摘要
目的·检测分离自血培养的肺炎克雷伯菌的毒力基因,以及分析高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,hvKP)和经典肺炎克雷伯菌(classic Klebsiella pneumoniae,cKP)感染患者的临床特征。方法·收集上海交通大学医学院附属新华医院2016年10月-2018年3月分离自血培养的肺炎克雷伯菌80株。采用黏液丝试验筛选高黏液性肺炎克雷伯菌(hypermucoviscous Klebsiella pneumoniae,HMKP),通过扩增wzi基因的方法进行荚膜血清分型,PCR方法检测hvKP常见的rmpA、magA、aerobactin等22种毒力基因,采用多位点序列分型方法对菌株进行基因分型,收集并分析患者的相关临床资料。结果·黏液丝试验结果显示,80株肺炎克雷伯菌中有9株为HMKP;毒力基因检测结果显示,10株为hvKP,magA、allS、iucA、iroN、kfu、wcaG、rmpA2、iutA、pLVPK、terW、silS基因在hvKP中检出率均显著高于cKP,差异具有统计学意义(均P<0.05)。荚膜血清分型以K14.K64型为主(24/80),多位点序列分型以ST11型为主(43/80)。与cKP相比,hvKP引起的血流感染以社区获得性较多,科室分布以急诊重症监护室为主,糖尿病患者比例高,合并肝脓肿的比例高。结论·上海交通大学医学院附属新华医院分离自血培养的肺炎克雷伯菌以cKP为主,大部分c KP为K14.K64/ST11型,且多为医院获得性感染;hvKP感染患者合并肝脓肿的比例较高。
Objective·To detect the virulence genes of Klebsiella pneumoniae isolated from blood cultures,and analyze the clinical characteristics of the patients infected with hypervirulent Klebsiella pneumoniae(hvKP)or classic Klebsiella pneumoniae(cKP).Methods·A total of 80 Klebsiella pneumoniae strains isolated from blood cultures in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from Oct.2016 to Mar.2018 were collected.String test was performed to determine hypermucoviscous Klebsiella pneumoniae(HMKP).The capsular serotypes were confirmed by wzi sequencing.The 22 virulence genes,such as rmpA,magA,and aerobactin,were identified by PCR.Multilocus sequence typing(MLST)was used to determine sequence type of these isolates.The clinical records were collected to analyze the characteristics of Klebsiella pneumoniae-infected patients.Results·The results of string test showed that 9 out of 80 Klebsiella pneumoniae strains were HMKP.The results of virulence gene detection showed that 10 strains were hvKP.Significant difference was found between hvKP and cKP in the detection rates of magA,allS,iucA,iroN,kfu,wcaG,rmpA2,iutA,pLVPK,silS and terW genes(P<0.05).The dominant capsular serotype of these isolates was K14.K64(24/80).MLST revealed that ST11 was the major type of 80 isolates(43/80).The bloodstream infections caused by hvKP were mainly community-acquired,and emergency intensive care unit was the dominant department.The proportion of diabetic patients and liver abscess were higher in hvKP.Conclusion·cKP is the dominant type of the Klebsiella pneumoniae strains isolated from blood cultures in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine.Most cKPs are K14.K64/ST11 and the infections are mainly hospital-acquired.The proportion of hvKP infected patients with liver abscess is high.
作者
管红艳
刘婧娴
刘瑛
GUAN Hong-yan;LIU Jing-xian;LIU Ying(Department of Clinical Microbiology,Clinical Laboratory,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2020年第2期235-241,共7页
Journal of Shanghai Jiao tong University:Medical Science
关键词
肺炎克雷伯菌
血培养
毒力基因
临床特征
Klebsiella pneumoniae
blood culture
virulence gene
clinical characteristic
