老年患者CRKP与CSKP感染临床特点以及毒力相关基因分布差异  

Differences in clinical characteristics and distribution of virulence-related genes between CRKP and CSKP infections in elderly patients

作　　者：马海艳 刘学文 马文东 吴雅坤 付盈菊 李颖 MA Haiyan;LIU Xuewen;MA Wendong;WU Yakun;FU Yingju;LI Ying(Department of Emergency Medicine,Tangshan Workers’Hospital,063003,China)

机构地区：[1]唐山市工人医院急诊内科,063003 [2]唐山市工人医院神经内科,063003

出　　处：《传染病信息》2023年第4期325-330,共6页Infectious Disease Information

基　　金：河北省卫生健康委科研基金项目(20210828)。

摘　　要：目的探讨老年患者碳青霉烯类耐药肺炎克雷伯菌(carbapenem-resistant Klebsiella pneumoniae,CRKP)与碳青霉烯类敏感肺炎克雷伯菌(carbapenem-susceptible Klebsiella pneumoniae,CSKP)的临床感染情况及毒力相关基因分布差异。方法选取2020年3月—2021年9月于唐山市工人医院住院的86例感染肺炎克雷伯菌(Klebsiella pneumoniae,KP)的老年患者作为研究对象,从患者各类临床标本中分离出86株KP,并根据其是否对碳青霉烯类抗菌耐药,分为CSKP组(n=50)和CRKP组(n=36)。使用全自动微生物药敏分析仪进行菌株鉴定;使用黏液拉丝试验鉴定菌株的毒力表型;使用多位点序列分型(multilocus sequence typing,MLST)分析菌株的克隆型,使用聚合酶链式反应(polymerase chain reaction,PCR)检测荚膜血清型及毒力基因。结果CRKP主要来源于痰标本,CSKP主要来源于血液标本。CRKP组中重症监护病房患者比例(86.11%)明显高于CSKP组(32.00%)(P<0.05)。CRKP组共检测到23种序列分型(sequence typing,ST),其中ST11型比例最高(41.67%);CSKP组共检测到24种ST型,其中ST23型比例最高(12.00%)。CRKP组检测出3株高毒力菌株(8.33%),其中K1型1株(2.78%),K5型2株(5.56%);CSKP组检测出20株高毒力菌株(40.00%),其中K57型7株(14.00%)。CRKP组magA、ybt、kfu基因阳性率明显低于CSKP组(P<0.05)。结论重症监护病房中,老年患者对CRKP感染率高于CSKP。CRKP以ST11型为主要流行菌株,临床应引起重视。Objective To explore the differences in clinical characteristics and distribution of virulence-related genes between carbapenem-resistant Klebsiella pneumoniae(CRKP)and carbapenem-susceptible Klebsiella pneumoniae(CSKP)infections in elderly patients.Methods Eighty-six elderly patients with Klebsiella pneumoniae(KP)infection attending our hospital from March 2020 to September 2021 were studied.Eighty-six strains of KP were isolated from various clinical specimens of each patient.According to whether the infected strains were resistant to carbapenem,patients were divided into the CSKP group(50 strains)and the CRKP group(36 strains).The strain identification was carried out by automatic microbial drug sensitivity analyzer.Multilocus sequence typing(MLST)was used to analyze the clones of the 2 groups of strains.Polymerase chain reaction(PCR)was used to detect virulence genes and capsular serotypes.Results Of all specimens,CRKP was mainly derived from sputum,and CSKP was mainly derived from blood.The proportion of patients in intensive care unit(ICU)in the CRKP group(86.11%)was significantly higher than that in the CSKP group(32.00%)(P<0.05).A total of 23 sequence typing(ST)were detected in the CRKP group,with the highest proportion of ST11(41.67%).A total of 24 ST types were detected in the CSKP group,with the highest proportion of ST23(12.00%).Three highly virulent strains(8.33%)were detected in the CRKP group,including one strain of K1 type(2.78%)and two strains of K5 type(5.56%).The CSKP group detected 20 highly virulent strains(40.00%),including seven strains of K57 type(14.00%).The positive rates of magA,ybt,and kfu genes in the CRKP group were significantly lower than those in the CSKP group(P<0.05).Conclusion The infection rate of CRKP strain in elderly patients is higher than that of CSKP strain in ICU patients.ST11 strain is the primary epidemic strain of CRKP strain,which should be paid attention to clinically.

关 键 词：碳青霉烯类敏感肺炎克雷伯菌 碳青霉烯类耐药肺炎克雷伯菌 血清型 基因型 多位点序列分型 临床特征 耐药性 

分 类 号：R735.7[医药卫生—肿瘤]