KL47型和KL64型产KPC酶肺炎克雷伯菌的菌株特征和体外药物敏感性分析  

The typing and in vitro antimicrobial susceptibility of KL47 and KL64 KPCproducing K.pneumoniae

作　　者：李晓晴 王露霞 卓超[2] 郭振辉 陈金辉[3] 孙朝晖 廖扬 肖斌[4] 黄晓燕 吴玉婷 LI Xiaoqing;WANG Luxia;ZHUO Chao;GUO Zhenhui;CHEN Jinhui;SUN Zhaohui;LIAO Yang;XIAO Bin;HUANG Xiaoyan;WU Yuting(Department of Laboratory Medicine,General Hospital of Southern Theatre Command,Guangzhou 510010,China)

机构地区：[1]中国人民解放军南部战区总医院检验科,广州510010 [2]广州医科大学第一附属医院呼吸疾病研究所 [3]南方医科大学 [4]广州医科大学附属第六医院,清远市人民医院检验医学部 [5]中国人民解放军南部战区总医院重症医学科内科病区(MICU),广州510010 [6]中国人民解放军南部战区总医院呼吸与危重症医学科,广州510010

出　　处：《中国感染与化疗杂志》2023年第3期341-346,共6页Chinese Journal of Infection and Chemotherapy

基　　金：广州市科技局基础研究项目(20200203005)。

摘　　要：目的分析KL47型和KL64型荚膜血清型产KPC酶肺炎克雷伯菌(KPC-KP)的菌株特点,比较多黏菌素B、替加环素、头孢他啶-阿维巴坦对KL47型和KL64型KPC-KP菌株的体外抗菌活性。方法纳入2019年1月—2020年12月南部战区总医院216例患者不同部位分离的280株经PCR确认携带blaKPC的KPC-KP菌株。用wzi测序法进行荚膜血清型测定,采用肉汤微量稀释法检测多黏菌素B、替加环素、头孢他啶-阿维巴坦以及临床常用抗菌药物的最低抑菌浓度(MIC)。结果280株KPC-KP中168株为患者单一部位分离的菌株,另112株来自48例患者2~5个不同部位分离到菌株。168株荚膜血清分型以KL47型和KL64为主,分别占44.6%(75/168)和38.7%(65/168),其他荚膜血清型(KL10、KL12、KL19、KL27、KL28、KL105、KL110)占14.9%(25/168),3株(1.8%)菌株无法归类于以上血清型。112株KPC-KP中82株来自37例患者不同部位分离的菌株荚膜血清型均为同一型,另30株来自11例患者不同部位分离的菌株荚膜血清型为不同型;KL47型和KL64型分别为54.5%(61/112)和27.7%(31/112),其他荚膜血清型为12.5%(14/112),有6株(5.4%)无法归类于以上血清型。KL47型和KL64型两组患者患有基础疾病中,除慢性阻塞性肺疾病患病率差异有统计学意义(P<0.01),其余临床危险因素差异均无统计学意义(P>0.05),KL47和KL64型患者14 d及28 d死亡率差异无统计学意义(P>0.05)。136株KL47对多黏菌素B、替加环素和头孢他啶-阿维巴坦敏感率为95.6%、97.8%和98.5%,MIC_(90)分别为16、2、8 mg/L;96株KL64对多黏菌素B、替加环素和头孢他啶-阿维巴坦敏感率为88.5%、91.7%和100%,MIC_(90)分别为16、2、4 mg/L。多黏菌素B和头孢他啶-阿维巴坦对KL47和KL64体外抗菌活性相当(P>0.05),而替加环素对KL47和KL64型KPC-KP菌株体外抗菌活性差异有统计学意义(P=0.04)。结论该院KPC-KP荚膜血清型以KL47和KL64型为主。多黏菌素B和头孢他啶-阿维巴坦对KL47和KL64体外抗菌�Objective To analyze the clinical characteristics of patients with infection by KL47 and KL64 KPC-producing K.pneumoniae(KPC-KP),and to compare the in vitro antibacterial activity of polymyxin B,tigecycline,ceftazidime-avibactam against KL47 and KL64 KPC-KP.Methods This study included 280 KPC-KP strains confirmed by PCR from 216 patients at different sites in the General Hospital of Southern Theatre Command from January 2019 to December 2020.The capsular serotypes were determined by wzi sequencing method.The minimum antibacterial concentration of polymyxin B,tigecycline,ceftazidime-avibactam and other antibiotics against KPC-KP was tested by broth dilution method.Results Of the 280 KPC-KP strains,168 were nonduplicate isolates from different patients.The other 112 strains were isolated from 2-5 different body sites of 48 patients.The capsular serotypes of the 168 nonduplicate strains were dominated by KL47 and KL64,accounting for 44.6%(75/168)and 38.7%(65/168),respectively,other capsular serotypes(KL10,KL12,KL19,KL27,KL28,KL105,KL110)accounted for 14.9%(25/168).Only the remaining 3 strains(1.8%)were not typed to any of the above serotypes.Of the 112 KPC-KP strains,the multiple isolates showed the same capsular serotype in 37 patients(82 strains),and different capsular serotypes in 11 patients(30 strains).The capsular serotype of the 112 KPC-KP strains was dominated by KL47 and KL64,accounting for 54.5%(61/112)and 27.7%(31/112),respectively,the other serotypes accounted for 12.5%(14/112).Six strains(5.4%)could not be classified into any of the above serotypes.The prevalence of underlying chronic obstructive pulmonary disease showed significant difference in terms of KL47 KPC-KP versus KL64 KPC-KP(P<0.01).The 14-day and 28-day mortality rates did not show significant difference in terms of KL47 KPC-KP versus KL64 KPC-KP(P>0.05).Overall,95.6%,97.8%and 98.5%of the 136 KL47 KPC-KP strains were susceptible to polymyxin B,tigecycline,and ceftazidimeavibactam,respectively.The corresponding MIC_(90)was 16,2,and 8 mg/L,res

关 键 词：肺炎克雷伯菌 KPC酶 多黏菌素B 替加环素 头孢他啶-阿维巴坦 

分 类 号：R378.996[医药卫生—病原生物学]