摘要
目的分析肺炎克雷伯菌肝脓肿(KPLA)患者的临床特征,了解肺炎克雷伯菌毒力基因携带情况,为临床早期诊断和合理治疗提供参考。方法回顾性分析江苏大学附属医院2017年7月—2019年8月收治的34例脓液培养阳性的细菌性肝脓肿患者的临床资料,分为KPLA组和非肺炎克雷伯菌肝脓肿(NKPLA)组。采用VITEK 2 Compact全自动微生物鉴定及药敏分析仪进行细菌鉴定及药敏试验,采用黏液丝试验确定肺炎克雷伯菌的高黏液表型,采用PCR法进行耐药基因、荚膜血清分型及毒力基因检测,并对结果进行统计学分析。结果34例细菌性肝脓肿中有22例为KPLA。KPLA组患者多有基础疾病糖尿病,而NKPLA组患者则多有基础疾病胆道疾病或恶性肿瘤。22株肺炎克雷伯菌中仅2株(9.1%)同时对环丙沙星、左旋氧氟沙星和复方磺胺甲口恶唑耐药。22株肺炎克雷伯菌中共检出2种ESBLs耐药基因,分别是bla TEM(36.4%)、bla CTX-M-1(27.3%)。本研究中22株肺炎克雷伯菌均为高毒力肺炎克雷伯菌,检出高毒力荚膜血清型5种,以K1型为主,占68.2%。22株肺炎克雷伯菌均携带毒力基因rmp A、iuc A、iro B、iut A。结论KPLA好发于中老年男性,多有糖尿病基础疾病,其菌株均为高毒力肺炎克雷伯菌,以K1血清型为主,并携带了大量的毒力基因,对临床常用的抗菌药物耐药率较低,但可携带耐药基因,需引起临床医生的高度关注。
Objective To analyze the clinical characteristics of patients with Klebsiella pneumoniae liver abscess(KPLA),understand the carrying of virulence gene of Klebsiella pneumoniae(KP),and provide reference for clinical early diagnosis and rational treatment.Methods Clinical data of 34 patients with positive pus culture for bacte-rial liver abscess in the Affiliated Hospital of Jiangsu University from July 2017 to August 2019 were retrospectively analyzed,and were divided into KPLA group and non-KPLA(NKPLA)group.VITEK 2 Compact automatic microbial identification and antimicrobial susceptibility analyzer were used for bacterial identification and antimicrobial susceptibility testing,string test was conducted for hypermucoviscous KP,polymerase chain reaction(PCR)was used to detect antimicrobial resistance genes,capsular serotype and virulence genes,results were statistically analyzed.Results Among 34 cases of bacterial liver abscess cases,22 patients were with KPLA.Most patients in KPLA group had underlying disease diabetes mellitus,while patients in NKPLA group had underlying disease biliary tract disease or malignant tumor.Only 2(9.1%)of 22 KP strains were both resistant to ciprofloxacin,levofloxacin and compound sulfamethoxazole,2 extended-spectrumβ-lactamases(ESBLs)resistance genes were detected from 22 strains of KP,which were bla TEM(36.4%)and bla CTX-M-1(27.3%).22 strains of KP were hypervirulent Klebsiella pneumoniae(hvKP),5 kinds of hypervirulent capsular serotypes were detected,and K1 was the main serotype,accounting for 68.2%.22 strains of KP all carried virulence genes rmp A,iuc A,iro B and iut A.Conclusion KPLA is more common in middle-aged and old men,most are with underlying disease diabetes mellitus,all strains are hvKP,mainly K1 serotype,and carry a large number of virulence genes,resistance rate to commonly used antimicrobial agents is low,but it can carry resistance genes,which needs to be paid great attention by clinicians.
作者
何蕾
阴晴
吴亮
周亚玲
吴瑶
戴晓玥
夏雯
HE Lei;YIN Qing;WU Liang;ZHOU Ya-ling;WU Yao;DAI Xiao-yue;XIA Wen(Department of Laboratory Medicine,Affiliated Hospital of Jiangsu University,Zhenjiang 212000,China;School of Medicine,Jiangsu University,Zhenjiang 212013,China)
出处
《中国感染控制杂志》
CAS
CSCD
北大核心
2021年第7期619-625,共7页
Chinese Journal of Infection Control
基金
江苏省2018年度预防医学科研课题(Y2018108)
镇江市2020年度社会发展指导性科技计划项目(FZ2020037)。
关键词
肺炎克雷伯菌
肝脓肿
临床特征
毒力基因
Klebsiella pneumoniae
liver abscess
clinical characteristic
virulence gene
