血流感染肺炎克雷伯菌的药敏结果及分子特点研究
Drug sensitivity analysis results and molecular characteristics of bloodstream
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摘要: 目的 研究高黏液表型肺炎克雷伯菌(HMVKP)与经典肺炎克雷伯菌(CKP)的荚膜血清型和毒力基因,分析HMVKP与CKP的药敏情况、耐药表型。方法 收集2013年1月-2016年12月血流感染肺炎克雷伯菌共185株,拉丝试验确定HMVKP; PCR方法扩增荚膜血清型、毒力基因,分析HMVKP与CKP的检出率; 检测分析抗菌药物敏感性; 体外纸片法检测产超广谱β内酰胺酶,通过改良Hodge试验和EDTA试验检测碳青霉烯酶表型。结果 高黏液型肺炎克雷伯菌占23.2%(43/185),六种高毒力荚膜血清均被检出,分别为K1(9.2%)、K2(11.4%)、K5(1.6%)、K20(2.2%)、K54(1.6%)、K57(6.5%),共占32.4%(60/185); HMVKP的毒力基因检出率均高于CKP,HMVKP与CKP毒力分数(P50)分别为7和4(P<0.05); HMVKP抗菌药物敏感率均高于CKP(P<0.05); 有3株(7.0%)HMVKP产超广谱β内酰胺酶,1株(2.3%)HMVKP改良Hodge试验阳性。结论 高毒力肺炎克雷伯菌以K1、K2、K57血清型常见,携带更多的毒力基因,且多为敏感株,ESBL试验阴性,但耐药菌株的出现不容忽视。Abstract: OBJECTIVE To study the capsular serotypes and virulence genes of hypermucoviscous Klebsiella pneumoniae(HMVKP) and classical K.pneumoniae(CKP), and to further analyze the drug sensitivity and drug resistance phenotype of HMVKP and CKP.HT5"HMETHODSHT5"SSA total of 185 strains of K.pneumoniae by bloodstream infections were collected from January 2013 to December 2016.HMVKP was determined by string-test.PCR method was used to amplify capsular serotypes and virulence genes, and the detection rates of HMVKP and CKP were analyzed.Meanwhile, antimicrobial susceptibility was also detected and analyzed; extended-spectrum β-lactamase was measured by in vitro disk method; in addition, carbapenem phenotype was detected by modified Hodge test and EDTA test.HT5"HRESULTSHT5"SSHypermucoviscous K.pneumoniae accounted for 23.2% (43/185) of the total strain.All six high virulent capsular serotypes were detected, including K1 (9.2%), K2 (11.4%), K5 (1.6%), K20 (2.2%), K54 (1.6%) and K57 (6.5%), with 32.4%(60/185) in total. The detection rate of virulence genes of HMVKP was higher than that of CKP, the toxicity (P50) of HMVKP and CKP were 7 and 4, respectively, showing difference ( P<0.05).Furthermore, drug sensitivity of HMVKP was significantly better than that of CKP ( P<0.05).There were 3 strains (7.0%) of HMVKP producing extended-spectrum β-lactamase, 1 strain (2.3%) of HMVKP indicated positive by modified Hodge test.HT5"HCONCLUSIONHT5"SSHypermucoviscous K.pneumoniaeare common in K1, K2 and K57 serotypes, and may carry more virulence factors, most of which are non-ESBL producing sensitive strains.However, the emergence of drug-resistant strains can't be ignored.
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