Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, United States of America.
Department of Preventive Medicine and Biostatistics, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America.
PLoS One. 2021 Aug 2;16(8):e0255636. doi: 10.1371/journal.pone.0255636. eCollection 2021.
Recent reclassification of the Klebsiella genus to include Klebsiella variicola, and its association with bacteremia and mortality, has raised concerns. We examined Klebsiella spp. infections among battlefield trauma patients, including occurrence of invasive K. variicola disease. Klebsiella isolates collected from 51 wounded military personnel (2009-2014) through the Trauma Infectious Disease Outcomes Study were examined using polymerase chain reaction (PCR) and pulsed-field gel electrophoresis. K. variicola isolates were evaluated for hypermucoviscosity phenotype by the string test. Patients were severely injured, largely from blast injuries, and all received antibiotics prior to Klebsiella isolation. Multidrug-resistant Klebsiella isolates were identified in 23 (45%) patients; however, there were no significant differences when patients with and without multidrug-resistant Klebsiella were compared. A total of 237 isolates initially identified as K. pneumoniae were analyzed, with 141 clinical isolates associated with infections (remaining were colonizing isolates collected through surveillance groin swabs). Using PCR sequencing, 221 (93%) isolates were confirmed as K. pneumoniae, 10 (4%) were K. variicola, and 6 (3%) were K. quasipneumoniae. Five K. variicola isolates were associated with infections. Compared to K. pneumoniae, infecting K. variicola isolates were more likely to be from blood (4/5 versus 24/134, p = 0.04), and less likely to be multidrug-resistant (0/5 versus 99/134, p<0.01). No K. variicola isolates demonstrated the hypermucoviscosity phenotype. Although K. variicola isolates were frequently isolated from bloodstream infections, they were less likely to be multidrug-resistant. Further work is needed to facilitate diagnosis of K. variicola and clarify its clinical significance in larger prospective studies.
最近，克雷伯氏菌属的重新分类包括了变异克雷伯菌，并将其与菌血症和死亡率联系起来，引起了人们的关注。我们研究了战场上创伤患者的克雷伯氏菌属感染，包括侵袭性变异克雷伯菌病的发生。通过创伤感染性疾病结局研究，使用聚合酶链反应（PCR）和脉冲场凝胶电泳检测了从 51 名受伤军人（2009-2014 年）中收集的克雷伯氏菌分离株。通过.string 试验评估变异克雷伯菌分离株的高粘液性表型。患者受伤严重，主要是由爆炸伤引起的，所有患者在分离出克雷伯氏菌之前都接受了抗生素治疗。在 23 名（45%）患者中发现了多药耐药性克雷伯氏菌分离株；然而，在比较有无多药耐药性克雷伯氏菌的患者时，没有发现显著差异。最初鉴定为肺炎克雷伯菌的 237 株分离株进行了分析，其中 141 株临床分离株与感染有关（其余为通过监测腹股沟拭子采集的定植分离株）。通过 PCR 测序，221 株（93%）分离株被确认为肺炎克雷伯菌，10 株（4%）为变异克雷伯菌，6 株（3%）为肺炎克雷伯菌。5 株变异克雷伯菌分离株与感染有关。与肺炎克雷伯菌相比，感染变异克雷伯菌的分离株更可能来自血液（5/5 与 134/24，p=0.04），且不太可能是多药耐药（5/5 与 134/99，p<0.01）。没有变异克雷伯菌分离株表现出高粘液性表型。尽管变异克雷伯菌分离株经常从血流感染中分离出来，但它们不太可能是多药耐药的。需要进一步的工作来促进变异克雷伯菌的诊断，并在更大的前瞻性研究中阐明其临床意义。
