引起多部位感染的肺炎克雷伯菌毒力特征研究  

Virulence characteristics of clinical Klebsiella pneumoniae isolates causing multi-site infection

作　　者：马艳宁[1] 张有江[1] 郭玲[1] 叶丽艳[1] 罗燕萍[1] 杨继勇[1] 

机构地区：[1]解放军总医院微生物科,北京100853

出　　处：《中华医院感染学杂志》2016年第21期4815-4816,4834,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81572056)

摘　　要：目的分析引起多部位感染的临床肺炎克雷伯菌的毒力特点,为后续相关工作提供帮助。方法收集2008年-2014年由肺炎克雷伯菌引起的血流感染合并其他部位感染(腹腔感染或泌尿系感染或呼吸道感染)病例80例。采用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)对分离到的肺炎克雷伯菌进行同源性和分子流行病学分析;采用PCR方法分析肺炎克雷伯菌的荚膜血清型和毒力基因携带情况。结果 68例(85%)患者的多部位感染是由同一克隆的肺炎克雷伯菌引起;这些菌株间的同源性较小;仅有44.1%的菌株具有高粘液表型;仅有16.2%和13.2%的菌株属于克隆复合体23(CC23)和克隆复合体65(CC65);有32.4%的菌株为K1/K2荚膜血清型,而32.4%和35.3%的菌株分别属于K5/K20/K54/K57和其他血清型。结论引起多部位感染的肺炎克雷伯菌多数为非K1/K2血清型的菌株且不具有高粘液表型。因此,以此标准鉴定高毒力肺炎克雷伯菌株存在较大误差。除目前已知的毒力因子,其他的机制可能在肺炎克雷伯菌引起的多部位感染中起重要作用。OBJECTIVE To analyze the characteristics of virulence of clinical Klebsiella pneumoniae isolates causing multi-site infections so as to provide guidance for subsequent work. METHODS A total of 80 patients with blood- stream infections complicated with （other sites of infections abdominal infections） , urinary tract infection or re- spiratory tract infection caused by the K. pneumoniae, who were treated in the hospital from 2008 to 2014, were enrolled in the study, then the homology and molecular epidemiology of the isolated K. pneumoniae strains were analyzed by using pulsed-field gel electrophoresis （PFGE） and multilocus sequence typing （MLST） ; the capsular serotypes and the virulence genes in the K. pneumoniae strains were determined by using PCR. RESULTS Totally 68 （85o//oo） patients had the multi-site infections that was caused by the same clone of K. pneumoniae; there was little homology among the strains; only 44.1% of the MSI-causing K. pneumoniae isolates exhibited hypermuco- viscosity （HV） phenotype; only 16.2% and 13.2% of the isolates belonged to CC23 and CC65, respectively. The capsularserotypes K1/K2 strains accounted for 32.4% among the K. pneumoniae strains causing MST, while 32. 4% and 35.3% of the isolates belonged to KS/K20/K54/K57 and other serotypes, respectively. CONCLUSION The majority of the K. pneumoniae strains causing MSI are the non-K1/K2 serotype strains and do not exhibit the HV phenotype. Therefore, there is big error in identifying the highly virulent K. pneumoniae strains based on the standard. In addition to the currently known virulence factors, other mechanisms may play an important role in the pathogenesis of MST caused by the K. pneumoniae.

关 键 词：肺炎克雷伯菌 多部位感染 高粘液 毒力因子 

分 类 号：R378.996[医药卫生—病原生物学]