2016年海南省高毒力肺炎克雷伯菌的临床分布、毒力基因和分子流行病学特点
|
摘要
目的分析2016年海南省某医院高毒力肺炎克雷伯菌(hvKP)的临床分布、荚膜分型、分子分型、毒力基因携带及药敏情况。方法回顾性分析2016年1—12月该院临床分离的肺炎克雷伯菌,通过黏液拉丝试验选取hvKP,对菌株进行药敏试验,与普通肺炎克雷伯菌(cKP)比较;采用聚合酶链反应(PCR)法对菌株进行荚膜分型、毒力基因和耐药基因检测,采用脉冲场凝胶电泳(PFGE)和多位点序列分型(MLST)方法对菌株进行分子分型。结果共分离hvKP84株,其中主要标本来源为痰(45株);K1和K2是hvKP的主要荚膜型,ST23、ST65和ST86是hvKP的主要ST型;rmpA、aerobatin、allS、kfuBC和cf29a在hvKP中的携带率分别为90.48%、96.43%、42.86%、66.67%和53.57%,均高于cKP,PFGE发现allS基因仅存在于K1型;hvKP对抗菌药物的耐药率普遍低于cKP。结论痰是hvKP菌株,尤其是K1型hvKP的主要标本来源;超过90%的hvKP菌株携带rmpA和aerobatin基因,allS基因仅存在于K1型hvKP中。
Objective To investigate clinical distribution,capsular serotyping,molecular typing,virulence gene carriage,and antimicrobial susceptibility of hypervirulent Klebsiella pneumoniae(hvKP)strains isolated from a hospital in Hainan Province in 2016.Methods Klebsiella pneumoniae(K.pneumoniae)isolated from the hospital between January and December 2016 were analyzed retrospectively,hvKP strains were selected through string test,antimicrobial susceptibility testing was performed and compared with classic K.pneumoniae(cKP);capsular serotyping,virulence genes,and drug resistance genes of hvKP strains were detected with polymerase chain reaction,molecular typing was performed with pulsed-field gel electrophoresis(PFGE)and multilocus sequence typing.Results A total of 84 hvKP strains were isolated,the main specimen source was sputum(45 strains);K1 and K2 were the major capsular serotypes of hvKP,while ST23,ST65,and ST86 were the main sequence types of hvKP.The carriage rates of rmpA,aerobatin,allS,kfuBC,and cf29 ain hvKP were 90.48%,96.43%,42.86%,66.67%,and 53.57% respectively,all of them were statistically higher than those of cKP strains,PFGE found that allS was positive only among K1 strains;most antimicrobial resistance rates of hvKP were lower than those of the cKP.Conclusion Sputum is the main specimen source of hvKP,especially K1 serotype;more than 90% of hvKP strains carry rmpA and aerobatingenes,allS gene only exists in K1 type hvKP.
Objective To investigate clinical distribution,capsular serotyping,molecular typing,virulence gene carriage,and antimicrobial susceptibility of hypervirulent Klebsiella pneumoniae(hvKP)strains isolated from a hospital in Hainan Province in 2016.Methods Klebsiella pneumoniae(K.pneumoniae)isolated from the hospital between January and December 2016 were analyzed retrospectively,hvKP strains were selected through string test,antimicrobial susceptibility testing was performed and compared with classic K.pneumoniae(cKP);capsular serotyping,virulence genes,and drug resistance genes of hvKP strains were detected with polymerase chain reaction,molecular typing was performed with pulsed-field gel electrophoresis(PFGE)and multilocus sequence typing.Results A total of 84 hvKP strains were isolated,the main specimen source was sputum(45 strains);K1 and K2 were the major capsular serotypes of hvKP,while ST23,ST65,and ST86 were the main sequence types of hvKP.The carriage rates of rmpA,aerobatin,allS,kfuBC,and cf29 ain hvKP were 90.48%,96.43%,42.86%,66.67%,and 53.57% respectively,all of them were statistically higher than those of cKP strains,PFGE found that allS was positive only among K1 strains;most antimicrobial resistance rates of hvKP were lower than those of the cKP.Conclusion Sputum is the main specimen source of hvKP,especially K1 serotype;more than 90% of hvKP strains carry rmpA and aerobatingenes,allS gene only exists in K1 type hvKP.
引文
[1]Hsu CR,Lin TL,Pan YJ,et al.Isolation of a bacteriophage specific for a new capsular type of Klebsiella pneumoniae and characterization of its polysaccharide depolymerase[J].PloS One,2013,8(8):e70092.
[2]Shon AS,Bajwa RP,Russo TA.Hypervirulent(hypermucoviscous)Klebsiella pneumoniae[J].Virulence,2013,4(2):107-118.
[3]Cheng HY,Chen YS,Wu CY,et al.RmpA regulation of capsular polysaccharide biosynthesis in Klebsiella pneumoniae CG43[J].J Bacteriol,2010,192(12):3144-3158.
[4]Nassif X,Sansonetti PJ.Correlation of the virulence of Klebsiella pneumoniae K1 and K2 with the presence of a plasmid encoding aerobactin[J].Infect Immun,1986,54(3):603-608.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:twenty-sixth informational supplement M100-S26[S].CLSI,2016.
[6]Wu H,Li D,Zhou H,et al.Bacteremia and other body site infection caused by hypervirulent and classic Klebsiella pneumoniae[J].Microb Pathog,2017,104:254-262.
[7]Han H,Zhou H,Li H,et al.Optimization of pulse-field gel electrophoresis for subtyping of Klebsiella pneumoniae[J].Int J Environ Res Public Health,2013,10(7):2720-2731.
[8]Namikawa H,Yamada K,Fujimoto H,et al.Two unusual cases of successful treatment of hypermucoviscous Klebsiella pneumoniae invasive syndrome[J].BMC Infect Dis,2016,16(1):680.
[9]徐修礼,王师,高佳节,等.某院近5年痰标本分离病原菌及耐药性分析[J].中国感染控制杂志,2015,14(2):89-93.
[10]Pang TC,Fung T,Samra J,et al.Pyogenic liver abscess:an audit of 10 years’experience[J].World J Gastroenterol,2011,17(12):1622-1630.
[11]Lin YC,Lu MC,Tang HL,et al.Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections:comparative virulence analysis with hypermucoviscosity-negative strain[J].BMC Microbiol,2011,11:50.
[12]Fung CP,Chang FY,Lee SC,et al.A global emerging disease of Klebsiella pneumoniae liver abscess:is serotype K1 an important factor for complicated endophthalmitis?[J].Gut,2002,50(3):420-424.
[13]Ma LC,Fang CT,Lee CZ,et al.Genomic heterogeneity in Klebsiella pneumoniae strains is associated with primary pyogenic liver abscess and metastatic Infection[J].J Infect Dis,2005,192:117-128.
[14]Cortés G,Borrell N,de Astorza B,et al.Molecular analysis of the contribution of the capsular polysaccharide and the lipopolysaccharide O side chain to the virulence of Klebsiella pneumoniae in a murine model of pneumonia[J].Infect Immun,2002,70(5):2583-2590.
[15]Struve C,Bojer M,Krogfelt KA.Characterization of Klebsiella pneumoniae type 1fimbriae by detction of phase variation during colonization and infection and impact on virulence[J].Infect Immun,2008,76(9):4055-4065.
[16]Struve C,Bojer M,Krogfelt KA.Identification of a conserved chromosomal region encoding Klebsiella pneumoniae type 1and type 3 fimbriae and assessment of the role of fimbriae in pathogenicity[J].Infect Immun,2009,77(11):5016-5024.
[17]Li W,Sun G,Yu Y,et al.Increasing occurrence of antimicrobial-resistant hypervirulent(hypermucoviscous)Klebsiella pneumoniae isolates in China[J].Clin Infect Dis,2014,58(2):225-232.
[18]Liu YM,Li BB,Zhang YY,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrob Agents Chemother,2014,58(9):5379-5385.
[19]王步补,阮战伟,项小婵,等.耐亚胺培南肺炎克雷伯菌分子流行病学及耐药传播机制研究[J].全科医学临床与教育,2014,12(1):18-22.
[20]Siu LK,Huang DB,Chiang T.Plasmid transferability of KPC into a virulent K2 serotype Klebsiella pneumoniae[J].BMC Infect Dis,2014,14:176.
[21]Wei DD,Wan LG,Zeng LB,et al.Emergence of KPC-producing Klebsiella pneumoniae,hypervirulent clone of capsular serotype K1 that belongs to sequence type 11in Mainland China[J].BMC Infect Dis,2016,85(2):192-194.
[22]Liao CH,Huang YT,Chang CY,et al.Capsular serotypes and multilocus sequence types of bacteremic Klebsiella pneumoniae isolates associated with different types of infections[J].Eur J Clin Microbiol Infect Dis,2014,33(3):365-369.
[2]Shon AS,Bajwa RP,Russo TA.Hypervirulent(hypermucoviscous)Klebsiella pneumoniae[J].Virulence,2013,4(2):107-118.
[3]Cheng HY,Chen YS,Wu CY,et al.RmpA regulation of capsular polysaccharide biosynthesis in Klebsiella pneumoniae CG43[J].J Bacteriol,2010,192(12):3144-3158.
[4]Nassif X,Sansonetti PJ.Correlation of the virulence of Klebsiella pneumoniae K1 and K2 with the presence of a plasmid encoding aerobactin[J].Infect Immun,1986,54(3):603-608.
[5]Clinical and Laboratory Standards Institute.Performance standards for antimicrobial susceptibility testing:twenty-sixth informational supplement M100-S26[S].CLSI,2016.
[6]Wu H,Li D,Zhou H,et al.Bacteremia and other body site infection caused by hypervirulent and classic Klebsiella pneumoniae[J].Microb Pathog,2017,104:254-262.
[7]Han H,Zhou H,Li H,et al.Optimization of pulse-field gel electrophoresis for subtyping of Klebsiella pneumoniae[J].Int J Environ Res Public Health,2013,10(7):2720-2731.
[8]Namikawa H,Yamada K,Fujimoto H,et al.Two unusual cases of successful treatment of hypermucoviscous Klebsiella pneumoniae invasive syndrome[J].BMC Infect Dis,2016,16(1):680.
[9]徐修礼,王师,高佳节,等.某院近5年痰标本分离病原菌及耐药性分析[J].中国感染控制杂志,2015,14(2):89-93.
[10]Pang TC,Fung T,Samra J,et al.Pyogenic liver abscess:an audit of 10 years’experience[J].World J Gastroenterol,2011,17(12):1622-1630.
[11]Lin YC,Lu MC,Tang HL,et al.Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections:comparative virulence analysis with hypermucoviscosity-negative strain[J].BMC Microbiol,2011,11:50.
[12]Fung CP,Chang FY,Lee SC,et al.A global emerging disease of Klebsiella pneumoniae liver abscess:is serotype K1 an important factor for complicated endophthalmitis?[J].Gut,2002,50(3):420-424.
[13]Ma LC,Fang CT,Lee CZ,et al.Genomic heterogeneity in Klebsiella pneumoniae strains is associated with primary pyogenic liver abscess and metastatic Infection[J].J Infect Dis,2005,192:117-128.
[14]Cortés G,Borrell N,de Astorza B,et al.Molecular analysis of the contribution of the capsular polysaccharide and the lipopolysaccharide O side chain to the virulence of Klebsiella pneumoniae in a murine model of pneumonia[J].Infect Immun,2002,70(5):2583-2590.
[15]Struve C,Bojer M,Krogfelt KA.Characterization of Klebsiella pneumoniae type 1fimbriae by detction of phase variation during colonization and infection and impact on virulence[J].Infect Immun,2008,76(9):4055-4065.
[16]Struve C,Bojer M,Krogfelt KA.Identification of a conserved chromosomal region encoding Klebsiella pneumoniae type 1and type 3 fimbriae and assessment of the role of fimbriae in pathogenicity[J].Infect Immun,2009,77(11):5016-5024.
[17]Li W,Sun G,Yu Y,et al.Increasing occurrence of antimicrobial-resistant hypervirulent(hypermucoviscous)Klebsiella pneumoniae isolates in China[J].Clin Infect Dis,2014,58(2):225-232.
[18]Liu YM,Li BB,Zhang YY,et al.Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China[J].Antimicrob Agents Chemother,2014,58(9):5379-5385.
[19]王步补,阮战伟,项小婵,等.耐亚胺培南肺炎克雷伯菌分子流行病学及耐药传播机制研究[J].全科医学临床与教育,2014,12(1):18-22.
[20]Siu LK,Huang DB,Chiang T.Plasmid transferability of KPC into a virulent K2 serotype Klebsiella pneumoniae[J].BMC Infect Dis,2014,14:176.
[21]Wei DD,Wan LG,Zeng LB,et al.Emergence of KPC-producing Klebsiella pneumoniae,hypervirulent clone of capsular serotype K1 that belongs to sequence type 11in Mainland China[J].BMC Infect Dis,2016,85(2):192-194.
[22]Liao CH,Huang YT,Chang CY,et al.Capsular serotypes and multilocus sequence types of bacteremic Klebsiella pneumoniae isolates associated with different types of infections[J].Eur J Clin Microbiol Infect Dis,2014,33(3):365-369.