医院内高黏液性肺炎克雷伯菌的流行分布、毒力基因及临床特征分析

发布时间：2018-06-25 18:39

本文选题：肺炎克雷伯菌 + 高黏液性　；参考：《上海交通大学学报(医学版)》2017年01期

【摘要】：目的·了解上海交通大学医学院附属瑞金医院高黏液性肺炎克雷伯杆菌(hv KP)的流行分布、耐药性、毒力基因特点及检出患者的临床特征。方法·收集该院2014年9月—2016年3月由住院患者各种标本分离的肺炎克雷伯菌作为实验菌株。拉丝试验阳性的菌株确定为hv KP,用聚合酶链反应(PCR)检测相关荚膜血清型及毒力基因。回顾性分析检出hv KP患者的临床资料。结果·①研究期间临床标本分离的不重复肺炎克雷伯菌共872株,其中hv KP 128株,检出率为14.7%。脓肿液标本检出率最高,为44.1%(15/34)。hv KP中呼吸道标本构成比最高,达70.3%(90/128)。②hv KP整体耐药性不高,但是出现2株对亚胺培南耐药的菌株。③hv KP荚膜血清型以K1型和K2型为主,其中K1型占31.3%(40/128),K2型占32.0%(41/128)。95.2%(20/21)的K57型hv KP来自呼吸道标本。所有hv KP均含fi m H、wab G和ure A基因,p-Rmp A和p-Rmp A2基因的检出率分别为91.4%(117/128)和82.8%(106/128)。kfu BC和all S基因的检出率分别为41.4%(53/128)和27.3%(35/128),与K1型相关。不同标本类型间荚膜血清型及毒力基因检出率比较,差异无统计学意义。④检出hv KP的患者中28.9%(37/128)合并糖尿病,44.5%(57/128)合并肿瘤或者使用过长时间的免疫抑制剂。引起明确临床感染者占60.9%(78/128),其中社区获得性感染占47.4%(37/78)。感染组与非感染组、医院获得性感染组和社区获得性感染组菌株的荚膜分型及毒力基因检出率比较,差异无统计学意义。结论·瑞金医院hv KP检出率不高,主要为呼吸道标本,存在一定比例的呼吸道定植。荚膜血清型以K1型和K2型为主,K57型主要见于呼吸道标本。荚膜血清型和毒力基因与标本类型、是否感染及感染来源无明显相关性。hv KP感染逐步由社区获得向医院获得转变,值得临床医师关注。
[Abstract]:Objective to investigate the prevalence, drug resistance, virulence gene and clinical characteristics of Klebsiella pneumoniae (hvKP) in Ruijin Hospital, Shanghai Jiaotong University. Methods Klebsiella pneumoniae isolated from various specimens of hospitalized patients from September 2014 to March 2016 were collected as experimental strains. The positive strain was identified as HV KP.The serum type and virulence gene were detected by polymerase chain reaction (PCR). The clinical data of patients with HV KP were analyzed retrospectively. Results 1 A total of 872 strains of Klebsiella pneumoniae were isolated from clinical specimens during the study period. The positive rate of abscess fluid samples was the highest, which was 44.1% (15 / 34). The proportion of respiratory tract specimens was the highest, which reached 70.3% (90 / 128) .2hv KP. However, there were two strains resistant to imipenem. K1 and K2 were the main types of K1 and K2 in the capsule of two strains resistant to imipenem. K1 accounted for 31.3% (40 / 128) and K2 accounted for 32.0% (41 / 128) .95.2% (20 / 21) of K57 HvKP from respiratory tract specimens. The detection rates of p-RMP A and p-RMP A2 genes in all HvKP genes were 91.4% (117 / 128) and 82.8% (106 / 128). The detection rates of K1 were 41.4% (53 / 128) and 27.3% (35 / 128), respectively. The detection rate of serum type and virulence gene of capsule among different specimen types was not significantly different. There was no significant difference in the detection rate of hvKP in 28.9% (37 / 128) of patients with diabetes mellitus and 44.5% (57 / 128) of patients with diabetes mellitus, or with immunosuppressive agents for too long. 60.9% (78 / 128) of the patients were clinically infected, of which 47.4% (37 / 78) were community-acquired infections. There was no significant difference between infection group and non-infection group, nosocomial infection group and community acquired infection group. Conclusion the detection rate of HVKP in Ruijin Hospital is not high, mainly respiratory tract specimen, there is a certain proportion of respiratory tract colonization. The serotypes of capsule were K 1 and K 2 mainly in respiratory tract. The serotypes and virulence genes of capsule and the type of specimen, whether infection and source of infection have no obvious correlation between infection and HevKP infection are gradually transformed from community to hospital, which deserves clinicians' attention.
【作者单位】：上海交通大学医学院附属瑞金医院重症医学科;上海交通大学医学院附属瑞金医院临床微生物科;
【基金】：上海市科学技术委员会项目(124119a6100) 上海交通大学“医工交叉基金”项目(YG2014MS57)~~
【分类号】：R440

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