高黏液表型肺炎克雷伯菌的临床分布特征及毒力分析  

Clinical distribution and virulence analysis of hypermucoviscous Klebsiella pneumoniae

作　　者：陈颖聪 屠艳烨 高晖 陈鑫伟 茹雯哲 杨象未 应丹央 CHEN Yingcong;TU Yanye;GAO Hui;CHEN Xinwei;RU Wenzhe;YANG Xiangwei;YING Danyang(Department of Clinical Laboratory,Ningbo Medical Center Lihuili Hospital,Ningbo 315000,China;不详)

机构地区：[1]宁波市医疗中心李惠利医院检验科,315000 [2]温州医科大学检验医学院 [3]宁海县第二医院检验科

出　　处：《浙江医学》2024年第3期257-261,268,I0005,共7页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2023KY1042);宁波市自然科学基金项目(2022J255)。

摘　　要：目的分析医院临床分离的肺炎克雷伯菌的临床分布特征及毒力基因,为临床治疗及医院感染防控提供参考依据。方法收集2022年1至12月宁波市医疗中心李惠利医院临床分离的96株对常规抗菌药物全敏感肺炎克雷伯菌,分析菌株的临床特征并检测其毒力基因。结果96株全敏感肺炎克雷伯菌中,K1、K2、K57为主要荚膜血清型,ST23为主要流行的多位点序列分型表型,其次为ST25、ST86型;高黏液表型肺炎克雷伯菌的铁载体基因ybtS、菌毛定值与黏附基因ycfM以及pLVPK-like毒力质粒pagO基因的携带率均为100.00%,常见的毒力基因如荚膜多糖生成调节基因(rmpA),铁载体基因(irp-1、fyuA、irp-2、aerobactin、repA),菌毛定值与黏附基因(mrkD),脂多糖形成相关基因(wabG)及pLVPK-like毒力质粒相关基因(rmpA2、iroB、icuA、terB、sills)的携带率均高于非高黏液表型肺炎克雷伯菌,差异均有统计学意义(均P<0.05);另外,分离出33株pLVPK-like毒力质粒阳性肺炎克雷伯菌。结论宁波市医疗中心李惠利医院高黏液表型全敏感肺炎克雷伯菌的毒力基因携带率较高,毒力质粒传播较为严重,提示宁波地区亟需关注医院感染防控,谨防全敏感肺炎克雷伯菌同时获得毒力质粒和耐药质粒成为“超级细菌”,给临床治疗带来严峻挑战。Objective To analyze the clinical distribution and virulence genes of Klebsiella pneumoniae isolates.Methods A total of 96 clinical isolates of Klebsiella pneumoniae were collected from Ningbo Medical Center Lihuili Hospital during January 2022 to December 2022,and the clinical distribution characteristics and virulence genes of the strains were analyzed.Results In 96 susceptible strains of Klebsiella pneumoniae,K1,K2 and K57 were identified as the predominant capsular genes;and ST23 was the main multilocus sequence typing,followed by ST25 and ST86.The ferricarrier gene ybtS,pilomycin number and adhesion gene ycfM and pLVPK-like virulence plasmid pagO gene were identified in all strains of hypermucoviscous phenotype Klebsiella pneumoniae.The carriage rates of common virulence genes,including the regulatory gene for capsular polysaccharide production(rmpA),iron-acquisition systems(irp-1,fyuA,irp-2,aerobactin and repA),fimbrial and adhesin genes(mrkD),lipopolysaccharide formation-related genes(wabG)and pLVPK-like virulence plasmid-related genes(rmpA2,iroB,icuA,terB and sills),were significantly higher in mucoid strains than those in nonmucoid counterparts.Furthermore,33 strains of Klebsiella pneumoniae carrying the pLVPK-like virulence plasmid were identified.Conclusion The carriage rates of virulence genes in hypermucoviscous phenotype Klebsiella pneumoniae are high in collected samples of this study,and the transmission of virulence plasmids is relatively serious,suggesting that appropriate prevention and control measures should taken in clinical setting.

关 键 词：肺炎克雷伯菌 高黏液表型 毒力基因 pLVPK-like毒力质粒 

分 类 号：R446.5[医药卫生—诊断学]