基于全基因组测序的高毒力肺炎克雷伯菌病原学特征  

Etiological characteristics of hypervirulent Klebsiella pneumoniae based on whole genome sequencing

作　　者：严伟[1] 沈月华[1] 查赟峰[1] 纪蕾[1] 徐德顺[1] YAN Wei;SHEN Yue-hua;ZHA Yun-feng;JI Lei;XU De-shun(Huzhou Prefectural Center for Disease Control and Prevention,Huzhou,Zhejiang 313oo0,China)

机构地区：[1]湖州市疾病预防控制中心,浙江湖州313000

出　　处：《中华医院感染学杂志》2025年第1期102-107,共6页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划项目资助(2023RC277)。

摘　　要：目的了解湖州地区医院来源的肺炎克雷伯菌的分子流行病学特征,为肺炎克雷伯菌感染的临床诊治提供理论依据。方法收集2022-2023年湖州市6家哨点医院临床分离的肺炎克雷伯菌,进行耐药性检测、拉丝试验筛选、脉冲场凝胶电泳(PFGE)分子分型及全基因组测序分析。结果共收集阳性菌株106株,主要来自50岁以上患者的痰液标本(66.04%),拉丝试验筛选出39株高毒力肺炎克雷伯菌(hvKP);耐药结果显示敏感率最高为替加环素和多粘菌素E,均为100.00%,耐药率最高的是氨苄西林(94.88%);PFGE分析显示相似度为51.56%~100.00%;通过全基因测序分析,共检出109种毒力基因和16种耐药基因,毒力基因rmpA、iucA、iroB在hvKP中的携带率分别为41.03%、69.23%、100.00%;检出3种不同亚型的β-内酰胺类耐药基因,且携带率达到100.00%,碳青霉烯类耐药基因bla_(KPC-2)携带率为7.69%;ST1049和ST23为主要的多位点序列分型(MLST)型别,单核苷酸多态性(SNP)发育树显示为3个进化分支。结论湖州地区hvKP的检出率较高,通过拉丝试验可筛选出高毒力株,hvKP主要MLST型别为ST1049,检出耐碳青霉烯hvKP,需引起临床高度重视。OBJECTIVE To understand the molecular epidemiological characteristics of Klebsiella pneumoniae strains isolated from hospitals in Huzhou,so as to provide theoretical bases for clinical diagnosis and treatment of K.pneumoniae infection.METHODS From 2022 to 2023,the clinical isolates of K.pneumoniae were collected from 6 sentinel hospitals of Huzhou.Drug susceptibility testing,string test,pulsed-field gel electrophoresis(PFGE)molecular typing and whole genome sequencing were carried out.RESULTS Totally 106 positive strains were collected,66.04%of which were isolated from sputum specimens of the patients aged more than 50 years old,and 39 strains of hypervirulent K.pneumoniae(hvKP)were screened out by the string test.The result of drug susceptibility testing showed that the drug susceptibility rates to both tigecycline and polymyxin E were 100.00%,while the drug resistance rate to ampicillin was highest(94.88%).PFGE analysis indicated that the similarity ranged between 51.56%and 100.00%.The whole genome sequencing analysis showed that totally 109 types of virulence genes and 16 types of drug resistance genes were detected;the carrying rates of virulence genes rmpA,iucA and iroB in the hvKP were 41.03%,69.23%and 100.00%,respectively.Three subtypes ofβ-lactams resistance genes were detected,with the carrying rates reaching up to 100.00%;the carrying rate of carbapenems resistance gene blakpc2 was 7.69%.ST1049 and ST23 were the major types of multilocus sequence typing(MLST),and single-nucleotide polymorphism(SNP)phylogenetic tree indicated that there were 3 evolutionary branches.CONCLUSIONS The isolation rate of hvKP is high in Huzhou.The hypervirulent strains can be screened out by the string test.ST1049 is the major MLST type of hvKP in the area.It is necessary to attach great importance to the carbapenem-resistant hvKP.

关 键 词：高毒力肺炎克雷伯菌 耐药 全基因组测序 病原学特征 湖州 

分 类 号：R378[医药卫生—病原生物学]