ICU多重耐药肺炎克雷伯菌易感因素分析及耐药表型与基因关系研究  

Analysis of susceptibility factors and the relationship between drug resistance phenotype and gene of multi-drug resistant Klebsiella pneumoniae in ICU

作　　者：舒美林 杨梅 饶成龙 戴红英[1] 邓琳琳 SHU Meilin;YANG Mei;RAO Chenglong;DAI Hongying;DENG Linlin(Laboratory Department,Yuechi County People’s Hospital,Guangan 638300,China)

机构地区：[1]岳池县人民医院检验科,广安638300 [2]南充市中心医院检验科,637000

出　　处：《传染病信息》2023年第6期539-546,共8页Infectious Disease Information

摘　　要：目的 分析重症监护室(intensive care unit, ICU)多重耐药肺炎克雷伯菌(Klebsiella pneumoniae, KP)的易感因素及耐药表型与基因关系,为临床制定综合防治措施提供依据。方法 选取2021年1月—2023年1月收治于岳池县人民医院ICU病房的180例KP感染患者作为研究对象,根据药物敏感性试验结果分为多重耐药组(n=80)和非多重耐药组(n=100),比较2组耐药表型及易感因素。用多因素Logistic回归分析影响ICU多重耐药KP易感因素,并建立列线图模型,分析KP基因组特征及相关的毒力因子。结果 多重耐药组中鉴定出的显著高表达的基因是决定O-抗原脂多糖血清型的血清抗性因子基因,决定多糖胶囊(K抗原)类型的是免疫逃避因子、胶囊合成调节、外排泵表达和肠杆菌素,这些基因与KP的感染方式及院内感染密切相关。多重耐药组的ICU住院时间、机械通气方式、机械通气时间、使用碳青霉烯类史、碳青霉烯类使用时间、输血史、使用肠外营养史、吸痰史、使用血管导管史均高于非多重耐药组(P均<0.05)。ICU住院时间≥19 d、机械通气≥7 d、使用有创机械通气、使用碳青霉烯类史、碳青霉烯类使用时间≥7 d、吸痰史是影响患者ICU多重耐药KP易感的独立危险因素。基于危险因素建立的列线图模型结果提示存在上述危险因素的患者ICU多重耐药KP易感的风险较高。模型内部验证结果显示,验证前后的校正曲线与理想曲线拟合良好。多重耐药组的KP基因测序结果显示,最丰富的质粒复制子类型是Col和Inc家族。结论 ICU中多重耐药KP感染与长时间住院、机械通气、使用碳青霉烯类史、吸痰史、特定基因表达和质粒复制子类型等因素密切相关,这些因素共同增加了患者感染风险。Objective To analyze the susceptibility factors of multi-drug resistant Klebsiella pneumoniae(KP)in intensive care unit(ICU)and the relationship between drug resistance phenotype and gene,so as to provide a basis for clinical development of comprehensive prevention and treatment measures.Methods A total of 180 patients with KP infection admitted to the ICU ward of Yuechi County People’s Hospital from January 2021 to January 2023 were selected as the research objects.According to the drug sensitivity results,they were divided into non-multi-drug resistant group(n=100)and multi-drug resistant group(n=80).Drug resistance phenotypes and susceptibility factors were compared between the two groups.Multivariate Logistic regression was used to analyze the risk factors of multidrug-resistant KP in ICU.A nomogram model was established to analyze the genomic characteristics of KP and related virulence factors.Results The KP gene sequencing results of the multidrug-resistant group showed that the most abundant plasmid replicators were the Col and Inc families.The significantly highly expressed genes identified in the multidrug resistance group were serum resistance factors determining the O-antigen lipopolysaccharide serotype,and the types of polysaccharide capsules(K antigen)were determined by immune evasion factors,capsule synthesis regulation,efflux pump expression and enterobacilicin,which were also closely related to KP infection mode and nosocomial infection.The length of ICU stay,mode of mechanical ventilation,duration of mechanical ventilation,history of carbapenem use,duration of carbapenem use,history of blood transfusion,history of parenteral nutrition,history of sputum suction,and history of vascular catheter use in the multi-drug resistant group were higher than those in the non-multi-drug resistant group(P<0.05).ICU length of stay≥19 d,mechanical ventilation≥7 d,use of invasive mechanical ventilation,history of carbapenem use,duration of carbapenem use≥7 d,and history of sputum suction were independent

关 键 词：重症监护室 肺炎克雷伯菌 多重耐药 易感因素 抗生素敏感性试验 耐药表型 基因学 毒力因子 

分 类 号：R378.996[医药卫生—病原生物学]