重症医学科血流感染耐碳青霉烯类高黏液型肺炎克雷伯菌的临床及分子特征  

Clinical and molecular characteristics of carbapenem-resistant hypermucoviscous Klebsiella pneumoniae isolated from bloodstream infection in ICU patients

作　　者：杜芳玲 魏丹丹[1] 梅艳芳[1] 龙丹[1] 万腊根[1] 刘洋[1] DU Fangling;WEI Dandan;MEI Yanfang;LONG Dan;WAN Lagen;LIU Yang(Department of Clinical Microbiology,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院检验科,南昌330006

出　　处：《中国感染与化疗杂志》2020年第2期181-186,共6页Chinese Journal of Infection and Chemotherapy

基　　金：国家自然科学基金(81560323);江西省自然科学基金(20181BAB205065);2018年南昌大学研究生创新专项资金(CX2018199)。

摘　　要：目的分析医院重症医学科(ICU)血流感染患者检出的耐碳青霉烯类高黏液型肺炎克雷伯菌(CR-HMKP)的临床及分子特征。方法2016年1月-2018年12月从ICU血流感染患者中分离40株耐碳青霉烯类肺炎克雷伯菌(CR-KP),通过拉丝试验分为14株CR-HMKP菌和26株CR-非HMKP菌,分析菌株的临床和药敏资料,采用PCR检测菌株的耐药基因、毒力基因及血清荚膜分型,多位点序列分型(MLST)和脉冲场凝胶电泳(PFGE)方法分析细菌的分子流行病学特征。结果CR-HMKP在CR-KP中的检出率为35.0%。CR-KP感染患者均接受两种或两种以上侵袭性操作和联合使用多种抗生素。CR-HMKP菌株感染患者60岁以上的占比、糖尿病患病率、死亡率比CR-非HMKP菌株感染患者高,且差异有统计学意义(P<0.05)。CR-KP菌株均为多重耐药(MDR)菌,CR-HMKP菌株对庆大霉素、妥布霉素、阿米卡星的耐药率比CR-非HMKP菌株低,且差异有统计学意义(P<0.05)。碳青霉烯酶基因以KPC为主(95.0%),rmtB基因在CR-HMKP菌株的检出率小于CR-非HMKP菌株,且差异有统计学意义(P<0.01)。CR-HMKP菌株中仅检出1株K2型菌株,rmpA、iutA、rmpA2三种毒力基因在CR-HMKP菌株的检出率均大于CR-非HMKP菌株,且差异有统计学意义(P<0.01)。PFGE和MLST显示CR-HMKP分为A、B型,A型(n=13,92.9%)均为ST11型,B型(n=1,7.1%)为ST65型。结论ICU血流感染患者分离的CR-HMKP菌株以ST11型为主,均为MDR菌,携带多种耐药基因与毒力基因,且患者死亡率高,应加强防控。CRHMKP与CR-非HMKP对氨基糖苷类抗生素的耐药情况有差别,临床在治疗过程中应区别对待。Objective To analyze the clinical and molecular characteristics of carbapenem-resistant hypermucoviscous Klebsiella pneumoniae(CR-HMKP)isolated from bloodstream infection in ICU patients.Methods A total of 40 strains of carbapenemresistant K.pneumoniae were isolated from bloodstream infection in ICU patients from January 2016 to December 2018.According to string test,these CR-KP strains were classified into 14 strains of CR-HMKP and 26 strains of CR-non-HMKP.The clinical data and antimicrobial susceptibility data were analyzed.Antibiotic resistance genes,virulence genes and capsular serotypes were detected by using PCR.The molecular epidemiological characteristics of the strains were analyzed by means of multilocus sequence typing(MLST)and pulsed-field gel electrophoresis(PFGE).Results The prevalence of CR-HMKP was 35.0%in CRKP isolates.All patients with CR-KP infection received two or more invasive procedures and used multiple antibiotics.Compared with CR-non-HMKP strain,CR-HMKP strain was associated with significantly higher proportion of old patients(≥60 years old),diabetes mellitus,and higher mortality of patients(P<0.05).All the 40 strains of CR-KP isolated from ICU were multi-drug resistant(MDR).CR-HMKP strains showed significant lower resistance rate to gentamicin,tobramycin,and amikacin than CR-non-HMKP strains(P<0.05).The prevalent carbapenemase gene was KPC gene(95.0%).The prevalence of rmtB gene was lower in CR-HMKP strains than in CR-non-HMKP strains(P<0.01).The prevalence of rmpA,iutA,and rmpA2 was higher in CRHMKP strains than in CR-non-HMKP strains(P<0.01).Only one K2 strain was identified in CR-HMKP strains.PFGE and MLST showed that CR-HMKP was classified into type A and type B.Type A(n=13,92.9%)is ST11 type,and type B(n=1,7.1%)is ST65 type.Conclusions This study indicates that the CR-HMKP strains isolated from bloodstream infection in ICU are mainly ST11 type.All these strains were multi-drug resistant,carrying a variety of drug resistance genes and virulence genes.CR-HMKP strain in bloodstream

关 键 词：肺炎克雷伯菌 高黏性 毒力基因 碳青霉烯类 耐药 重症医学科 

分 类 号：R378.996[医药卫生—病原生物学]