高毒力和碳青霉烯耐药肺炎克雷伯菌血流感染临床及分子流行病学特征  

Clinical and molecular epidemiological characteristics of hypervirulent and carbapenem-resistant Klebsiella pneumoniae causing bloodstream infection

作　　者：黄雅轩 蔡依含 何婉霞 张莉滟 赵越 HUANG Ya-xuan;CAI Yi-han;HE Wan-xia;ZHANG Li-yan;ZHAO Yue(Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences,Southern Medical University,Guangzhou,Guangdong 510080,China;不详)

机构地区：[1]南方医科大学附属广东省人民医院/广东省医学科学院检验科,广东广州510080 [2]南方医科大学检验与生物技术学院,广东广州510515 [3]广州南方学院云康医学与健康学院,广东广州510970

出　　处：《中华医院感染学杂志》2023年第22期3417-3422,共6页Chinese Journal of Nosocomiology

基　　金：广东省基础与应用基础研究基金资助项目(2021A1515220022)。

摘　　要：目的探讨高毒力肺炎克雷伯菌(hvKp)和碳青霉烯耐药肺炎克雷伯菌(CRKP)血流感染临床及分子流行病学特征.方法收集2020年1月-2022年6月广东省人民医院经临床检验血培养确诊的由肺炎克雷伯菌所致血流感染患者的病历资料及相关菌株,共32株纳入研究,包括hvKp 16株、CR-hvKp 1株,共17株定义为hvKp;CRKP 15株.采用全基因组测序方法,分析菌株耐药基因、毒力基因分布特征及荚膜血清型.运用多位点序列分型(MLST)技术分析菌株序列型(ST).结果血流感染患者均伴有多种基础疾病,CRKP感染患者侵入性操作较多、病死率较高(P<0.05),患者主要分布于重症监护室(ICU)、感染科、儿科等科室.测序结果分析显示:CRKP主要携带bla KPC-1、bla NDM-1耐药基因,毒力基因以entA、entB、entE、fepA、fepC、fepG、ompA、xcpR、yagV/ecpE、ykgK/ecpR等为主,荚膜血清型以K14、K64为主,MLST分型结果以ST11为主.而hvKp主要携带的毒力基因以entA、entB、entE、fepB、fimA、irp1、mgtB、ompA、yagV/ecpE、ybtA等为主,荚膜血清型以K1、K2为主,MLST分型以ST23、ST25为主.其中1株CR-hvKp同样携带多种毒力基因,为ST751型.结论血流感染患者分离的hvKp、CRKP菌株携带多种毒力基因和耐药基因,给临床抗感染治疗和预后带来挑战,且CR-hvKp的出现极大威胁患者健康.实验室应加强对此类病原菌监测,检出后应及时报告临床,并采取积极措施,减少其在医院播散.OBJECTIVE To explore the clinical and molecular epidemiological characteristics of hypervirulent Klebsiella pneumoniae(hvKp)and carbapenem-resistant K.pneumoniae(CRKP)causing bloodstream infection.METHODS The medical data were collected from the patients who were diagnosed with K.pneumoniae bloodstream infection by clinical blood culture in Guangdong Provincial People's Hospital from Jan 2020 to Jun 2022.Totally 32 strains of K.pneumoniae were included in the study,including 16 strains of hvKp and 1 strain of CRhvKp.Totally 17 strains were defined as hvKp,and 15 strains were defined as CRKP.The drug resistance genes,virulence genes and capsular serotypes were analyzed by whole genome sequencing.The sequence types of the strains were analyzed by multilocus sequence typing(MLST).RESULTS All of the bloodstream infection patients were complicated with underlying diseases.The invasive procedures were more,and the mortality rate of the CRKP infection patients was higher(P<0.05).The patients were mainly from intensive care unit(ICU),infection department and pediatrics department.The result of sequencing analysis showed that CRKP strains mainly carried with blaKPC-1 and blaNDM-1 drug resistance genes and the virulence genes entA,entB,entE,fepA,fepC,fepG,ompA,ccpR,yag V/ecpE and ykgK/ecpR;K14 and K64 were the major capsular serotypes,and the result of MLST typing showed that ST11 was dominant.While the hvKp mainly carried with the virulence genes such as entA,entB,entE,fepB,fimA,irpl,mgtB,ompA,yag V/ecpE and ybtA;Kl and K2 were the major capsular serotypes;MLST showed that ST23 and ST25 were dominant.1 strain of CR-hvKp carried with multiple virulence genes and was ST751.CONCLUSION The hvKp and CRKP strains that are isolated from the patients with bloodstream infection carry with multiple virulence genes and drug resistance genes,which brings challenge to clinical treatment of infection and prognosis.The emergence of CR-hvKp poses great threats to the health of patients.It is necessary to strengthen the laboratory test of

关 键 词：高毒力肺炎克雷伯菌 碳青霉烯耐药肺炎克雷伯菌 血流感染 临床特征 分子流行病学 

分 类 号：R378.996[医药卫生—病原生物学]