高毒力肺炎克雷伯菌感染临床及分子流行病学特征

Clinical and molecular epidemiological characteristics of hypervirulent Klebsiella pneumoniae

    摘要
  • 摘要:
    目的 探讨高毒力肺炎克雷伯菌（hvKP）与经典型肺炎克雷伯菌株（cKP）在毒力基因、荚膜血清型、拉丝实验、临床特征、预后以及药物敏感性的差异。
    方法 收集2022年11月1日－2023年10月31日川北医学院附属医院临床分离的肺炎克雷伯菌（KP），收集患者的临床资料，并进行药敏试验、拉丝实验，同时通过聚合酶链反应（PCR）进行毒力基因（rmpA、iucA、peg-344）及荚膜血清型（K1、K2、K5、K20、K57）检测。
    结果 共分离KP菌株207株，包括社区感染170株（82.12%），其中hvKP 135株（79.41%）、cKP 35株（20.59%）；医院感染37株（17.87%），其中hvKP 29株（78.38%）、cKP 8株（21.63%）。预后方面cKP治疗失败率更高，差异有统计学意义（P＜0.05）。肝脓肿病例共13例，均为hvKP，主要荚膜血清型为K2型（30.77%）和K1型（23.07%）。hvKP拉丝实验阳性率（78.66%）高于cKP组（16.28%），差异有统计学意义（P＜0.001）。hvKP主要以三个毒力基因均为阳性菌株为主（70.12%），主要荚膜血清型为K1（22.56%）、K2（19.51%）和K57（15.24%）。hvKP常见抗菌药物耐药率均低于cKP组，共检出7株（4.27%）耐碳青霉烯高毒力肺炎克雷伯菌（HCKP）菌株。
    结论 社区与医院感染的hvKP检出率均较高，hvKP和cKP在临床特征方面无显著差异，但cKP组预后更差；肝脓肿均为hvKP感染且脓毒症发生率高；hvKP耐药率低于cKP，但检出的7株HCKP菌株需引起临床与感控人员高度警惕。

     

    Abstract:
    OBJECTIVE  To explore the differences in virulence genes, capsular serotypes, string tests, clinical characteristics, prognosis and drug susceptibility between hypervirulent Klebsiella pneumoniae （hvKP） and classic Klebsiella pneumoniae （cKP） strains.
    METHODS  K. pneumoniae （KP） strains clinically isolated from the Affiliated Hospital of North Sichuan Medical College from Nov. 1, 2022 to Oct. 31, 2023 were collected, along with the clinical data of the patients. Drug susceptibility tests and string tests were conducted, and polymerase chain reaction （PCR） was used to detect virulence genes （rmpA, iucA, peg-344） and capsular serotypes （K1, K2, K5, K20, K57）.
    RESULTS  A total of 207 KP strains were isolated, including 170 community-associated infections （82.12%）, of which 135 were hvKP （79.41%） and 35 were cKP （20.59%）. Totally 37（17.87%） strains caused health care-associated infections, of which 29 were hvKP （78.38%） and 8 were cKP （21.63%）. In terms of prognosis, cKP had a higher treatment failure rate with a statistically significant difference （P＜0.05）. There were 13 cases of liver abscess, all caused by hvKP, with the main capsular serotypes being K2 （30.77%） and K1 （23.07%）. The positive rate of the string test in hvKP （78.66%） was higher than that in the cKP group （16.28%） with a statistically significant difference （P＜0.001）. The majority of hvKP strains were positive for all three virulence genes （70.12%）, with the main capsular serotypes being K1 （22.56%）, K2 （19.51%） and K57 （15.24%）. The resistance rates of hvKP to commonly used antibacterial agents were lower than those of the cKP group. A total of 7 strains （4.27%） of carbapenem-resistant hypervirulent K. pneumoniae （HCKP） were detected.
    CONCLUSIONS  Both community-associated and hospital-associated hvKP have high detection rates. There are no significant differences in clinical characteristics between hvKP and cKP, but the prognosis is worse in the cKP group. All liver abscesses are caused by hvKP infection, with a high incidence of sepsis. The resistance rate of hvKP is lower than that of cKP, but the detection of 7 HCKP strains requires heightened vigilance from clinical and infection control personnel.

     

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