上海交通大学学报(医学版)

• 论著(临床研究) • 上一篇    下一篇

医院内高黏液性肺炎克雷伯菌的流行分布、毒力基因及临床特征分析

田李均1,王晓丽1,肖淑珍2,孙景勇2,刘嘉琳1,瞿洪平1   

  1. 上海交通大学 医学院附属瑞金医院 1. 重症医学科,2. 临床微生物科,上海 200025
  • 出版日期:2017-01-28 发布日期:2017-01-19
  • 通讯作者: 瞿洪平,电子信箱:hongpingqu0412@hotmail.com。
  • 作者简介:田李均(1984—),男,主治医师,硕士生;电子信箱:adam-120@163.com。
  • 基金资助:

    上海市科学技术委员会项目(124119a6100);上海交通大学“医工交叉基金”项目(YG2014MS57)

Epidemiological distribution, virulent genes and clinical characteristics of hypermucoviscous Klebsiella pneumonia in a Hospital

TIAN Li-jun1, WANG Xiao-li1, XIAO Shu-zhen2, SUN Jing-yong2, LIU Jia-lin1, QU Hong-ping1   

  1. 1. Department of Critical Care Medicine, 2. Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2017-01-28 Published:2017-01-19
  • Supported by:

    Project of Science and Technology Commission of Shanghai Municipality, 124119a6100; Shanghai Jiao Tong University Cooperation Grant of Medicine, Science, Engineering, YG2014MS57

摘要:

目的 ·了解上海交通大学医学院附属瑞金医院高黏液性肺炎克雷伯杆菌( hvKP)的流行分布、耐药性、毒力基因特点及检出患者的临床特征。方法 ·收集该院2014年9月—2016年3月由住院患者各种标本分离的肺炎克雷伯菌作为实验菌株。拉丝试验阳性的菌株确定为hvKP,用聚合酶链反应(PCR)检测相关荚膜血清型及毒力基因。回顾性分析检出hvKP患者的临床资料。结果 ·①研究期间临床标本分离的不重复肺炎克雷伯菌共872株,其中hvKP 128株,检出率为14.7%。脓肿液标本检出率最高,为44.1%(15/34)。hvKP中呼吸道标本构成比最高,达70.3%(90/128)。②hvKP整体耐药性不高,但是出现2株对亚胺培南耐药的菌株。③hvKP荚膜血清型以K1型和K2型为主,其中K1型占31.3%(40/128),K2型占32.0%(41/128)。95.2%(20/21)的K57型hvKP来自呼吸道标本。所有hvKP均含fimH、wabG和ureA基因,p-RmpA和p-RmpA2基因的检出率分别为91.4%(117/128)和82.8%(106/128)。kfuBC和allS基因的检出率分别为41.4%(53/128)和27.3%(35/128),与K1型相关。不同标本类型间荚膜血清型及毒力基因检出率比较,差异无统计学意义。④检出hvKP的患者中28.9%(37/128)合并糖尿病,44.5%(57/128)合并肿瘤或者使用过长时间的免疫抑制剂。引起明确临床感染者占60.9%(78/128),其中社区获得性感染占47.4%(37/78)。感染组与非感染组、医院获得性感染组和社区获得性感染组菌株的荚膜分型及毒力基因检出率比较,差异无统计学意义。结论 ·瑞金医院hvKP检出率不高,主要为呼吸道标本,存在一定比例的呼吸道定植。荚膜血清型以K1型和K2型为主,K57型主要见于呼吸道标本。荚膜血清型和毒力基因与标本类型、是否感染及感染来源无明显相关性。hvKP感染逐步由社区获得向医院获得转变,值得临床医师关注。

关键词: 肺炎克雷伯菌, 高黏液性, 毒力基因, 临床特征

Abstract:

Objective · To investigate the epidemiological distribution, antibiotic resistance and virulent genes of the hypermucoviscous Klebsiella pneumonia (hvKP) strains isolated from Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine and the clinical characteristics of these patients. Methods · Klebsiella pneumonia isolates were collected from hospitalized patients between September 2014 and March 2016. hvKP isolates were identified by string test. Capsular serotypes and virulent genes were detected using polymerase chain reaction (PCR). Clinical data of the hvKP-detected patients were retrospectively studied. Results · ① Of the 872 non-repetitive Klebsiella pneumonia strains, the prevalence of hvKP was 14.7% (128/872), and the highest prevalence of hvKP was 44.1% (15/34) from pus. Respiratory tract specimen was the most prevailing specimen of hvKP (70.3%, 90/128). ② Vast majority of the hvKP strains were susceptible to main antimicrobial agents, but two carbapenem-resistant hvKP strains were found. ③ Most of hvKP strains belonged to K1 (31.3%, 40/128) or K2 (32.0%, 41/128) capsular serotypes. 95.2% (20/21) of K57 serotype hvKP strains were isolated from respiratory tract. All hvKP strains were fimH, wabG and ureA positive. The incidences of p-RmpA and p-RmpA2 were 91.4% (117/128) and 82.8% (106/128) respectively, while the incidences of kfuBC and allS were 41.4% (53/128) and 27.3% (35/128) respectively, related to K1 serotype. The prevalence of capsular serotypes and virulent genes displayed no significant difference among different specimen types. ④ hvKP isolates occurred commonly in patients with diabetes mellitus (28.9%, 37/128) and cancer/immunosuppression (44.5%, 57/128). 60.9% (78/128) of the hvKP isolates could cause an infection, among which 47.4% (37/78) were community-acquired infection. The prevalence of capsular serotypes and virulent genes of hvKP also displayed no significant difference between infection group and non-infection group, as well as community-acquired infection group and hospital-acquired infection group. Conclusion · The prevalence of hvKP in Ruijin hospital was not high, and the dominant specimen of hvKP was respiratory tract specimen, some of which were colonization bacteria. K1/K2 capsular serotypes were the predominant serotypes, and almost all K57 capsular serotype hvKP strains were isolated from respiratory tract. The prevalence of capsular serotypes and virulent genes of hvKP was not significantly associated with specimen type, infection and source of infection. It is noteworthy that hvKP infection shows a convert from community-acquired to hospital-acquired.

Key words: Klebsiella pneumonia, hypermucoviscous, virulent gene, clinical characteristic