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[对医院感染分离的肺炎克雷伯菌菌株多种毒力因子的研究]

[Investigation of various virulence factors of Klebsiella pneumoniae strains isolated from nosocomial infections].

作者信息

Kuş Halit, Arslan Uğur, Türk Dağı Hatice, Fındık Duygu

机构信息

Konya Beyhekim State Hospital, Medical Microbiology Laboratory, Konya, Turkey.

Selcuk University Faculty of Medicine, Department of Medical Microbiology, Konya, Turkey.

出版信息

Mikrobiyol Bul. 2017 Oct;51(4):329-339. doi: 10.5578/mb.59716.

Abstract

Klebsiella pneumoniae is an opportunistic pathogen that commonly affects immunosuppressed patients and causes nosocomial infections. K.pneumoniae has a variety of virulence factors, especially capsule polysaccharide, hypermucoviscosity (HV), fimbriae, toxins and determinants for iron acquisition. The aim of this study was to detect the virulence factors in K.pneumoniae strains isolated from nosocomial infections in two years. Fifty three K.pneumoniae strains isolated from the samples of patients with nosocomial infections in the Medical Microbiology Laboratory of Selcuk University Faculty of Medicine Hospital between 2011 and 2013 were included in the study. Identification and antimicrobial susceptibilities of the isolates were performed by VITEK 2 automatic system. Biofilm formation,α-hemolysin, capsule and HV were investigated by phenotypic methods. Polymerase chain reaction (PCR) was used to detect virulence genes encoding adhesins (fimH-1, mrkD, kpn, ycfM), siderophores (entB: enterobactin, iutA: aerobactin, irp-1, irp-2, ybtS, fyuA: yersiniabactin, iroN: catechols receptor), protectines or invasins (rmpA, magA, traT) and toxins (hlyA, cnf-1). Of the 53 K.pneumoniae isolates,12 (22.6%) were isolated from in patients of reanimation intensive care unit, 8 (15.1%) medical oncology, 7 (13.2%) newborn intensive care unit and 26 (49%) other clinics. The distribution of the isolates according to the samples was as follows: urine (n= 14), blood (n= 13), wound (n= 8), drainage fluid (n= 10), broncho-alveolar lavage (n= 7), and cerebrospinal fluid (n= 1). Isolates which were resistant to meropenem were 5.7% and production of extended spectrum beta-lactamase (ESBL) was 71.7%. The capsule, biofilm formation, and HV were observed in 100%, 79.2%, and 1.9% of the isolates, respectively. Production of α-hemolysin was not detected in any of the isolates. The genes; entB (96.2%), ycfM (86.8%), and mrkD (83.0%) showed high prevalence. The other genes were detected in different ratios: fimH-1 (64.2%), fyuA (54.7%), kpn (49.1%), ybtS (41.5%), irp-1(41.5%), irp-2 (37.7%), traT (11.3%) and iutA (5.7%). Virulence genes; iroN, rmpA, magA, hlyA and cnf-1 were not detected in any of the isolates. Enterobactin had the highest rate among siderophores, and ycfM and mrkD in adhesins. The capsule and biofilm formation were commonly found in the isolates. Hypermucoviscosity was only found in one isolate but associated genes were not detected. Alfa hemolysin production and hlyA gene were not determined. As a result, it seems that the basis of the pathogenicity of K.pneumoniae strains isolated from nosocomial infections are capsule, adhesins, enterobactin and ability of biofilm formation. There is a need for new studies for the continuous monitoring of toxin and invasion ability as well as antibiotic resistance in the control of hospital infection caused by K.pneumoniae.

摘要

肺炎克雷伯菌是一种机会致病菌,通常感染免疫功能低下的患者并引起医院感染。肺炎克雷伯菌有多种毒力因子,尤其是荚膜多糖、高黏液性(HV)、菌毛、毒素和铁摄取决定因素。本研究的目的是检测两年内从医院感染中分离出的肺炎克雷伯菌菌株中的毒力因子。本研究纳入了2011年至2013年间从塞尔丘克大学医学院医院医学微生物实验室医院感染患者样本中分离出的53株肺炎克雷伯菌菌株。通过VITEK 2自动系统对分离株进行鉴定和药敏试验。采用表型方法研究生物膜形成、α-溶血素、荚膜和HV。采用聚合酶链反应(PCR)检测编码黏附素(fimH-1、mrkD、kpn、ycfM)、铁载体(entB:肠杆菌素、iutA:气杆菌素、irp-1、irp-2、ybtS、fyuA:耶尔森菌素、iroN:儿茶酚受体)、保护素或侵袭素(rmpA、magA、traT)和毒素(hlyA、cnf-1)的毒力基因。在53株肺炎克雷伯菌分离株中,12株(22.6%)从复苏重症监护病房患者中分离得到,8株(15.1%)从医学肿瘤病房分离得到,7株(13.2%)从新生儿重症监护病房分离得到,26株(49%)从其他科室分离得到。分离株根据样本的分布如下:尿液(n = 14)、血液(n = 13)、伤口(n = 8)、引流液(n = 10)、支气管肺泡灌洗(n = 7)和脑脊液(n = 1)。对美罗培南耐药的分离株占5.7%,产超广谱β-内酰胺酶(ESBL)的分离株占71.7%。分别在100%、79.2%和1.9%的分离株中观察到荚膜、生物膜形成和HV。在任何分离株中均未检测到α-溶血素的产生。entB(96.2%)、ycfM(86.8%)和mrkD(83.0%)基因显示出高流行率。其他基因的检测比例不同:fimH-1(64.2%)、fyuA(54.7%)、kpn(49.1%)、ybtS(41.5%)、irp-1(41.5%)、irp-2(37.7%)、traT(11.3%)和iutA(5.7%)。毒力基因iroN、rmpA、magA、hlyA和cnf-1在任何分离株中均未检测到。在铁载体中肠杆菌素的比例最高,在黏附素中ycfM和mrkD的比例最高。荚膜和生物膜形成在分离株中普遍存在。仅在一株分离株中发现高黏液性,但未检测到相关基因。未检测到α-溶血素的产生和hlyA基因。结果表明,从医院感染中分离出的肺炎克雷伯菌菌株的致病性基础是荚膜、黏附素、肠杆菌素和生物膜形成能力。有必要开展新的研究,以持续监测毒素和侵袭能力以及抗生素耐药性,从而控制肺炎克雷伯菌引起的医院感染。

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