Zhou X Q, Fu Y Q, Xu M, Zhou H, Zhou J Y, Lu J J, Zhu Jianjun
Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang University Medical College (the second People's Hospital of Yuhang District, Hangzhou), Hangzhou 311121, China.
Department of Respiratory Disease, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2022 May 12;45(5):438-444. doi: 10.3760/cma.j.cn112147-20210820-00580.
To study the clinical and microbiological characteristics of hypervirulent (hvKP) lung abscess, and to compare with the classic (cKP) lung abscess. A total of 18 patients with lung abscesses admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 2017 to September 2020 enrolled. The strains with positive result of string test were defined as hvKP, and the negative strains were defined as cKP. The patients' basic diseases, symptoms, laboratory data and other clinical characteristics were collected. The microbiological characteristics of the strains included as following: VITEK method to determine the susceptibility of the strains to antibiotics; PCR to detect the capsular serotypes and virulence genes. The differences in clinical characteristics and microbiological characteristics of strains between hvKP group and cKP group were compared. Among the 18 patients with lung abscess, 12 were hvKP infection, mainly male (10 cases), with a median age of 59.0 years; 8 cases in the hvKP group had an onset time of ≤2 weeks, and the median onset time was 10.5 days. There were significantly more diabetes (12 cases) and extrapulmonary abscesses (11 cases) in hvKP group than those in cKP group (both <0.001). The extrapulmonary abscesses in the hvKP group were mainly liver abscesses (10 cases), and 4 cases were multi-site (≥3) abscesses. The number of indwelling catheters and invasive procedures before infection were higher in cKP group than those in hvKP group (both =0.025). The imaging of lung abscess was mainly subpleural with the size of less than 10 cm. There were more multiple abscesses cases in hvKP group (9 cases) than cKP group (=0.009). The median interval time between the detection of a pulmonary abscess and an extrapulmonary abscess was 1.0 day. The resistance rate of common antibiotics was significantly lower in hvKP than cKP. hvKP lung abscesses are more common in patients with diabetes, and the clinical manifestations are nonspecific. The lung imaging manifestations are multiple subpleural abscesses, indicating hematogenous dissemination. Liver abscesses were present in most cases, suggesting the source of infection. The main virulent gene of hypervirulent is . For patients with hvKP lung abscess, attention should be paid to finding hidden lesions.
研究高毒力肺炎克雷伯菌（hvKP）肺脓肿的临床和微生物学特征，并与经典肺炎克雷伯菌（cKP）肺脓肿进行比较。选取2017年1月至2020年9月在浙江大学医学院附属第一医院住院的18例肺脓肿患者。拉丝试验结果阳性的菌株定义为hvKP，阴性菌株定义为cKP。收集患者的基础疾病、症状、实验室数据及其他临床特征。菌株的微生物学特征包括：采用VITEK法测定菌株对抗生素的敏感性；采用聚合酶链反应（PCR）检测荚膜血清型和毒力基因。比较hvKP组和cKP组菌株的临床特征和微生物学特征差异。18例肺脓肿患者中，hvKP感染12例，以男性为主（10例），中位年龄59.0岁；hvKP组8例发病时间≤2周，中位发病时间为10.5天。hvKP组糖尿病患者（12例）和肺外脓肿患者（11例）明显多于cKP组（均<0.001）。hvKP组肺外脓肿主要为肝脓肿（10例），4例为多部位（≥3个）脓肿。cKP组感染前留置导管和侵入性操作的次数高于hvKP组（均=0.025）。肺脓肿影像学表现主要为胸膜下，大小小于10 cm。hvKP组多发脓肿病例（9例）多于cKP组（=0.009）。肺脓肿与肺外脓肿检出的中位间隔时间为1.0天。hvKP对常用抗生素的耐药率明显低于cKP。hvKP肺脓肿在糖尿病患者中更常见，临床表现无特异性。肺部影像学表现为多发胸膜下脓肿，提示血行播散。多数病例存在肝脓肿，提示感染源。高毒力菌株的主要毒力基因为……对于hvKP肺脓肿患者，应注意发现隐匿性病变。
