高毒力肺炎克雷伯菌毒力特征及分子流行病学研究  

Virulence characteristics and molecular epidemiology of hypervirulent Kleb⁃siella pneumoniae

作　　者：孙宇 柳俊年 玄路晗 袁苏娥 杜雪飞[1] SUN Yu;LIU Jun⁃nian;XUAN Lu⁃han;YUAN Su⁃e;DU Xue⁃fei(Clinical Laboratory,The Fourth Affiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第四医院检验科,黑龙江哈尔滨150001

出　　处：《哈尔滨医科大学学报》2024年第5期533-538,共6页Journal of Harbin Medical University

摘　　要：目的 探讨高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,HvKP)的临床及分子流行病学特征。方法 收集哈尔滨医科大学附属第四医院2022年6月~2022年12月临床分离的非重复肺炎克雷伯菌(Klebsiella pneumoniae,KP),采用拉丝实验对HvKP进行初筛,拉丝阳性菌株提取DNA作为模板扩增毒力基因iucA、iroB、rmpA和rmpA2,4个毒力基因均阳性的菌株定义为HvKP。收集HvKP患者临床资料,进行药敏实验,并检测其多位点序列分型(multilocus sequence typing, MLST)、Wzi血清分型以及多种毒力基因携带情况。结果 共收集391株KP,其中130株为HvKP,阳性率33.25%。HvKP主要来源于重症监护室(15.38%)和呼吸内科(15.38%),标本类型主要为痰液(49.23%)和脓液(20.77%),HvKP患者主要以老年人为主(60.77%),且以男性居多(66.15%)。HvKP对12种抗菌药物的耐药率均较低(≤12%)。发现8株碳青霉烯耐药高毒力肺炎克雷伯菌(CR-HvKP),以携带KPC基因为主(87.5%)。在HvKP中ST23序列型占优势,且K1和K2是主要的Wzi血清型,另外,发现一个新的ST型(ST6795)。mrkD、fim-H、entB、ybtS、kfu、Wabg和uge在HvKP中的携带率分别为100%、99.23%、100%、87.69%、84.62%、96.92%、98.46%。结论 临床应加强对HvKP的监测,制定合理的方案防止HvKP尤其是CR-HvKP的广泛传播。Objective To investigate the clinical and molecular epidemiological characteristics of hypervirulent Klebsiella pneumoniae(HvKP).Methods Non⁃repetitive Klebsiella pneumoni⁃ae(KP)clinically isolated from the Fourth Affiliated Hospital of Harbin Medical University from June 2022 to December 2022 were collected,and the HvKP was initially screened by string test.DNA of the four positive strains were extracted as a template to amplify virulence genes iucA,iroB,rmpA and rmpA2.The strains with all four virulence genes positive were de⁃fined as HvKP.Clinical data of HvKP patients were collected,drug susceptibility tests were performed,and multilocus sequence typing(MLST),Wzi serotyping and multiple virulence gene carrying were detected.Results A total of 391 KP strains were collected,130 of which were HvKP,with a positive rate of 33.25%.HvKP was mainly derived from intensive care unit(15.38%)and respiratory department(15.38%).Sputum(49.23%)and pus(20.77%)were the main specimen types,the patients with HvKP were mainly the elderly(60.77%),and the majority were men(66.15%).The drug resistance rate of HvKP to 12 kinds of antibi⁃otics was low(≤12%).Eight strains of carbapenem⁃resistant hypervirulent Klebsiella pneu⁃moniae(CR⁃HvKP)were found,mainly carrying KPC gene(87.5%).ST23 sequence type was dominant in HvKP,and K1 and K2 were the main Wzi serotypes.In addition,a new ST type(ST6795)was found.The carrying rates of mrkD,fim⁃H,entB,ybtS,kfu,Wabg and uge in HvKP were 100%,99.23%,100%,87.69%,84.62%,96.92%and 98.46%,re⁃spectively.Conclusion Clinical monitoring of HvKP should be strengthened,and reasonable programs should be formulated to prevent the wide spread of HvKP,especially CR⁃HvKP.

关 键 词：高毒力肺炎克雷伯菌 多位点序列分型 毒力基因 碳青霉烯耐药 

分 类 号：R563.1[医药卫生—呼吸系统]