高黏型肺炎克雷伯菌分子流行病学特点  

Clinical characteristics and molecular epidemiology of hypermucoviscous Klebsiella pneumoniae

作　　者：郑璐 康海全 赵树龙 王彦玲 顾兵 马萍 李洪春 ZHENG Lu;KANG Hai-quan;ZHAO Shu-long;WANG Yan-ling;GU Bing;MA Ping;LI Hong-chun(Medical Technology School,Xuzhou Medical University,Xuzhou,Jiangsu 221004,China;不详)

机构地区：[1]徐州医科大学医学技术学院,江苏徐州221004 [2]徐州医科大学附属医院检验科,江苏徐州221002

出　　处：《中华医院感染学杂志》2020年第4期481-486,共6页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金资助项目(81871734);江苏省六大人次高峰基金资助项目(WSN-091);徐州市科技技术基金资助项目(KC19160)。

摘　　要：目的分析临床分离的高黏性肺炎克雷伯菌(Hypermucoviscous Klebsiella Pneumoniae,HMKP)分子流行特征,为临床控制此类细菌的传播提供实验室资料。方法收集2017年4月-2019年5月某教学医院临床患者首次分离的HMKP,PCR扩增6种常见高毒力血清型基因K1、K2、K5、K20、K54、K57,9个毒力基因rmpA、kfu、Aerobactin、iroN、entB、ybtS、fimH、mrkD、allS,多位点序列分型(MLST)分析菌株间的同源性。结果共收集63株HMKP,标本主要来自急诊ICU和神经内科ICU,两者共占33.33%(21/63);痰液标本占比最高,为50.79%(32/63),其次为血液标本,占20.63%(13/63)。HMKP菌株对大部分抗菌药物均敏感。血清分型以K1和K2型为主,分别占39.68%和30.16%。K1型的毒力基因携带模式以rmpA+Kfu+Aer+iroN+entB+ybtS+fimH+mrkD+allS为主,占92.00%,K2型以rmpA+Aer+iroN+entB+fimH+mrkD为主,占47.37%。主要的ST分型有ST23型21株,ST86型7株,ST65型4株,ST218型4株。结论HMKP在医院内多引起重症监护患者的下呼吸道感染,应当制定严格的预防措施和实施长期的监测来控制HMKP菌株在这些病区的流行。OBJECTIVE To analyze the molecular prevalence characteristics of clinical isolated hypertrophic Klebsiella pneumoniae(HMKP)and provide laboratory data for clinical control of the spread of such bacteria.METHODS HMKP isolated from clinical patients in a teaching hospital for the first time from Apr.2017 to May 2019 were collected.Six common high virulence serotype genes(K1,K2,K5,K20,K54,K57)and 9 virulence genes(rmpA,kfu,Aerobactin,iroN,entB,ybtS,fimH,mrkD,allS)were amplified by PCR.Multi-locus sequence typing(MLST)were used to analyze the homology between strains.RESULTS A total of 63 strains HMKP were collected,and the specimen were mainly from the emergency ICU and intra-neural ICU,both of which accounted for 33.33%(21/63).The sputum specimens accounted for the highest proportion,50.79%(32/63),followed by blood specimens,20.63%(13/63).The HMKP strain is sensitive to most antimicrobial drugs.The serotypes were mainly K1 and K2,accounting for 39.68%and 30.16%,respectively.The K1 type virulence gene carrying mode was mainly rmpA+Kfu+Aer+iroN+entB+ybtS+fimH+mrkD+allS,accounting for 92.00%,K2 type was mainly rmpA+Aer+iroN+entB+fimH+mrkD,accounting for 47.37%.The main ST types included 21 strains of ST23 type,7 strains of ST86 type,4 strains of ST65 type,4 strains of ST218 type.CONCLUSION HMKP often caused lower respiratory tract infections in intensive care patients in hospitals.Strict preventive measures and long-term monitoring should be established to control the prevalence of HMKP strains in these wards.

关 键 词：高黏型 肺炎克雷伯菌 多位点序列分型 

分 类 号：R378[医药卫生—病原生物学]