血流感染肺炎克雷伯菌的药敏结果及分子特点研究  

Drug sensitivity analysis results and molecular characteristics of bloodstream infections in patients with Klebsiella pneumoniae

作　　者：程颖 祝进[2] 白永凤[2] 陆军[2] 俞云松[1] CHENG Ying＂ , ZHU Jin, BAI Yong-feng, LU Jun, YU Yun-Song(Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310016, Chin)

机构地区：[1]浙江大学医学院附属邵逸夫医院感染科,浙江杭州310016 [2]浙江省衢州市人民医院检验科,浙江衢州324000

出　　处：《中华医院感染学杂志》2018年第6期844-847,共4页Chinese Journal of Nosocomiology

基　　金：衢州市科技局基金资助项目(2016082)

摘　　要：目的研究高黏液表型肺炎克雷伯菌(HMVKP)与经典肺炎克雷伯菌(CKP)的荚膜血清型和毒力基因,分析HMVKP与CKP的药敏情况、耐药表型。方法收集2013年1月-2016年12月血流感染肺炎克雷伯菌共185株,拉丝试验确定HMVKP;PCR方法扩增荚膜血清型、毒力基因,分析HMVKP与CKP的检出率;检测分析抗菌药物敏感性;体外纸片法检测产超广谱β内酰胺酶,通过改良Hodge试验和EDTA试验检测碳青霉烯酶表型。结果高黏液型肺炎克雷伯菌占23.2%(43/185),六种高毒力荚膜血清均被检出,分别为K1(9.2%)、K2(11.4%)、K5(1.6%)、K20(2.2%)、K54(1.6%)、K57(6.5%),共占32.4%(60/185);HMVKP的毒力基因检出率均高于CKP,HMVKP与CKP毒力分数(P50)分别为7和4(P<0.05);HMVKP抗菌药物敏感率均高于CKP(P<0.05);有3株(7.0%)HMVKP产超广谱β内酰胺酶,1株(2.3%)HMVKP改良Hodge试验阳性。结论高毒力肺炎克雷伯菌以K1、K2、K57血清型常见,携带更多的毒力基因,且多为敏感株,ESBL试验阴性,但耐药菌株的出现不容忽视。OBJECTIVE To study the capsular serotypes and virulence genes of hypermucoviscous Klebsiella pneumoniae（HMVKP）and classical K.pneumoniae（CKP）,and to further analyze the drug sensitivity and drug resistance phenotype of HMVKP and CKP.METHODS A total of 185 strains of K.pneumoniae by bloodstream infections were collected from January 2013 to December 2016.HMVKP was determined by string-test.PCR method was used to amplify capsular serotypes and virulence genes,and the detection rates of HMVKP and CKP were analyzed.Meanwhile,antimicrobial susceptibility was also detected and analyzed;extended-spectrumβ-lactamase was measured by in vitro disk method;in addition,carbapenem phenotype was detected by modified Hodge test and EDTA test.RESULTS Hypermucoviscous K.pneumoniae accounted for 23.2%（43/185）of the total strain.All six high virulent capsular serotypes were detected,including K1（9.2%）,K2（11.4%）,K5（1.6%）,K20（2.2%）,K54（1.6%）and K57（6.5%）,with 32.4%（60/185）in total.The detection rate of virulence genes of HMVKP was higher than that of CKP,the toxicity（P50）of HMVKP and CKP were 7 and 4,respectively,showing difference（P0.05）.Furthermore,drug sensitivity of HMVKP was significantly better than that of CKP（P0.05）.There were 3 strains（7.0%）of HMVKP producing extended-spectrumβ-lactamase,1 strain（2.3%）of HMVKP indicated positive by modified Hodge test.CONCLUSION Hypermucoviscous K.pneumoniae are common in K1,K2 and K57 serotypes,and may carry more virulence factors,most of which are non-ESBL producing sensitive strains.However,the emergence of drug-resistant strains can′t be ignored.

关 键 词：肺炎克雷伯菌 毒力 高黏液型 荚膜血清型 

分 类 号：R378.996[医药卫生—病原生物学]