摘要
目的探讨高黏液型肺炎克雷伯菌的药物敏感性及其荚膜血清分型和临床特征,为医院制订感染控制措施提供依据。方法对该院2018年1-6月送检的细菌培养阳性标本进行鉴定和药敏试验,收集检出的肺炎克雷伯菌,拉丝试验筛选出有黏液丝形成,并且长度大于5 mm的菌株为高黏液型,分析高黏液型和非黏液型肺炎克雷伯菌的药敏结果差异。通过PCR方法,分析高黏液型肺炎克雷伯菌的高毒力荚膜血清分型,同时查阅相应患者的病历信息,对患者的临床特征进行分析。结果 170株肺炎克雷伯菌中,拉丝试验阳性菌占36.5%。高黏液型肺炎克雷伯菌药物敏感率高于非黏液型肺炎克雷伯菌(P<0.05);非黏液型肺炎克雷伯菌产超广谱β内酰胺酶的阳性率(38.9%)高于高黏液型肺炎克雷伯菌(11.3%),差异有统计学意义(P<0.05)。高黏液型高毒力荚膜血清型菌株阳性率为58.1%,其中K1、K2、K5、K20、K54、K57型分别占 19.4 %、 22.2 %、 8.3 %、13.9%、8.3%、27.8%。痰液标本分离阳性率为69.4%,伤口分泌物为11.1%,腹水为 8.3 %,全血标本为2.8%,尿液为8.3%。痰液标本所分离的阳性菌株中,K57型所占比例最高,腹水标本和全血标本均为K1型所占比例最高,尿液标本为K5型所占比例最高。高黏液型肺炎克雷伯菌主要分布在重症监护病房(38.9 %),基础疾病以肺部疾病为主,占69.4%。结论高黏液型肺炎克雷伯菌存在于多种临床标本中,K1、K2、K57血清型检出率较高,应该加强监控,制订更严格的感染控制措施才能避免耐药性毒力菌株的出现和播散。
Objective To analyze drug sensitivity,capsular serotyping and clinical characteristics of Klebsiella pneumoniae with hyper-mucoviscosity phenotype,and so as to provide a basis for hospitals to develop sensory measures.Methods The samples from the hospital were collected from January to June 2018 for identification and drug susceptibility test.The Klebsiella pneumoniae was collected and the mucus filament formation was screened by the wire drawing test,and the length of mucous strands was more than 5 mm.The strain was used as a research object to analyze the difference in drug susceptibility results between high mucus and non-mucinous Klebsiella pneumoniae.The high-toxicity capsular serotyping of these high-viscous Klebsiella pneumoniae was analyzed by PCR method,and the medical records of the corresponding patients were consulted to analyze the clinical characteristics of the patients.Results Among 170 strains of Klebsiella pneumoniae,the positive strains of wire drawing test accounted for 36.5%.The drug sensitivity rate of high-viscous Klebsiella pneumoniae was higher than that of non-mucus type (P<0.05),the positive rate of ESBLs in non-mucus group (38.9%) was higher than that in high-viscous group (11.3%),difference was statistically significant (P<0.05).The positive rate of high virulence capsular serotypes in high-viscous group was 58.1%,in which K1,K2,K5,K20,K54 and K57 accounted for 19.4%,22.2%,8.3%,13.9%,8.3%,27.8% respectively.Positive rates of specimens distributed in the sputum,wound secretions,abdominal digestive tract,whole blood and urinary tract were 69.4%,11.1%,8.3%,2.8% and 8.3%.The proportion of K57 in the sputum was the highest,the abdominal digestive tract and blood specimens were both K1 phenotype,and the urinary tract specimens were all the K5 phenotype.High-viscous Klebsiella pneumoniae distributed in intensive care units accounted for 38.9%,and patients with lung diseases accounted for 69.4%.Conclusion High-viscous Klebsiella pneumoniae exists many kinds of clinical specimens,K1,K2 and K57 phenotype have higher detective rates.Effective monitoring and stricter infection control measures should be taken to avoid drug resistance and transmission.
作者
汤翠霞
陈世豪
高艳珠
梁凤琼
利雯秀
TANG Cuixia;CHEN Shihao;GAO Yanzhu;LIANG Fengqiong;LI Wenxiu(Department of Clinical Laboratory,People′s Hospital of Xinhui District,Jiangmen,Guangdong 529100,China)
出处
《检验医学与临床》
CAS
2019年第14期2037-2041,共5页
Laboratory Medicine and Clinic
关键词
高黏液型
肺炎克雷伯菌
高毒力荚膜
血清分型
high-viscous
Klebsiella pneumoniae
high virulence capsule
serotyping
