VAP患者下呼吸道分离CRKP的临床及分子生物学流行特征  

Clinical and molecular epidemiological characteristics of CRKP isolated from lower respiratory tract of patients with ventilator-associated pneumonia

作　　者：刘周[1] 储雯雯[1] 李昕[1] 汪雅婷 周强[1] LIU Zhou;CHU Wen-wen;LI Xin;WANG Ya-ting;ZHOU Qiang(Department of Laboratory Medicine, The Second Hospital of Anhui Medical University, Hefei 230601, China)

机构地区：[1]安徽医科大学第二附属医院检验科,安徽合肥230601

出　　处：《中国感染控制杂志》2021年第5期403-409,共7页Chinese Journal of Infection Control

基　　金：安徽省自然科学基金(1908085QH366)。

摘　　要：目的分析呼吸机相关肺炎(VAP)患者下呼吸标本分离的耐碳青霉烯类肺炎克雷伯菌(CRKP)临床特征、基因型及主要毒力因子携带情况。方法收集2019年1—12月某院VAP患者下呼吸道标本分离的非重复肺炎克雷伯菌(KP),比较CRKP组与碳青霉烯非耐药KP组(nCRKP组)感染患者的临床特征及耐药性,多位点序列分型、荚膜wzi分型型别的差异,分析CRKP毒力因子携带情况及同源性。结果共收集56株KP,其中60.7%(34株)为CRKP。CRKP组患者入住ICU日数≥20 d、死亡及自动出院患者的比例高于nCRKP组患者(均P<0.05)。CRKP组菌株对常用抗菌药物耐药率高于nCRKP组(均P<0.05),CRKP主要(97.1%)携带blaKPC-2基因,对替加环素以外的抗菌药物耐药率高。82.4%的CRKP属于ST11型,K64为主要荚膜型(50.0%);45.4%的nCRKP属于ST11型,荚膜型以K47为主(40.9%);K64型菌株在CRKP菌株中的比例高于nCRKP菌株(P<0.01)。CRKP携带多种毒力因子,pLVPK-like质粒介导的毒力因子rmpA2、iucA及iroN主要由K64-ST11型CRKP携带,且PFGE分析结果显示K64-ST11型CRKP存在克隆传播。结论VAP下呼吸道标本分离的CRKP呈现多重耐药,其主要分子型别为K64-ST11型,该型CRKP携带多种质粒介导的毒力因子并存在克隆传播,应密切监控其临床流行趋势。Objective To analyze the clinical characteristics,genotypes and major virulence factors of carbapenem-resistant Klebsiella pneumoniae(CRKP)isolated from lower respiratory specimens of patients with ventilator-associated pneumonia(VAP).Methods Non-repetitive Klebsiella pneumoniae(KP)isolated from lower respiratory tract specimens of VAP patients in a hospital from January to December 2019 were collected,clinical characteristics,antimicrobial resistance,multilocus sequence typing and capsular wzi typing of patients were compared between CRKP group and non-CRKP(nCRKP)group,carrying status and homology of virulence factors of CRKP were analyzed.Results A total of 56 strains of KP were collected,60.7%(n=34)of which were CRKP.The proportion of patients with intensive care unit(ICU)stay≥20 days,death and discharged voluntarily in CRKP group were all higher than those in nCRKP group(all P<0.05).Resistance rate of CRKP group to commonly used antimicrobial agents was higher than that of nCRKP group(all P<0.05).Most CRKP(97.1%)carried blaKPC-2 gene,resistance rates to antimicrobial agents other than tigecycline were high.82.4%of CRKP were ST11 type and K64 was the main capsule type(50.0%);45.4%of nCRKP were ST11 type and K47 was the main capsule type(40.9%);proportion of K64 type in CRKP was higher than that of nCRKP strain(P<0.01).CRKP carried a variety of virulence factors,virulence factors rmpA2,iucA and iroN mediated by pLVPK-like plasmid were mainly carried by K64-ST11 CRKP,PFGE analysis showed that there was clonal transmission of K64-ST11 CRKP.Conclusion CRKP isolated from VAP lower respiratory tract specimens shows multiple resistance,and its main molecular type is K64-ST11,this type carries a variety of plasmid-mediated virulence factors and has clonal transmission,clinical epidemic trend should be closely monitored.

关 键 词：耐碳青霉烯类肺炎克雷伯菌 呼吸机相关肺炎 基因型 毒力因子 

分 类 号：R181.3+2[医药卫生—流行病学]