Chen Yanzhu, Chen Yi
Department of Intensive Care Unit, Binhaiwan Central Hospital of Dongguan, Dongguan City, Guangdong Province, China.
J Transl Int Med. 2021 Jan 5;9(2):71-75. doi: 10.2478/jtim-2021-0004. eCollection 2021 Jun.
Hypervirulent (hvKp) is an evolving pathotype with higher virulence than classical (cKp) and is characterized by community-acquired, multiple sites of infections and young and healthy hosts. hvKP infections were primarily found in East Asia and have been increasingly reported worldwide over the past few decades. To better understand the clinical challenges faced by China with hvKP, this review will provide a summary and discussion focused on recognizing hvKP strains and prevalence of antibiotic-resistant hypervirulent strains in China and the mechanisms of acquiring antimicrobial resistance. Compared with cKP, hvKP is likely to cause serious disseminated infections, leading to a higher mortality. However, sensitive and specific clinical microbiology laboratory tests are still not available. Given the limited published data due to the clinical difficulty in differentiating hvKP from cKP, extrapolation of the previous data may not be applicable for the management of hvKP. A consensus definition of hvKP is needed. Furthermore, an increasing number of reports have described hvKp strains with antimicrobial resistance acquisition, increasing the challenges for management of hvKP. China, as an epidemic country, is also facing these challenges. Quite a number of studies from China have reported antibiotic-resistant hvKP strains, including extended-spectrum β-lactamase (ESBL), and carbapenem-, tigecycline-, and colistin-resistant strains. hvKP infections, especially those of antimicrobial-resistant strains, pose to be a great threat for public health in China. Therefore, an immediate response to recognize the hypervirulent strains and provide optimal treatments, especially those with resistance determinants, is an urgent priority for China.
高毒力肺炎克雷伯菌（hvKp）是一种不断演变的致病型，其毒力高于经典肺炎克雷伯菌（cKp），特征为社区获得性感染、多部位感染以及感染对象为年轻健康宿主。hvKP感染最初主要在东亚被发现，在过去几十年里在全球范围内的报道日益增多。为了更好地了解中国在hvKP方面面临的临床挑战，本综述将进行总结和讨论，重点关注中国hvKP菌株的识别、耐抗生素高毒力菌株的流行情况以及获得抗菌药物耐药性的机制。与cKP相比，hvKP更易引发严重的播散性感染，导致更高的死亡率。然而，目前仍缺乏敏感且特异的临床微生物学实验室检测方法。鉴于在临床中难以区分hvKP和cKP，已发表的数据有限，以往的数据推断可能不适用于hvKP的管理。因此需要对hvKP达成共识定义。此外，越来越多的报告描述了获得抗菌药物耐药性的hvKp菌株，这增加了hvKP管理的挑战。中国作为该病的流行国家，也面临着这些挑战。中国的多项研究报告了耐抗生素的hvKP菌株，包括产超广谱β-内酰胺酶（ESBL）以及耐碳青霉烯类、替加环素和黏菌素的菌株。hvKP感染，尤其是耐药菌株感染，对中国的公共卫生构成了巨大威胁。因此，立即识别高毒力菌株并提供最佳治疗，尤其是针对具有耐药决定因素的菌株，是中国的当务之急。
