伦赫远, 潘芬, 于方圆, 何平. 儿童肺炎克雷伯菌感染分子流行病学特征[J]. 上海交通大学学报（医学版）, 2025, 45(8): 1027-1034.

JIANG Jie, ZHANG Hong, LUN Heyuan, PAN Fen, YU Fangyuan, HE Ping. Molecular epidemiology of Klebsiella pneumoniae isolated from children[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(8): 1027-1034.

图/表 2

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Characteristic	Total (n=133)	CSKP group (n=83)	CRKP group (n=50)	χ²/Z value	P value
Gender (mode)/n(%)	70 (52.63)	45 (54.22)	25 (50.00)	0.223	0.637
Age/n(%)				6.716	0.082
Newborns (<28 d)	36 (27.07)	17 (20.48)	19 (38.00)
Infants (≥28 d and ≤3 years old)	69 (51.88)	44 (53.01)	25 (50.00)
Preschool (>3 years and <6 years old)	5 (3.76)	4 (4.82)	1 (2.00)
School-age period (≥6 years old)	23 (17.29)	18 (21.69)	5 (10.00)
Specimen/n(%)				7.633	0.054
Sputum	87 (65.41)	48 (57.83)	39 (78.00)
Urine	11 (8.27)	9 (10.84)	2 (4.00)
Blood	6 (4.51)	3 (3.61)	3 (6.00)
Others	29 (21.80)	23 (27.71)	6 (12.00)
Department/n(%)				13.367	0.004
Respiratory department	5 (3.76)	4 (4.82)	1 (2.00)
Neonatal ward	77 (57.89)	38 (45.78)	39 (78.00)
ICU	23 (17.29)	18 (21.69)	5 (10.00)
Others	28 (21.05)	23 (27.71)	5 (10.00)
Infection category/n(%)				24.946	<0.001
Hospital-acquired infection	64 (48.12)	26 (31.33)	38 (76.00)
Community-acquired infection	69 (51.88)	57 (68.67)	12 (24.00)
Invasive operation/n(%)	79 (59.40)	36 (43.37)	43 (86.00)	22.779	<0.001
Surgery/n(%)	24 (18.05)	18 (21.69)	6 (12.00)	1.980	0.159
Premature infant/n(%)	37 (27.82)	9 (10.84)	28 (56.00)	31.686	<0.001
Low birth weight infants/n(%)	29 (21.80)	5 (6.02)	24 (48.00)	32.245	<0.001
Length of stay/d	14 (3‒270)	10 (3‒87)	56 (3‒270)	-6.485	<0.001
Therapeutic efficacy/n(%)				2.251	0.134
Cure or improvement	125 (93.98)	80 (96.39)	45 (90.00)
Death or discontinuation of treatment	8 (6.02)	3 (3.61)	5 (10.00)

Characteristic	Total (n=133)	CSKP group (n=83)	CRKP group (n=50)	χ²/Z value	P value
Gender (mode)/n(%)	70 (52.63)	45 (54.22)	25 (50.00)	0.223	0.637
Age/n(%)				6.716	0.082
Newborns (<28 d)	36 (27.07)	17 (20.48)	19 (38.00)
Infants (≥28 d and ≤3 years old)	69 (51.88)	44 (53.01)	25 (50.00)
Preschool (>3 years and <6 years old)	5 (3.76)	4 (4.82)	1 (2.00)
School-age period (≥6 years old)	23 (17.29)	18 (21.69)	5 (10.00)
Specimen/n(%)				7.633	0.054
Sputum	87 (65.41)	48 (57.83)	39 (78.00)
Urine	11 (8.27)	9 (10.84)	2 (4.00)
Blood	6 (4.51)	3 (3.61)	3 (6.00)
Others	29 (21.80)	23 (27.71)	6 (12.00)
Department/n(%)				13.367	0.004
Respiratory department	5 (3.76)	4 (4.82)	1 (2.00)
Neonatal ward	77 (57.89)	38 (45.78)	39 (78.00)
ICU	23 (17.29)	18 (21.69)	5 (10.00)
Others	28 (21.05)	23 (27.71)	5 (10.00)
Infection category/n(%)				24.946	<0.001
Hospital-acquired infection	64 (48.12)	26 (31.33)	38 (76.00)
Community-acquired infection	69 (51.88)	57 (68.67)	12 (24.00)
Invasive operation/n(%)	79 (59.40)	36 (43.37)	43 (86.00)	22.779	<0.001
Surgery/n(%)	24 (18.05)	18 (21.69)	6 (12.00)	1.980	0.159
Premature infant/n(%)	37 (27.82)	9 (10.84)	28 (56.00)	31.686	<0.001
Low birth weight infants/n(%)	29 (21.80)	5 (6.02)	24 (48.00)	32.245	<0.001
Length of stay/d	14 (3‒270)	10 (3‒87)	56 (3‒270)	-6.485	<0.001
Therapeutic efficacy/n(%)				2.251	0.134
Cure or improvement	125 (93.98)	80 (96.39)	45 (90.00)
Death or discontinuation of treatment	8 (6.02)	3 (3.61)	5 (10.00)