2Urgences Néphrologiques et Transplantation Rénale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
1Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier Assistance Publique-Hôpitaux de Paris, Colombes, France.
J Med Microbiol. 2018 Aug;67(8):1083-1089. doi: 10.1099/jmm.0.000788. Epub 2018 Jul 4.
Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a leading cause of severe community-acquired pneumonia, liver abscess and disseminated infection in the Far East. Data regarding the incidence, clinical features and microbiological characteristics related to hvKp infections in the Western world are scarce.
The incidence, clinical features and microbiological characteristics of hvKp infections were investigated through a 5-year survey conducted in a single French intensive care unit. K. pneumoniae strains were screened for hypermucoviscosity based on a string test. Multilocus sequence typing and multiplex PCR analysis targeting virulence genes were performed on string test-positive strains.
Over a 53-month period, a total of 59 infections due to K. pneumoniae were identified including 26 community-onset infections. Twelve hvKp infections were documented, accounting for 46.1 % of community-acquired K. pneumoniae. Community-acquired pneumonia (n=6), aspiration pneumonia (n=4) and liver abscess (n=2) represented initial sites and mode of infection. Compared to non-hvKp infections, patients with hvKp infections displayed higher rates of multi-organ failure (83.3 % vs 35.7 %; P=0.04), but mortality rates were not different (50 % vs 35 %; P=0.71). Strains K1/ST23 (n=5) and K2/ST86 (n=5) predominated. All hvKp strains displayed wild-type susceptibility.
hvKp represent a potentially underestimated cause of fatal infections in the Western world.
高毒力肺炎克雷伯菌（hvKp）已成为远东地区严重社区获得性肺炎、肝脓肿和播散性感染的主要病因。关于西方世界与 hvKp 感染相关的发病率、临床特征和微生物学特征的数据很少。
通过在法国的一个重症监护病房进行的为期 5 年的调查，研究了 hvKp 感染的发病率、临床特征和微生物学特征。根据.string 试验筛选产超粘液的肺炎克雷伯菌。对.string 试验阳性菌株进行多位点序列分型和针对毒力基因的多重 PCR 分析。
在 53 个月的时间内，共发现 59 例肺炎克雷伯菌感染，其中 26 例为社区获得性感染。共确诊 12 例 hvKp 感染，占社区获得性肺炎克雷伯菌的 46.1%。社区获得性肺炎（n=6）、吸入性肺炎（n=4）和肝脓肿（n=2）是初始感染部位和感染途径。与非 hvKp 感染相比，hvKp 感染患者多器官衰竭的发生率更高（83.3% vs 35.7%；P=0.04），但死亡率无差异（50% vs 35%；P=0.71）。优势菌株为 K1/ST23（n=5）和 K2/ST86（n=5）。所有 hvKp 菌株均表现为野生型敏感性。
hvKp 可能是西方世界被低估的致死性感染的病因。
