摘要
目的探讨我院肺炎克雷伯菌肝脓肿的临床特点和病原学特征,为肺炎克雷伯菌肝脓肿的诊治提供依据。方法回顾性分析我院2018年4月至2019年4月收治的30例确诊为肺炎克雷伯菌感染所致肝脓肿患者的临床特点,采用VITEK-2全自动微生物分析系统检测菌株的耐药性,PCR法进行荚膜血清型及毒力基因的检测。结果肺炎克雷伯菌肝脓肿患者年龄<65岁多见,以发热(73.3%)和肝区疼痛(66.7%)为主要临床表现。其中86.7%的患者具有胆管炎、胆囊炎等胆道疾病,76.7%的患者肠道有肺炎克雷伯菌定植,60%的患者处于肝移植状态。30株菌株对常见抗菌药物的耐药率≤40%,其中对三代头孢他啶和四代头孢吡肟的耐药率分别为10%和3.3%,未发现碳青霉烯类耐药菌株。拉丝试验阳性率为66.7%(20/30),荚膜血清型以K1血清型为主,占40%(12/30),其次为K2型,占20.0%(6/30)。具有高黏表型的菌株(HvKP)均检测到rmpA基因,携带率为100%;而普通肺炎克雷伯菌rmpA基因的携带率为20%。结论肺炎克雷伯菌肝脓肿患者年龄较轻,菌株的肠道定植是感染的危险因素。菌株对除头孢他啶和头孢吡肟以外的头孢类抗生素耐药率较高。K1、K2型为主要荚膜血清型,毒力基因rmpA携带率高。
Objective To analyze the clinical and etiological characteristics of Klebsiella pneumoniae liver abscess in our hospital,and to provide basis for the diagnosis and treatment of Klebsiella pneumoniae liver abscess.Methods Retrospectively analyze the clinical characteristics of 30 patients diagnosed with liver abscess caused by Klebsiella pneumoniae treated in our hospital from April 2018 to April 2019.The strains of antibiotics susceptibility was identified with Vitek 2 system,and capsule serotypes and virulence genes were detected using polymerase chain reaction.Results Most of the patients were less than 65 years old and the main clinical manifestations were fever(73.3%)and liver pain(66.7%).About 86.7%patients were complicated with biliary diseases,such as cholangitis and cholecystitis,76.7%were with Klebsiella pneumoniae colonization in intestine,and 60%were in status of liver transplantation.The resistance rates of 30 strains to common antibiotics were less than 40%,and to ceftazidime and cefepime it was 10%and 3.3%,respectively.There were no carbapenem-resistant strains.The positive rate of string test was 66.7%(20/30).The dominant capsule serotype was K1(40%,20/30),followed by K2(20.0%,6/30).Gene rmpA was detected in 100%of the Klebsiella pneumoniae with hypermucoviscous phenotype and in 20%of the strains with non-hypermucoviscous phenotype.Conclusion Patients with Klebsiella pneumoniae liver abscess are relatively young and the colonization in intestine is the risk factor for the infection.The resistance rate of the strains to cephalosporins is high,except for ceftazidime and cefepime.The dominant capsule serotype is K1 and K2 and the virulence gene rmpA is highly detected.
作者
张雯霞
陈君灏
陈晨
李玲霞
张珏
ZHANG Wen-xia;CHEN Jun-hao;CHEN Chen;LI Ling-xia;ZHANG Jue(Department of Clinical Laboratory,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)
出处
《实用药物与临床》
CAS
2020年第11期1038-1041,共4页
Practical Pharmacy and Clinical Remedies
关键词
肺炎克雷伯菌
肝脓肿
耐药性
毒力基因
Klebsiella pneumoniae
Liver abscess
Drug resistance
Virulence gene
