2018-2021年北京市某区腹泻病例粪便中肺炎克雷伯菌的病原学和分子特征分析  

Pathogenic and molecular characteristics of Klebsiella pneumoniae in fecal samples from diarrhea cases in a district of Beijing in 2018-2021

作　　者：张爽[1] 赵娟 刘畅[3] 王海瑞 杨茜 王会波[1] 王园园[1] 李辉 张建涛 张振东 陈楠 李颖[1] 张茂俊[4] 田睿 ZHANG Shuang;ZHAO Juan;LIU Chang;WANG Hai-rui;YANG Xi;WANG Hui-bo;WANG Yuan-yuan;LI Hui;ZHANG Jian-tao;ZHANG Zhen-dong;CHEN Nan;LI Ying;ZHANG Mao-jun;TIAN Rui(Shunyi District Center for Disease Control and Prevention,Beijing 101300,China;General Administration Of Customs(Beijing)International Travel Healthcare Center,Beijing 100013,China;Baotou Medical College,Inner Mongolia University of Science&Technology,Inner Mongolia 014040,China;National Institute for Communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]北京市顺义区疾病预防控制中心,北京101300 [2]海关总署(北京)国际旅行卫生保健中心,北京100013 [3]内蒙古科技大学包头医学院,内蒙古014040 [4]中国疾病预防控制中心传染病预防控制所,北京102206

出　　处：《中国人兽共患病学报》2024年第8期745-749,757,共6页Chinese Journal of Zoonoses

基　　金：海关总署科研项目(No.2023HK069);国家重点研发计划(No.2021YFC2301001)联合资助。

摘　　要：目的了解北京市某区腹泻病例粪便中肺炎克雷伯菌(Klebsiella pneumoniae,KP)的病原学和分子特征。方法收集2018-2021年北京市某区门诊腹泻病例的粪便样本,进行KP分离培养鉴定,对KP分离株进行耐药表型检测和全基因组测序,测序结果进行多位点序列分析(Multilocus sequence typing,MLST)并建立全基因组系统进化树,同时分析病例的流行病学和临床特征。结果2018-2021年共检测粪便样本1103份,KP总检出率10.43%(115/1103),与其他致泻病原的混合感染率为42.61%(49/115)。女性阳性检出率稍高,为12.47%(61/489),16~45岁的青壮年检出最多,在1月、4~5月和8~9月3个时间段分别出现阳性小高峰。病例消化道症状以恶心为主,多为水样便。115株KP菌株耐药率前3位为氨苄西林、四环素和磺胺异噁唑,共有29株菌株对3类以上抗生素耐药。菌株共分为72种序列型(Sequence type,ST),其中ST23型最多,系统进化树显示菌株可分为4个主要分支,其中有14株ST23型菌株与高毒力NTUH-K2044参考株亲缘关系非常接近。结论北京市某区腹泻病例粪便样本中持续存在KP感染,女性、青壮年易感。本地区KP耐药情况严峻,ST型多样,且存在与高毒力菌株亲缘关系非常接近的ST23型致病菌株。This study was aimed at investigating the patho genic and molecular characteristics of Klebsiella pneumoniae(KP)in fecal samples of diarrhea cases in a district of Beijing.Fecal samples from diarrhea cases in an outpatient department in a district of Beijing from 2018 to 2021 were collected,and used for isolation and culture of KP.The KP strains isolated strains were subjected to drug resistance phenotype testing and whole-genome sequencing.Multilocus sequence typing and whole-genome phyletic evolution analysis were performed on the sequencing results.The cases’epidemiological and clinical characteristics were analyzed.From 2018 to 2021,1103 fecal samples were collected and detected.The total detection rate of KP was 10.43%(115/1103),and the infection rate of KP mixed with other diarrhea-causing pathogens was 42.61%(49/115).The positivity rate was slightly high(12.47%,61/489)among females and was highest in young adults 16-45 years of age.Small peaks were observed in January,April to May,and August to September.The gastrointestinal symptoms in cases were mainly nausea and watery stool,and the suspicious food was unknown.Ampicillin,tetracycline,and sulfafurazole were the top three antibiotics to which these 115 KP strains showed resistance,and 29 strains were resistant to multiple antibiotics.The strains were divided into 72 sequence types,among which ST23 was dominant.According to the phylogenetic tree,the strains were divided into four main branches,among which 14 ST23 strains had a very close genetic relationship with the highly virulent NTUH-K2044 reference strain.KP infection persisted in fecal samples from diarrhea cases in the district of Beijing.Women and young adults were particularly susceptible.The drug resistance of KP strains in this region was very serious,and the ST types were diverse.Moreover,the ST23 pathogenic strains were closely related to high virulence strains.

关 键 词：肺炎克雷伯菌 药敏 全基因组测序 

分 类 号：R378.4[医药卫生—病原生物学]