| In recent years,clinical isolation rate and drug resistance of Klebsiella pneumoniae has increased,and the drug resistance strains have signs of abuse,this study is aimed to help understand the epidemic situation of Klebsiella pneumoniae,study its virulence mechanism,analyze its drug resistance and suggest that the clinical use of rational standard drugs,so as to strengthen the control of nosocomial infection and curb its prevalence.Objective:There are more and more reports on hypervirulence Klebsiella pneumoniae(HvKP)in China in recent years,which is different from classic Klebsiella pneumoniae(cKP).HvKP is mainly from the community.It can make healthy young individuals ill and has strong ability to spread.The aim of this study was to compare HvKP and cKP isolated by the first affiliated hospital of Guangzhou Medical University,to understand the drug resistance,serotype and clinical characteristics of HvKP,and to investigate whether laboratory virulence and clinical pathogenicity were equivalent.Methods :1.Collect samples.Klebsiella pneumoniae isolated from various specimens of patients hospitalized from January 2016 to June 2018 was collected from the First Affiliated Hospital of Guangzhou Medical University.Strains positive for the string test were identified as hypervirulence Klebsiella pneumoniae(HvKP)and the other as classicKlebsiella pneumoniae(cKP).The ratio of HvKP to cKP and the ratio of HvKP to cKP in sputum,blood,urine,pleural and ascites fluid,and drainage fluid among specimens with different sources were calculated.2.Polymerase chain reaction(PCR)was used to detect high virulence related serotypes(K1,K2,K5,K20,K54,K57).The distribution of HvKP and cKP between different serotypes and the distribution of specimen types among different serotypes were observed.3.All strains were tested for drug sensitivity by Vitek 2 and K-B.The drug resistance of HvKP group and cKP group was compared,and the high virulence related serotypes K1 and K2 were selected for drug resistance comparison.4.The clinical data of HvKP and cKP were analyzed retrospectively.Since HvKP is mainly separated from blood and sterile body fluids,patients with KP from blood and sterile body fluids were selected for stratified analysis of clinical information.Result:390 non-repetitive strains of Klebsiella pneumoniae were isolated.Among them,68.5%(267/390)were respiratory tract specimens,10%(39/390)were pus and pleural ascites,8.9%(35/390)were urine specimens,7.2%(28/390)were blood specimens,and5.4%(21/390)were other specimens.142 strains(36.4%)of HvKP and 248 strains(63.6%)of cKP were identified by string experiment.The source distribution of HvKP strains was 54.9%(78/142)of respiratory tract specimens,17.6%(25/142)of blood,14.1%(20/142)of pleural and ascites drainage,and 4.9%(7/142)of urine.The distribution of cKP strains was 77.8%(193/248)in respiratory tract specimens,10.9%(27/248)in urine,7.6%(19/248)in pleural and ascites drainage and 1.2%(3/248)in blood.Among 142 strains of HvKP,73.9%(105/142)were hypervirulence related capsular serotypes,of which 21.8%(31/142)were K1,22.5%(32/142)were K2,15.5%(22/142)were K57,and 8.5%(12/142)were K5.Among 248 cKPs,9.7%(24/248)hypervirulence related capsular serotypes were found,of which 7.3%(18/248)K2 and 1.6%(4/248)157were found.Drug sensitivity of 142 strains of HvKP and 248 strains of cKP were analyzed.The resistance rate of HvKP to carbenol,penicillin,cephalosporins and quinolones was significantly lower than that to cKP.The resistance rate of K1 type to ?-lactam plus enzyme inhibitor,hydromyrene,aminoglycoside and quinolone was 0,which was lower than K2 type.The clinical data of 142 strains of HvKP and 248 strains of cKP were retrospectively analyzed.The distribution of HvKP in the two groups was regular.Hepatic abscess and diabetes mellitus were the risk factors of HvKP.HvKP mainly came from community acquired infection,while cKP mostly came from infection within the hospital.HvKP can cause multiple sites of infection and is migratory.There were no differences in length of stay,length of ICU stay,septic shock,14-day mortality,or 28-day mortality between the two groups.There were 67 strains of KP from blood and sterile body fluids,among which 45 strains of HvKP and 22 strains of cKP were compared.There was no difference in clinical hypervirulence between HvKP and cKP in terms of laboratory indexes,hospitalization time,ICU time and proportion,hock or not,prognosis,mortality,etc.Conclusion:HvKP is more common in K1,K2 and K57 serotypes,and its resistance rate to many common antibiotics is significantly lower than that of cKP.The resistant rate of hypervirulence related serotype K1 type KP to many common antibiotics was significantly lower than that of K2 type.It was found by comparing the clinical data of patients with HvKP and cKP that HvKP were shorter than cKP in duration,and there was no difference in mortality between the two groups.The correlation between laboratory HvKP phenotype and clinical infection pathogenicity remains to be investigated. |
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