Department of Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, 210002, Nanjing, People's Republic of China.
Laboratory of Microbiology, Institute of Clinical Laboratory Medicine, Jinling Hospital, 305 East Zhongshan Road, Nanjing, People's Republic of China.
Eur J Clin Microbiol Infect Dis. 2018 Apr;37(4):679-689. doi: 10.1007/s10096-017-3160-z. Epub 2017 Dec 14.
The prevalence of hypervirulent Klebsiella pneumoniae (hvKP) is high in China, but clinical characteristics and outcomes of hvKP induced bloodstream infections (BSIs) are not clear. The purpose of the present study was to determine the risk factors and clinical outcomes of hvKP-BSIs in populations admitted in a teaching hospital of Nanjing, China. The genetic characteristics and antibiotic resistance patterns of the hvKP strains were further analyzed. A retrospective study was conducted in 143 patients with K. pneumoniae BSIs at Jinling Hospital in China from September 2015 to December 2016. A positive polymerase chain reaction (PCR) amplification of the plasmid-borne rmpA (p-rmpA) and aerobactin (iucA) was identified as hvKP. Overall, 24.5% (35/143) of K. pneumoniae isolates were hvKP. Multivariate analysis implicated diabetes mellitus (OR = 3.356) and community-acquired BSIs (OR = 4.898) as independent risk factors for hvKP-BSIs. The 30-day mortality rate of the hvKP-BSIs group was 37.1% (13/35) compared with 40.7% (44/108) in the cKP-BSIs control group (P = 0.706). The KPC-producing isolates (OR = 2.851), underlying disease with gastrointestinal fistula (OR = 3.054), APACHE II score ≥ 15 (OR = 6.694) and Pitt bacteremia score ≥ 2 (OR = 6.232) at infection onset were independent predictors for 30-day mortality of K. pneumoniae bacteremia patients. A high percentage (57.1%, 20/35) of KPC-producing isolates was observed among hvKP strains and ST11 was dominant in hvKP strains (17/35, 48.6%). KPC-producing hvKP is emerging, indicating the importance of epidemiologic surveillance and clinical awareness of this pathogen.
在中国，高毒力肺炎克雷伯菌（hvKP）的流行率很高，但 hvKP 引起的血流感染（BSI）的临床特征和结局尚不清楚。本研究的目的是确定在中国南京某教学医院住院人群中 hvKP-BSI 的危险因素和临床结局。进一步分析了 hvKP 菌株的遗传特征和抗生素耐药模式。对 2015 年 9 月至 2016 年 12 月在中国金陵医院住院的 143 例肺炎克雷伯菌 BSI 患者进行了回顾性研究。质粒携带的 rmpA（p-rmpA）和aerobactin（iucA）的阳性聚合酶链反应（PCR）扩增被鉴定为 hvKP。总体而言，143 株肺炎克雷伯菌分离株中有 24.5%（35/143）为 hvKP。多因素分析表明，糖尿病（OR=3.356）和社区获得性 BSI（OR=4.898）是 hvKP-BSI 的独立危险因素。hvKP-BSI 组的 30 天死亡率为 37.1%（13/35），而 cKP-BSI 对照组为 40.7%（44/108）（P=0.706）。产 KPC 株（OR=2.851）、感染时存在胃肠道瘘等基础疾病（OR=3.054）、APACHE II 评分≥15（OR=6.694）和 Pitt 菌血症评分≥2（OR=6.232）是肺炎克雷伯菌菌血症患者 30 天死亡的独立预测因素。在 hvKP 菌株中观察到高比例（57.1%，20/35）的产 KPC 株，ST11 是 hvKP 菌株的优势株（17/35，48.6%）。产 KPC 的 hvKP 正在出现，表明对这种病原体进行流行病学监测和临床认识的重要性。
