高毒力肺炎克雷伯菌肺脓肿临床特征及菌株微生物学特征研究  

Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae lung abscess

作　　者：周潇清 符一骐[2] 徐敏[3] 周华[2] 周建英[2] 鲁海燕 朱建俊 Zhou Xiaoqing;Fu Yiqi;Xu Min;Zhou Hua;Zhou Jianying;Lu Haiyan;Zhu Jianjun(Department of Intensive Care Unit,the First Affiliated Hospital of Zhejiang University Medical College(the second People′s Hospital of Yuhang District,Hangzhou),Hangzhou 311121,China;Department of Respiratory Disease,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Department of Microbiology,the First Affiliated Hospital,Zhejiang University Medical College,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院(杭州市余杭区第二人民医院重症医学科),杭州311121 [2]浙江大学医学院附属第一医院呼吸与危重症医学科,杭州310003 [3]浙江大学医学院附属第一医院检验科微生物室,杭州310003

出　　处：《中华结核和呼吸杂志》2022年第5期438-444,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金(81971897)。

摘　　要：目的研究高毒力肺炎克雷伯菌(Hypervirulent Klebsiella pneumoniae,hvKP)肺脓肿的临床特征及菌株微生物学特征,并与经典肺炎克雷伯菌(Classic Klebsiella pneumoniae,cKP)肺脓肿进行比较。方法选取2017年1月至2020年9月浙江大学医学院附属第一医院收治的18例微生物学诊断明确的肺炎克雷伯菌肺脓肿患者为研究对象。菌株拉丝实验阳性患者纳入hvKP组,阴性患者纳入cKP组;收集患者的基础疾病、症状、实验室检查等临床特征。菌株微生物学特征包括:VITEK法测定菌株对抗菌药物体外敏感性;PCR检测菌株荚膜血清型和毒力基因。单因素分析hvKP组和cKP组的临床特征及菌株微生物学特征差异。结果18例肺炎克雷伯菌肺脓肿患者中hvKP组12例,以男性为主(10例),中位年龄59.0岁;hvKP组中起病时间≤2周者8例,中位发病时间为10.5 d,患有糖尿病(12例)、合并肺外脓肿(11例)明显多于cKP组(均P<0.001)。hvKP组肺外脓肿以肝脓肿为主(10例),多部位(≥3个)脓肿占4例。cKP组中留置导管及感染前侵袭性操作例数多于hvKP组(均P=0.025)。肺炎克雷伯菌肺脓肿影像学以胸膜下、脓肿大小<10 cm为主,hvKP组肺部影像学表现为多发脓肿的患者(9例)多于cKP组(P=0.009),通过影像学发现肺脓肿与肺外脓肿的中位时间间隔为1.0 d。hvKP组对常见抗菌药物耐药率明显低于cKP组。结论hvKP肺脓肿常见于糖尿病患者,临床表现无特异性,肺部影像学表现为胸膜下多发脓肿,符合血源播散特点;多数病例同时存在肝脓肿,提示为血源播散的来源。hvKP肺脓肿主要毒力基因为aero,对于hvKP肺脓肿患者,应注意寻找隐匿病灶。Objective To study the clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae(hvKP)lung abscess,and to compare with the classic Klebsiella pneumoniae(cKP)lung abscess.Methods A total of 18 patients with Klebsiella pneumoniae lung abscesses admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to September 2020 enrolled.The strains with positive result of string test were defined as hvKP,and the negative strains were defined as cKP.The patients′basic diseases,symptoms,laboratory data and other clinical characteristics were collected.The microbiological characteristics of the strains included as following:VITEK method to determine the in vitro susceptibility of the strains to antibiotics;PCR to detect the capsular serotypes and virulence genes.The differences in clinical characteristics and microbiological characteristics of strains between hvKP group and cKP group were compared.Results Among the 18 patients with Klebsiella pneumoniae lung abscess,12 were hvKP infection,mainly male(10 cases),with a median age of 59.0 years;8 cases in the hvKP group had an onset time of≤2 weeks,and the median onset time was 10.5 days.There were significantly more diabetes(12 cases)and extrapulmonary abscesses(11 cases)in hvKP group than those in cKP group(both P<0.001).The extrapulmonary abscesses in the hvKP group were mainly liver abscesses(10 cases),and 4 cases were multi-site(≥3)abscesses.The number of indwelling catheters and invasive procedures before infection were higher in cKP group than those in hvKP group(both P=0.025).The imaging of Klebsiella pneumoniae lung abscess was mainly subpleural with the size of less than 10 cm.There were more multiple abscesses cases in hvKP group(9 cases)than cKP group(P=0.009).The median interval time between the detection of a pulmonary abscess and an extrapulmonary abscess was 1.0 day.The resistance rate of common antibiotics was significantly lower in hvKP than cKP.Conclusions hvKP lung abscesses are more c

关 键 词：克雷伯菌 肺脓肿 毒力 细菌荚膜 

分 类 号：R563.2[医药卫生—呼吸系统]