广东省肺炎克雷伯菌临床分离株病原特征分析

目的 了解广东省肺炎克雷伯菌临床分离株的抗生素耐药情况与多位点序列分型(multilocus sequence typing, MLST)特征。方法 收集了广东省9个地市的肺炎克雷伯菌临床分离株102株，采用微量肉汤稀释法测定菌株对30种抗菌药物的敏感性，同时对所有分离株进行MLST分型，分析其菌群分布特征。结果 根据药敏试验与黏液拉丝试验结果，广东省9个地市102株肺炎克雷伯菌临床分离株的耐药特点可分成4类，即(ESBLs)KP(43株，其中9株为ESBLs-hvKP)、CRKP(8株，其中1株为CR-hvKP)、较敏感的KP(30株，均为hvKP)和其它类型多重耐药KP(MDRKP)(21株，其中6株为MDR-hvKP)。MLST分型结果显示102株临床分离株可分成54个MLST型，其中有6种为新发现的ST型，地区分布上看，湛江地区以ST23(4/30)为主；茂名地区以ST1224(4/12)为主；阳江地区以ST11(3/6)为主；珠海地区以ST15(3/8)为主，其他地区的ST型呈多态性。结论 我省肺炎克雷伯菌临床分离株的耐药情况较严重，菌群分布多样，在某些地区存在耐药变异株，应加强对此类菌株的耐药性和菌群结构变化的监测。

Analysis of pathogenic characteristics of clinical isolates of Klebsiella pneumoniae from Guangdong province

Objective To comprehend antibiotic resistance and MLST (multilocus sequence typing) typing characteristics of clinical isolates of Klebsiella pneumoniae in Guangdong province. Methods 102 strains of Klebsiella pneumoniae were collected from nine cities in Guangdong province. The sensitivities of the strains to 30 antibacterial drugs were determined by the broth dilution method. In addition, all isolated strains were classified into MLST, and their distribution characteristics were analyzed. Results According to the results of drug sensitivity tests and string tests, the drug resistance of 102 strains of clinical isolated Klebsiella pneumoniae from nine cities of Guangdong province could be divided into four types, namely, (ESBLs) KP (43strains, 9 of which were ESBLs-hvKP), CRKP (8 strains, 1 of which was CR-hvKP), more sensitive KP (30 strains, all were hvKP), and other types of multidrug-resistant KP (MDRKP) (21 strains, 6 of which were MDR-hvKP). Results of MLST classification indicated that 102 clinical isolates could be divided into 54 MLST types, among which six were newly discovered ST types. In terms of regional distribution, Zhanjiang was dominated by ST23 (4/30); Maoming was dominated by ST1224 (4/12); Yangjiang was dominated by ST11 (3/6); Zhuhai was dominated by ST15 (3/8), and the ST types in other areas were polymorphic. Conclusion The drug resistance of clinical isolates of Klebsiella pneumoniae from our province was serious, and the distribution of bacterial flora was diverse. There were some variation strains in some areas, and thus the monitoring of drug resistance and the change of microflora structure should be strengthened.