侵袭性高黏液型肺炎克雷伯菌感染的临床和分子特征研究

A clinical and molecular characteristics study of Klebsiella pneumoniae infection with highly invasive mucinous pneumonia

摘要:

摘 要：目的 分析引起侵袭性高黏液型肺炎克雷伯菌(HMVKP)感染患者的临床和分子特征，为侵袭性高黏液型 肺炎克雷伯菌感染的精准诊断和临床抗感染治疗提供依据。方法 分析临床分离的侵袭性高黏液型肺炎克雷伯菌感染 患者临床资料，利用PCR方法对菌株荚膜血清型、毒力基因及耐药基因检测进行分子特征研究。结果 96 株侵袭性肺 炎克雷伯菌感染的菌株中 64 株为HMVKP，脓液标本在HMVKP组标本中的占比(32.8%)最大；在HMVKP组中共检出 4 例产ESBL菌株及 2 株耐碳青霉烯类药物菌株；HMVKP菌株的荚膜血清型以K1(40.6%)和K2(29.7%)为主，毒力基因 以peg344、iucA和iroB携带率最高。HMVKP与N-HMVKP菌株的 7 个毒力基因(peg344、rmpA、rmpA2、magA、iucA、 iroB与kfu)差异均有统计学意义(P<0.05)。结论 K1 和K2 是本地区侵袭性感染HMVKP最常见的荚膜血清型，peg344、 iucA、iroB、rmpA是HMVKP主要的毒力基因，现在已出现合并多重耐药尤其是耐碳青霉烯类抗生素的HMVKP菌株，应 重视。

Abstract:

Abstract: Objective This study aims to analyze the clinical and molecular characteristics of patients with invasive mucinous Klebsiella pneumoniae (HMVKP) infection, providing evidence for precise diagnosis and clinical antimicrobial therapy of invasive mucinous Klebsiella pneumoniae infection. Methods Clinical data of patients with invasive mucinous Klebsiella pneumoniae infection were analyzed, and molecular characteristics including capsule serotype, virulence genes, and drug resistance genes were detected using PCR. Results Among the 96 strains of invasive Klebsiella pneumoniae, 64 strains were identified as HMVKP, with pus (32.8%) being the most common specimen in the HMVKP group. Four ESBL-producing strains and two carbapenem-resistant strains were detected among the HMVKP strains. The predominant capsule serotypes of HMVKP were K1 (40.6%) and K2 (29.7%), while the highest prevalence of virulence genes were peg344, iucA, and iroB. Seven virulence genes (peg344, rmpA, rmpA2, magA, iucA, iroB, and kfu) showed statistically significant differences between the HMVKP and non-HMVKP groups (P<0.05). Conclusion K1 and K2 are the most common capsule serotypes of invasive HMVKP in this region, while peg344, iucA, iroB, and rmpA are the main virulence genes. Multiple drug-resistant HMVKP strains, especially those resistant to carbapenems, have emerged, necessitating heightened awareness.