湛江地区高毒力肺炎克雷伯菌分子流行特征

doi:10.3969/j.issn.1673-8640.2023.11.004

摘要/Abstract

摘要：

目的了解湛江地区高毒力肺炎克雷伯菌（hvKP）分子流行特征，为临床合理防治hvKP感染提供理论依据。方法收集175株肺炎克雷伯菌（KP）临床分离株，根据拉丝试验和毒力基因检测结果将175株KP分为hvKP组（48株）和经典型肺炎克雷伯菌（CKP）组（127株）。采用聚合酶链反应（PCR）和多位点序列分型（MLST）对hvKP组菌株进行荚膜血清分型和ST分子分型。比较2组抗菌药物敏感性试验结果和感染患者临床特征的差异。结果 hvKP组以K1荚膜血清型（62.50%）和ST23型（58.33%）为主。hvKP组抗菌药物敏感性较CKP组强，耐药表型携带率更低（P<0.001）。hvKP组患者以社区感染为主（56.25%），CKP组患者以医院感染为主（61.42%），2个组差异有统计学意义（P=0.035）。hvKP组患者并发肝脓肿、败血症、呼吸道感染、血流感染、肝胆道感染和全身多部位感染者所占比例高于CKP组，CKP组患者发生泌尿道感染或有泌尿系统基础疾病史者所占比例高于hvKP组（P<0.05）。hvKP组白细胞总数、丙氨酸氨基转移酶、天门冬氨酸氨基转移酶高于CKP组（P<0.05）。结论 K1-ST23型是湛江地区hvKP优势流行株。hvKP较CKP对抗菌药物更敏感。hvKP感染患者易出现全身多部位感染和肝脓肿、血流感染等并发症；其感染相关指标水平偏高，且伴有肝功能损伤。

关键词: 肺炎克雷伯菌, 高毒力肺炎克雷伯菌, 多位点序列分型, 毒力基因, 耐药性, 荚膜血清型

Abstract:

Objective To study the molecular epidemic characteristics of hypervirulent Klebsiella pneumoniae（hvKP） in Zhanjiang，and to provide a reference for clinical rational prevention and treatment of hvKP infection. Methods A total of 175 clinical isolates of Klebsiella pneumoniae（KP） were collected. The KP isolates were classified into hvKP group（48 isolates） and classic Klebsiella pneumoniae（CKP） group（127 isolates） by string test and virulence gene determination. Polymerase chain reaction（PCR） and multilocus sequence typing（MLST） were used to analyze the capsular serotyping and ST molecular typing of hvKP isolates，and the results of drug susceptibility test and the clinical characteristic of patients with infection were compared between the 2 groups. Results K1 capsular serotype（62.50%） and ST23（58.33%） were predominant in hvKP group. The hvKP group was more sensitive to antibiotics and had a lower rate of drug resistance phenotype than those of CKP group（P<0.001）. Community infection was predominant in hvKP group（56.25%），while nosocomial infection was predominant in CKP group（61.42%）（P=0.035）. The hvKP group had a higher proportion of liver abscess，sepsis，respiratory tract infection，bloodstream infection，hepatobiliary tract infection and systemic multi-site infection than CKP group（P<0.05）. However，the CKP group had a higher proportion of patients with a history of urinary system disease and urinary tract infection than hvKP group（P<0.05）. The total white blood cell count，alanine aminotransferase and aspartate aminotransferase in hvKP group were higher than those in CKP group（P<0.05）. Conclusions K1-ST23 hvKP is the dominant epidemic isolate in Zhanjiang. The hvKP is more sensitive to antibiotics than CKP. The patients with hvKP infection are prone to systemic multi-site infection，liver abscess and sepsis，and they have high infection indicators accompanied by liver function damage.

Key words: Klebsiella pneumoniae, Hypervirulence, Multilocus sequence typing, Virulent gene, Drug resistance, Capsular serotype

中图分类号:

R378.99

邓晨, 戴家泽, 邱丽红, 沈威廷, 蔡木发, 罗文英. 湛江地区高毒力肺炎克雷伯菌分子流行特征[J]. 检验医学, 2023, 38(11): 1026-1031.

DENG Chen, DAI Jiaze, QIU Lihong, SHEN Weiting, CAI Mufa, LUO Wenying. Molecular epidemic characteristics of hypervirulent Klebsiella pneumoniae in Zhanjiang[J]. Laboratory Medicine, 2023, 38(11): 1026-1031.

图/表 5

参考文献 13

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引物名称	前向引物序列（5'~3'）	反向引物序列（5'~3'）	片段大小/bp	退火温度/ ℃
K1	GGTGCTCTTTACATCATTGC	GCAATGGCCATTTGCGTTAG	1 283	55
K2	GACCCGATATTCATACTTGACAGAG	CCTGAAGTAAAATCGTAAATAGATGGC	641	57
K5	TGGTAGTGATGCTCGCGA	CCTGAACCCACCCCAATC	280	56
K20	CGGTGCTACAGTGCATCATT	GTTATACGATGCTCAGTCGC	741	56
K54	CATTAGCTCAGTGGTTGGCT	GCTTGACAAACACCATAGCAG	881	56
K57	CTCAGGGCTAGAAGTGTCAT	CACTAACCCAGAAAGTCGAG	1 037	56
rmpa	GAGTAGTTAATAAATCAATAGCAAT	CAGTAGGCATTGCAGCA	332	50
rmpa2	GTGCAATAAGGATGTTACATTA	GGATGCCCTCCTCCTG	430	50
iucA	AATCAATGGCTATTCCCGCTG	CGCTTCACTTCTTTCACTGACAGG	239	59
iroB	ATCTCATCATCTACCCTCCGCTC	GGTTCGCCGTCGTTTTCAA	235	59
aerobaction	GCATAGGCGGATACGAACAT	CACAGGGCAATTGCTTACC	556	55
peg344	CTTGAAACTATCCCTCCAGTC	CCAGCGAAAGAATAACCCC	508	53
gapA	TGAAATATGACTCCACTCACGG	CTTCAGAAGCGGCTTTGATGGCTT	450	60
infB	CTCGCTGCTGGACTATATTCG	CGCTTTCAGCTCAAGAACTTC	318	50
mdh	CCCAACTCGCTTCAGGTTCA	CCGTTTTTCCCCAGCAGCAG	477	50
pgi	CTGCTGGCGCTGATCGGCAT	TTATAGCGGTTAATCAGGCCGT	432	50
phoE	ACCTACCGCAACACCGACTTCTTCGG	TGATCAGAACTGGTAGGTGAT	420	50
rpoB	GGCGAAATGGCWGAGAACCA	GAGTCTTCGAAGTTGTAACC	501	50
tonB	CTTTATACCTCGGTACATCAGGTT	ATTCGCCGGCTGRGCRGAGAG	414	45

引物名称	前向引物序列（5'~3'）	反向引物序列（5'~3'）	片段大小/bp	退火温度/ ℃
K1	GGTGCTCTTTACATCATTGC	GCAATGGCCATTTGCGTTAG	1 283	55
K2	GACCCGATATTCATACTTGACAGAG	CCTGAAGTAAAATCGTAAATAGATGGC	641	57
K5	TGGTAGTGATGCTCGCGA	CCTGAACCCACCCCAATC	280	56
K20	CGGTGCTACAGTGCATCATT	GTTATACGATGCTCAGTCGC	741	56
K54	CATTAGCTCAGTGGTTGGCT	GCTTGACAAACACCATAGCAG	881	56
K57	CTCAGGGCTAGAAGTGTCAT	CACTAACCCAGAAAGTCGAG	1 037	56
rmpa	GAGTAGTTAATAAATCAATAGCAAT	CAGTAGGCATTGCAGCA	332	50
rmpa2	GTGCAATAAGGATGTTACATTA	GGATGCCCTCCTCCTG	430	50
iucA	AATCAATGGCTATTCCCGCTG	CGCTTCACTTCTTTCACTGACAGG	239	59
iroB	ATCTCATCATCTACCCTCCGCTC	GGTTCGCCGTCGTTTTCAA	235	59
aerobaction	GCATAGGCGGATACGAACAT	CACAGGGCAATTGCTTACC	556	55
peg344	CTTGAAACTATCCCTCCAGTC	CCAGCGAAAGAATAACCCC	508	53
gapA	TGAAATATGACTCCACTCACGG	CTTCAGAAGCGGCTTTGATGGCTT	450	60
infB	CTCGCTGCTGGACTATATTCG	CGCTTTCAGCTCAAGAACTTC	318	50
mdh	CCCAACTCGCTTCAGGTTCA	CCGTTTTTCCCCAGCAGCAG	477	50
pgi	CTGCTGGCGCTGATCGGCAT	TTATAGCGGTTAATCAGGCCGT	432	50
phoE	ACCTACCGCAACACCGACTTCTTCGG	TGATCAGAACTGGTAGGTGAT	420	50
rpoB	GGCGAAATGGCWGAGAACCA	GAGTCTTCGAAGTTGTAACC	501	50
tonB	CTTTATACCTCGGTACATCAGGTT	ATTCGCCGGCTGRGCRGAGAG	414	45

ST型别	荚膜血清型	菌株数/株	构成比/%
ST23	K1	28	58.33
ST65	K2	3	6.25
ST86	K2	3	6.25
ST268	K20	3	6.25
ST412	K57	3	6.25
ST375	K2	2	4.17
ST592	K57	2	4.17
ST367	K1	1	2.08
ST700	K1	1	2.08
ST29	K54	1	2.08
ST218	K57	1	2.08

ST型别	荚膜血清型	菌株数/株	构成比/%
ST23	K1	28	58.33
ST65	K2	3	6.25
ST86	K2	3	6.25
ST268	K20	3	6.25
ST412	K57	3	6.25
ST375	K2	2	4.17
ST592	K57	2	4.17
ST367	K1	1	2.08
ST700	K1	1	2.08
ST29	K54	1	2.08
ST218	K57	1	2.08

组别	例数	阿米卡星	亚胺培南	头孢哌酮-舒巴坦	头孢他啶	替加环素
hvKP组	48	47（97.92）	47（97.92）	47（97.92）	46（95.83）	46（95.83）
CKP组	127	92（72.44）	84（66.14）	60（47.24）	34（26.77）	90（70.87）
χ²值		13.836	18.687	37.648	66.949	12.538
P值		<0.001	<0.001	<0.001	<0.001	<0.001
组别	哌拉西林-他唑巴坦		头孢吡肟	左氧氟沙星	复方磺胺甲噁唑	ESBL阳性
hvKP组	46（95.83）		45（93.75）	45（93.75）	45（93.75）	2（4.17）
CKP组	59（46.46）		33（25.98）	19（14.96）	31（24.41）	76（59.84）
χ²值	35.387		64.750	93.221	68.172	43.707
P值	<0.001		<0.001	<0.001	<0.001	<0.001