侵袭性高黏液型肺炎克雷伯菌感染的临床和分子特征研究  

A clinical and molecular characteristics study of Klebsiella pneumoniae infection with highly invasive mucinous pneumonia

作　　者：刘志云 梁雪雁[2] 曹海燕 李璐[3] 李格格 钟莹莹 冼志丽 吴显劲 LIU Zhi-yun;LIANG Xue-yan;CAO Hai-yan;LI Lu;LI Ge-ge;ZHONG Ying-ying;XIAN Zhi-li;WU Xianjin(Shantou University Medical College,Shantou 515041,China;Huizhou Central People's Hospital,Huizhou 516001,China;Guangdong Medical University,Dongguan 523808,China;Jiaying Medical College,Meizhou 514031,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]惠州市中心人民医院,广东惠州516001 [3]广东医科大学,广东东莞523808 [4]嘉应医学院,广东梅州514031

出　　处：《广东医科大学学报》2024年第2期157-161,168,共6页Journal of Guangdong Medical University

基　　金：国家自然科学基金青年项目(32300048);广东省基础与应用基础研究基金省市联合基金项目(2022A1515110158);2023年广东医科大学百项青年研究项目资助计划(GDMUD2023001);广东医科大学博士科研启动项目(GDMUB2022028);2021年广东省惠州市科技研发计划项目(2021WC0106346)。

摘　　要：目的分析引起侵袭性高黏液型肺炎克雷伯菌(HMVKP)感染患者的临床和分子特征,为侵袭性高黏液型肺炎克雷伯菌感染的精准诊断和临床抗感染治疗提供依据。方法分析临床分离的侵袭性高黏液型肺炎克雷伯菌感染患者临床资料,利用PCR方法对菌株荚膜血清型、毒力基因及耐药基因检测进行分子特征研究。结果96株侵袭性肺炎克雷伯菌感染的菌株中64株为HMVKP,脓液标本在HMVKP组标本中的占比(32.8%)最大;在HMVKP组中共检出4例产ESBL菌株及2株耐碳青霉烯类药物菌株;HMVKP菌株的荚膜血清型以K1(40.6%)和K2(29.7%)为主,毒力基因以peg344、iucA和iroB携带率最高。HMVKP与N-HMVKP菌株的7个毒力基因(peg344、rmpA、rmpA2、magA、iucA、iroB与kfu)差异均有统计学意义(P<0.05)。结论K1和K2是本地区侵袭性感染HMVKP最常见的荚膜血清型,peg344、iucA、iroB、rmpA是HMVKP主要的毒力基因,现在已出现合并多重耐药尤其是耐碳青霉烯类抗生素的HMVKP菌株,应重视。Objective This study aims to analyze the clinical and molecular characteristics of patients with invasive mucinous Klebsiella pneumoniae(HMVKP)infection,providing evidence for precise diagnosis and clinical antimicrobial therapy of invasive mucinous Klebsiella pneumoniae infection.Methods Clinical data of patients with invasive mucinous Klebsiella pneumoniae infection were analyzed,and molecular characteristics including capsule serotype,virulence genes,and drug resistance genes were detected using PCR.Results Among the 96 strains of invasive Klebsiella pneumoniae,64 strains were identified as HMVKP,with pus(32.8%)being the most common specimen in the HMVKP group.Four ESBL-producing strains and two carbapenem-resistant strains were detected among the HMVKP strains.The predominant capsule serotypes of HMVKP were K1(40.6%)and K2(29.7%),while the highest prevalence of virulence genes were peg344,iucA,and iroB.Seven virulence genes(peg344,rmpA,rmpA2,magA,iucA,iroB,and kfu)showed statistically significant differences between the HMVKP and non-HMVKP groups(P<0.05).Conclusion K1 and K2 are the most common capsule serotypes of invasive HMVKP in this region,while peg344,iucA,iroB,and rmpA are the main virulence genes.Multiple drug-resistant HMVKP strains,especially those resistant to carbapenems,have emerged,necessitating heightened awareness.

关 键 词：肺炎克雷伯菌 高黏液型 侵袭性感染 耐药性 毒力基因 

分 类 号：R378[医药卫生—病原生物学]