Department of Infectious Diseases, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Department of Rheumatology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Front Cell Infect Microbiol. 2021 Sep 16;11:688989. doi: 10.3389/fcimb.2021.688989. eCollection 2021.
There is a paucity of studies using clinical characteristics and whole-genome sequencing together to fully identify the risk factors of patients with (KP) bloodstream infection (BSI).
We retrospectively analyzed the clinical and microbiological characteristics of patients with KP BSI. Isolates were processed using Illumina NGS, and relevant bioinformatics analysis was conducted (multi-locus sequence typing, serotype, phylogenetic reconstruction, detection of antibiotic resistance, and virulence genes). A logistic regression model was used to evaluate the risk factors of hosts and causative KP isolates associated with 30-day mortality in patients infected with KP BSI.
Of the 79 eligible patients, the 30-day mortality rate of patients with KP BSI was 30.4%. Multivariate analysis showed that host-associated factors (increased APACHE II score and septic shock) were strongly associated with increased 30-day mortality. For the pathogenic factors, carriage of (OR, 1.46; 95% CI, 1.11-1.81, = 0.002) or (OR, 1.31; 95% CI, 1.02-1.69, = 0.043) was an independent risk factor, especially when accompanied by a multidrug-resistant phenotype. In addition, ST11-K64 hypervirulent carbapenem-resistant KP co-harbored acquired together with (76.5%, 13/17) and (100%, 17/17) genes. Comparative genomic analysis showed that they were clustered together based on a phylogenetic tree, and more virulence genes were observed in the group of ST11-K64 strains compared with ST11-non-K64. The patients infected with ST11-K64 strains were associated with relatively high mortality (47.2%, 7/17).
The carriage of and was seen to be an independent mortality risk factor in patients with KP BSI. The identification of hypervirulent and carbapenem-resistant KP strains associated with high mortality should prompt surveillance.
目前，使用临床特征和全基因组测序相结合来全面确定 （KP）血流感染（BSI）患者的风险因素的研究很少。
我们回顾性分析了 KP BSI 患者的临床和微生物学特征。使用 Illumina NGS 处理分离株，并进行相关的生物信息学分析（多位点序列分型、血清型、系统发育重建、抗生素耐药性和毒力基因检测）。使用逻辑回归模型评估与 KP 分离株相关的宿主和致病因素与 KP BSI 患者 30 天死亡率的关系。
在 79 名符合条件的患者中，KP BSI 患者的 30 天死亡率为 30.4%。多变量分析表明，宿主相关因素（APACHE II 评分增加和感染性休克）与 30 天死亡率增加密切相关。对于致病因素，携带 （OR，1.46；95%CI，1.11-1.81， = 0.002）或 （OR，1.31；95%CI，1.02-1.69， = 0.043）是独立的危险因素，尤其是当伴有多药耐药表型时。此外，ST11-K64 高毒力碳青霉烯耐药 KP 与获得性 共同携带 （76.5%，13/17）和 （100%，17/17）基因。比较基因组分析表明，它们基于系统发育树聚类在一起，并且在 ST11-K64 菌株组中观察到更多的毒力基因。感染 ST11-K64 菌株的患者死亡率较高（47.2%，17/17）。
携带 和 被认为是 KP BSI 患者的独立死亡危险因素。鉴定与高死亡率相关的高毒力和碳青霉烯耐药 KP 菌株应引起监测。
