太原市某三甲医院非呼吸道标本分离的高毒力肺炎克雷伯菌流行病学调查  

Epidemiological investigation of hypervirulent Klebsiella pneumoniae(hvKP)isolated from non-respiratory specimens in a tertiary hospital in Taiyuan city

作　　者：王瑞雪 王海如 李浩[2] 杨志宁 WANG Ruixue;WANG Hairu;LI Hao;YANG Zhining(Department of Laboratory Medicine,Shanxi Bethune Hospital,Taiyuan 030032,China;Department of Laboratory Medicine,First Affiliated Hospital of Shanxi Medical University;Department of Laboratory Medicine,Shanxi Provincial Cardiovascular Hospital)

机构地区：[1]山西白求恩医院检验科,太原030032 [2]山西医科大学第一医院检验科 [3]山西省心血管病医院检验科

出　　处：《山西医科大学学报》2023年第10期1397-1403,共7页Journal of Shanxi Medical University

基　　金：山西省基础研究计划青年项目(201901D211514)。

摘　　要：目的了解太原市某三甲医院非呼吸道标本分离的高毒力肺炎克雷伯菌(hvKP)感染特点、耐药性、高毒力荚膜多糖血清分型及序列分型。方法收集2021年10月至2022年12月山西白求恩医院非呼吸道标本分离肺炎克雷伯菌(KP)171株,以检测到毒力基因iucA及_(p)rmpA/_(p)rmpA2为依据,将菌株分为阳性组(hvKP组)和阴性组(经典KP,cKP组)。卡方检验分析感染部位、感染类型、耐药菌株以及6种高毒力荚膜多糖血清型(K1、K2、K5、K20、K54和K57)在两组中的分布特征,二分类logistic回归筛选hvKP感染高危因素,采用多位点序列分型(multilocus sequence typing,MLST)对hvKP进行分子分型。结果hvKP在肝脓肿、脓毒血症、其他部位脓肿及腹部感染中存在优势分布(均P<0.05),cKP在尿路感染中存在优势分布(P<0.05);社区获得性感染是该医院非呼吸道标本分离hvKP的主要感染类型(P<0.001);血清白蛋白(ALB)<28.6 g/L是hvKP感染独立危险因素(OR=2.832,95%CI 1.207~6.646,P=0.017)。非呼吸道感染hvKP对临床常用抗菌药物耐药率保持在3.08%~18.46%之间,除阿米卡星外,均显著低于cKP组(均P<0.05)。高毒力荚膜多糖血清型K1、K2占hvKP总数的52.31%和21.54%,与hvKP高度相关(均P<0.001);K5、K20、K54、K57检出率较低(1.54%~4.62%),未发现与hvKP存在相关性(均P>0.05)。MLST将hvKP分成18种不同的序列类型(sequence type,ST),其中ST23占50.77%,其次为ST65和ST86,均占7.70%。ST23型hvKP与K1血清型密切相关(P<0.001)。非ST23型hvKP则与K2血清型密切相关(P<0.001),主要对应ST65(35.71%)和ST86(28.57%)型。暂未发现ST23型hvKP获得碳青霉烯耐药表型。结论该医院非呼吸道标本分离的hvKP主要与多个部位脓肿(包括肝脓肿)、脓毒血症及腹部感染相关,但很少侵犯泌尿系统,并且以引起社区获得性感染为主。患者血清ALB水平低下,更容易发生hvKP的感染。目前该医院非呼吸道感染的hvKP耐药程度较低,K1、K2高毒力荚Objective To investigate the infection characteristics,the drug resistance,the hypervirulent capsular polysaccharide serotyping and the sequence typing of hypervirulent Klebsiella pneumoniae(hvKP)isolated from non-respiratory specimens in a tertiary hospital in Taiyuan city.Methods A total of 171 non-repeated cases of KP were isolated from non-respiratory specimens in Shanxi Beune Hospital from October 2021 to December 2022.The strains were divided into positive group(hvKP group)and negative group(classical KP,cKP group)according to iucA and _(p)rmpA/_(p)rmpA2 positive or not.Chi-square test was used to analyze the distribution of infection sites,infection types,drug-resistant strains,and six hypervirulent capsular polysaccharide serotypes(K1,K2,K5,K20,K54,and K57)in the two groups.Binary logistic regression was used to screen high-risk factors of hvKP infection,and multilocus sequence typing(MLST)was used to analyze the prevalence of hvKP sequence types.Results HvKP possessed a dominant distribution in liver abscesses,sepsis,other abscesses,and abdominal infections(all P<0.05),while cKP possessed a dominant distribution in urinary tract infections(P<0.05).Community-acquired infection was the main infection type of hvKP isolated from non-respiratory specimens in the hospital(P<0.001).Serum albumin(ALB)<28.6 g/L was an independent risk factor for hvKP infection(OR=2.832,95%CI 1.207-6.646,P=0.017).The resistance rates of hvKP strains isolated from non-respiratory specimens in the hospital to the frequently used antibiotics were 3.08%-18.46%,and except for Amikacin,the resistance rates of hvKP strains were significantly lower than those of cKP strains(all P<0.05).The hypervirulent capsular polysaccharides serotypes K1,K2 accounted for 52.31%and 21.54%in hvKP strains respectively,which were strongly associated with hvKP(both P<0.001).And the detection rates of serotypes K5,K20,K54 and K57 were 1.54%-4.62%in hvKP strains,which were not associated with hvKP(all P>0.05).MLST classified hvKP into 18 different ST types,of

关 键 词：高毒力肺炎克雷伯菌 感染特征 耐药性 高毒力荚膜多糖血清分型 多位点序列分析 

分 类 号：R181[医药卫生—流行病学]