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中国大陆新出现的高毒力肺炎克雷伯菌血流感染的临床和分子特征

Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China.

作者信息

Liu Ying Mei, Li Bin Bin, Zhang Yu Yu, Zhang Wu, Shen Hong, Li Hui, Cao Bin

机构信息

Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China.

Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.

出版信息

Antimicrob Agents Chemother. 2014 Sep;58(9):5379-85. doi: 10.1128/AAC.02523-14. Epub 2014 Jun 30.

Abstract

Recently, the newly emerged hypervirulent Klebsiella pneumoniae strain (hvKP) has caused great concern globally, but the clinical features and molecular characteristics of bacteremia caused by hvKP are rarely reported in mainland China. Seventy patients with K. pneumoniae bacteremia were investigated to study the clinical features of hvKP infection from 2008 till 2012 in Beijing Chao-Yang Hospital. The molecular characteristics of the hvKP strains were also studied using PCR, multilocus sequence typing, and pulsed-field gel electrophoresis (PFGE) methods. hvKP was identified in 31.4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). Patients with hvKP infection tended to have no underlying diseases compared to those with classic K. pneumoniae (cKP). More hvKP-positive patients (95.5%) had community-acquired infection than did cKP-infected patients (35.4%) (P<0.001). The 30-day mortality rate was lower in hvKP-infected patients than in cKP-infected patients (4.5% compared to 16.7%). Resistance to tested antimicrobials was significantly greater in cKP- than in hvKP-infected patients. Two extended-spectrum-beta-lactamase (ESBL)-producing hvKP strains were found. Seven novel sequence types (STs) and 4 new alleles of K. pneumoniae were revealed. A strong correlation was found between two STs (ST23, ST1265) and the K1 serotype. The hvKP isolates (n=22) had 14 different PFGE patterns, and among them 10 K1 isolates shared similar PFGE patterns. The emerging hvKP strain was prevalent in patients with severe community-acquired infections in healthy individuals in China. Identification of ESBL-producing hvKP strains in hvKP-infected patients will facilitate clinical management of hvKP infection.

摘要

最近,新出现的高毒力肺炎克雷伯菌菌株(hvKP)已引起全球广泛关注,但中国大陆地区关于hvKP所致菌血症的临床特征和分子特征鲜有报道。对70例肺炎克雷伯菌菌血症患者进行调查,以研究2008年至2012年期间北京朝阳医院hvKP感染的临床特征。还采用聚合酶链反应(PCR)、多位点序列分型和脉冲场凝胶电泳(PFGE)方法研究了hvKP菌株的分子特征。在31.4%的肺炎克雷伯菌菌血症患者中鉴定出hvKP,其表现出4种血清型(K1、K2、K20和K57)。与经典肺炎克雷伯菌(cKP)感染患者相比,hvKP感染患者往往没有基础疾病。hvKP阳性患者中社区获得性感染的比例(95.5%)高于cKP感染患者(35.4%)(P<0.001)。hvKP感染患者的30天死亡率低于cKP感染患者(分别为4.5%和16.7%)。cKP感染患者对测试抗菌药物的耐药性明显高于hvKP感染患者。发现了2株产超广谱β-内酰胺酶(ESBL)的hvKP菌株。揭示了7种新型肺炎克雷伯菌序列类型(STs)和4个新等位基因。发现两种STs(ST23、ST1265)与K1血清型之间存在强相关性。hvKP分离株(n=22)有14种不同的PFGE图谱,其中10株K1分离株具有相似的PFGE图谱。新出现的hvKP菌株在中国健康个体严重社区获得性感染患者中较为普遍。在hvKP感染患者中鉴定出产ESBL的hvKP菌株将有助于hvKP感染的临床管理。

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