由一株新型 ST23 单系变体的多药耐药、高毒力肺炎克雷伯菌引起的内源性眼内炎：中国首例报告。
Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China.
机构信息
Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Center of Clinical Laboratory, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
BMC Infect Dis. 2018 Dec 17;18(1):669. doi: 10.1186/s12879-018-3543-5.
BACKGROUND
Endogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome. Most HVKP strains display a wild-type susceptibility profile to antibiotics. However, reports of antimicrobial-resistant HVKP have increased over time, which poses a serious therapeutic dilemma.
CASE PRESENTATION
A 25-year-old man with a liver abscess and poorly controlled diabetes mellitus was admitted for endophthalmitis due to K. pneumoniae. The isolate displayed hypermucoviscosity as determined by a positive string test and exhibited resistance to ceftazidime, piperacillin-tazobactam and amikacin. Whole genome sequencing (WGS) analysis demonstrated the isolate to be a K1-serotype strain and belong to a novel single locus variant of ST23, ST2922. In addition to the virulence genes linked to HVKP, rmpA, magA, iucABCDiutA (aerobactin), ybtAPSTUX (yersiniabactin) and iroBDN (salmochelin), it was found to harbor extended-spectrum β-lactamase (ESBL) gene (bla), AmpC β-lactamase gene (bla), and 16S rRNA methylase gene (armA).
CONCLUSIONS
This is the first known case of endogenous endophthalmitis caused by a multidrug-resistant HVKP strain ever reported in China. Early diagnosis and treatment with intravenous and intravitreal injection of carbapenem were essential for a favorable visual outcome.
背景
由高毒力肺炎克雷伯菌（HVKP）引起的内源性眼内炎是一种新兴的传染病，通常会导致严重的视力丧失。大多数 HVKP 菌株对抗生素表现出野生型敏感性。然而，随着时间的推移，对抗生素耐药的 HVKP 的报告有所增加，这给治疗带来了严重的困境。
病例介绍
一名 25 岁男性，患有肝脓肿和未控制的糖尿病，因肺炎克雷伯菌感染入院治疗眼内炎。该分离株的.string 试验呈阳性，表现为超黏液性，对头孢他啶、哌拉西林他唑巴坦和阿米卡星耐药。全基因组测序（WGS）分析表明，该分离株为 K1 血清型菌株，属于 ST23、ST2922 的一种新型单基因座变异。除了与 HVKP 相关的毒力基因 rmpA、magA、iucABCDiutA（aerobactin）、ybtAPSTUX（yersiniabactin）和 iroBDN（salmochelin）外，还发现其携带扩展谱β-内酰胺酶（ESBL）基因（bla）、AmpC β-内酰胺酶基因（bla）和 16S rRNA 甲基化酶基因（armA）。
结论
这是中国首例报道的由多重耐药性 HVKP 菌株引起的内源性眼内炎。早期诊断和治疗采用静脉和玻璃体内注射碳青霉烯类药物对获得良好的视力结局至关重要。
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