perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2020-65-5-158-163perinatology-1252Research ArticleК XVII РОССИЙСКОМУ КОНГРЕССУ «ПЕДИАТРИЯ И ДЕТСКАЯ ХИРУРГИЯ В ПРИВОЛЖСКОМ ФЕДЕРАЛЬНОМ ОКРУГЕ». ОРИГИНАЛЬНЫЕ СТАТЬИTO THE XVI RUSSIAN CONGRESS «PEDIATRICS AND PEDIATRIC SURGERY IN THE PRIVOLZHSKY FEDERAL DISTRICT». ORIGINAL ARTICLESЧастота колонизации «гипервирулентными» штаммами Klebsiella pneumoniae новорожденных и грудных детей с внебольничной и нозокомиальной клебсиеллезной инфекциейFrequency of colonization with “hypervirulent” Klebsiella pneumoniae strains of newborns and infants with community-acquired and nosocomial klebsiella infectionСеменоваД. Р.SemenovaD. R.

Семенова Дина Рашидовна — аспирант кафедры инфекционных болезней

nadgy@bk.ruНиколаеваИ. В.NikolaevaI. V.

Николаева Ирина Венедиктовна — доктор медицинских наук, профессор, заведующий кафедрой инфекционных болезней

ФиалкинаС. В.FialkinaS. V.

Фиалкина Светлана Викторовна

123098 Москва, ул. Гамалеи, д. 18

Moscow

ХаертыновХ. С.KhaertynovKh. S.АнохинВ. А.AnohinV. A.

Анохин Владимир Алексеевич — доктор медицинских наук, профессор, заведующий кафедрой детских.

420012 Казань, ул. Бутлерова, д. 49

ВалиуллинаИ. Р.ValiullinaI. R.

Валиуллина Инна Робертовна — заведующий лабораторией клинической бактериологии.

420011 Казань, ул. Оренбургский тракт, д. 140

Kazan

ФГБОУ ВО Казанский государственный медицинский университет Минздрава РоссииРоссияKazan State Medical UniversityRussian FederationФГБОУ ВО Казанский государственный медицинский университет» Минздрава РоссииРоссияKazan State Medical UniversityRussian FederationФГБУ Национальный исследовательский центр эпидемиологии и микробиологии им. Н.Ф. ГамалеиРоссияGamaleya Federal Research Centre for Epidemiology and MicrobiologyRussian FederationГАУЗ Детская республиканская клиническая больница Минздрава Республики ТатарстанРоссияChildren's Republican Clinical HospitalRussian Federation202021112020655158163Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20202020Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/1252

В настоящее время наметилась тенденция роста числа инвазивных форм инфекции (абсцесс печени, менингит, энд-офтальмит и др.), вызванных «гипервирулентными» штаммами Klebsiella pneumoniae (англ. hvKP) у взрослых. Нами изучена частота выделения hvKP у новорожденных и грудных детей с различными формами внебольничной и нозокомиальной клебсиеллезной инфекции. «Гйпервирулентными» считали штаммы клебсиелл, обладающие геном rmpA, который ассоциируется с «гипермукоидным фенотипом» клебсиелл. Детекция гена проводилась методом полимеразной цепной реакции. Всего исследовано 85 штаммов. Ген rmpA обнаружен у 20 (23%) клинических штаммов Kl. pneumoniae, в том числе у 14 (33,3%) кишечных штаммов, у 3 (25%) штаммов, выделенных из мочи, и 3 (15,7%) штаммов из мазков со слизистой оболочки зева. У штаммов клебсиелл, выделенных из крови (n=5), эндотрахеальной трубки (n=6), спинномозговой жидкости (n=1), ген не обнаружен. hvKP достоверно чаще выделялись у детей с внебольничной инфекцией (32%), чем у детей с нозокомиальной инфекцией (11,4%; отношение шансов 3,647; 95% доверительный интервал 1,100—12,096). Из 20 детей, инфицированных hvKP, 12 (60%) были бессимптомными носителями, у 3 (15%) имелись симптомы инфекции мочевых путей и у 5 (25%) — симптомы кишечной инфекции. Инфицированные дети имеют потенциальный риск эндогенной диссеминации возбудителя, а также могут представлять эпидемиологическую опасность для окружающих.

Currently, there is a trend towards the increase in invasive forms of infection (liver abscess, meningitis, endophthalmitis, etc.) caused by “hypervirulent” strains of Klebsiella pneumoniae (hvKP) in adults. We have studied the frequency of hvKP release in newborns and infants with various forms of community-acquired and nosocomial klebsiella infection. Strains of Klebsiella possessing the rmp A gene, which is associated with hypermucoid phenotype, were considered “hypervirulent. Klebsiella strains with the “hypermucoid phenotype”-associated rmpA gene were considered “hypervirulent”. The gene was detected by polymerase chain reaction. The authors studied a total of 85 strains. The rmpA gene was found in 20 (23%) Kl. pneumoniae strains, including 14 (33.3%) intestinal strains, 3 (25%) urine strains, 3 (15.7%) pharyngeal mucosa strains. The Klebsiella strains isolated from blood (n=5), endotracheal tube (n=6), cerebrospinal fluid (n=1) did not contain the gene. hvKP were significantly more often isolated in children with community-acquired infection (32%) than in children with nosocomial infection (11.4%; OR 3.647; 95% CI 1.100—12.096). Out of 20 children infected with hvKP, 12 (60%) patients were asymptomatic carriers, 3 (15%) children had symptoms of a urinary tract infection, and 5 (25%) children had symptoms of an intestinal infection. Infected children have both a potential risk of endogenous dissemination of the pathogen, and they are an epidemiologically dangerous to others.

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The authors declare that there are no conflicts of interest present.