程颖　白永凤　邱玉萍　陆军

[關键词] 肺炎克雷伯菌;肝脓肿;高毒力;侵袭综合征

[中图分类号] R575.4          [文献标识码] B          [文章编号] 1673-9701（2021）17-0124-05

Clinical features of Klebsiella pneumoniae liver abscess and molecular characteristics of bacterial infection

CHENG Ying   BAI Yongfeng   QIU Yuping   LU Jun

Department of Laboratory Medicine， Quzhou People′s Hospital in Zhejiang Province， Quzhou   324000， China

[Abstract] Objective To study the clinical conditions and microbiological characteristics of Klebsiella pneumoniae liver abscess， which is helpful to provide evidence for rapid clinical identification and effective control. Methods Complete cases caused by Klebsiella pneumoniae in line with the diagnosis of liver abscess in Quzhou People′s Hospital from January 2013 to December 2019 were collected. The clinical features were analyzed. The micro broth dilution method was used for drug susceptibility testing. Serum capsule type and virulence genes were detected by PCR Method. Results Klebsiella pneumoniae liver abscess was common in men， 37.83%（14/37） of patients had a history of diabetes， and 37.83%（14/37） of patients had gallbladder stones and cholecystitis. The abscess was mainly single， and the single abscess was mainly the right lobe of the liver，accounting for 74.28%（26/35）. Metastatic infection occurred in 40.54%（15/37） patients， and lung infection occurred in 32.43%（12/37） patients. Laboratory examination showed that WBC increased （13.94±6.37）×109/L， CRP increased significantly （148.85±56.75）mg/L， and the Klebsiella pneumoniae were sensitive to various antibiotics. 78.37% （29/37） strains of Klebsiella pneumoniae produced a high mucus phenotype. Serum capsule types were mainly K1 and K2， which carried multiple virulence genes. The detection of virulence genes showed that rmpA+ was 78.37%（29/37）， iroN+ was 72.97%（27/37）， and kfu+ was 64.86% （24/37）. Conclusion Klebsiella pneumoniae liver abscess is common in patients with liver and gallbladder disease or diabetes.It is mainly a single abscess. Most patients can metastasize.In severe cases，it can even cause blindness and central nervous system infection.It is mostly caused by Klebsiella pneumoniae， which carries a variety of virulence genes，high mucus phenotype， and serum capsule type K1 and K2. A timely understanding of the molecular characteristics of the strains in this region will help clinicians to diagnose and treat early.

[Key words] Klebsiella pneumoniae; Liver abscess; High virulence; Invasive syndrome

肝脓肿是常见的肝胆疾病，引起的病原体多种多样，因为生活习惯的改变和检测技术的改进，肺炎克雷伯菌已经是引起的细菌性肝脓肿的主要原因[1-2]，1986年，无肝胆疾病史的患者感染肺炎克雷伯菌，引起的肝脓肿，并出现转移性眼内炎被首次报道[3]，这种引起肝脓肿的肺炎克雷伯菌可以引起神经系统感染[4]、眼内炎[5]等严重的侵袭性综合征，而因屏障作用原因，部分部位药效难以到达，这种转移感染严重甚至引起多器官衰竭、休克，延长住院时间，增加治疗难度。因此，本研究引起肝脓肿的肺炎克雷伯菌的药敏情况、毒力基因和黏液表型，与其引起肝脓肿的临床特点包括转移情况、用药情况等，及时掌握有效信息，为临床有效控制，及时判断，减少不良预后。同时合理使用抗生素有利于减少耐药菌出现，为病情控制提供可靠依据，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2013年1月至2019年12月衢州市人民医院符合细菌性肝脓肿诊断的完整病历，共37例。纳入标准[6]：①有发热或寒战;②伴随腹痛、腹胀;③B超或CT等检查提示有脓肿病灶;④血培养结果为肺炎克雷伯菌。排除结核、阿米巴性肝脓肿[7]。

1.2 仪器与试剂

MicroScan walkAway-96细菌鉴定及药敏分析仪（美国西门子）;Tanon凝胶成像系统、Tanon电泳仪;LifeTouch PCR仪;PCR试剂包括Taq聚合酶、dNTP、DNA Marker等均购自日本Takara公司，引物合成自上海生工生物工程股份有限公司。……