11型序列感染的临床结局和微生物学特征
Clinical Outcomes and Microbiological Characteristics of Sequence Type 11 Infection.
作者信息
Yang Ping, Wu Zhenchao, Liu Chao, Zheng Jiajia, Wu Nan, Wu Zhangli, Yi Juan, Lu Ming, Shen Ning
机构信息
Institute of Medical Technology, Peking University Health Science Center, Beijing, China.
Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China.
出版信息
Front Med (Lausanne). 2022 May 16;9:889020. doi: 10.3389/fmed.2022.889020. eCollection 2022.
BACKGROUND
Sequence type 11 (ST11) (Kp) is highly prevalent in China and is a typical sequence type among KPC-producing isolates. This study aimed to evaluate the clinical outcomes and microbiological features of ST11 Kp infections.
METHODS
A retrospective cohort study was conducted at Peking University Third Hospital from January 2017 to March 2021. Clinical data were collected from medical records. Antimicrobial susceptibility testing and string tests were performed. Whole-genome sequencing was used to analyze the capsular serotypes, detect virulence-associated genes, and perform multilocus sequence typing. The risk of all-cause mortality in ST11 Kp-infected patients was compared to that in non-ST11 Kp-infected patients.
RESULTS
From 139 patients infected with Kp, 49 ST11 Kp (35.3%) strains were isolated. The Charlson comorbidity index in the ST11 group was higher than that in the non-ST11 group (3.94 ± 1.59 vs. 2.41 ± 1.54, = 0.001). A greater number of ST11 Kp-infected patients required ICU admission (46.9 vs. 16.7%, < 0.001) and mechanical ventilation (28.6 vs. 10.0%, = 0.005). All ST11 isolates presented a multidrug-resistant (MDR) phenotype, and twenty-nine (59.2%) hypervirulent Kp (hvKp) were identified. Twenty-four ST11 strains presented with hypermucoviscosity. The presence of capsular types K47 and K64 was frequent in the ST11 Kp strains ( < 0.001). The key virulence-associated genes , and were present in 26.5, 42.9, 59.2, 0, and 26.5% of the isolates, respectively, in the ST11 group. Twenty-one ST11 isolates harbored the combination of +. The 30-day mortality rate and sequential organ failure assessment (SOFA) score were significantly higher in ST11 Kp-infected patients than in non-ST11 Kp-infected patients ( < 0.01). ST11 Kp infection appeared to be an independent risk factor for mortality in ST11 Kp-infected patients.
CONCLUSIONS
A high prevalence of the ST11 clone was found in the hospital, which accounted for elevated antimicrobial resistance and exhibited great molecularly inferred virulence. Patients with ST11 Kp infection had a tendency toward increased 30-day mortality and SOFA scores. ST11 Kp infection was an independent risk factor for mortality, suggesting that enhanced surveillance and management are essential.
背景
序列型11（ST11）肺炎克雷伯菌（Kp）在中国高度流行，是产KPC分离株中的典型序列型。本研究旨在评估ST11 Kp感染的临床结局和微生物学特征。
方法
于2017年1月至2021年3月在北京大学第三医院进行一项回顾性队列研究。从病历中收集临床数据。进行了药敏试验和拉丝试验。采用全基因组测序分析荚膜血清型、检测毒力相关基因并进行多位点序列分型。比较ST11 Kp感染患者与非ST11 Kp感染患者的全因死亡风险。
结果
从139例感染Kp的患者中分离出49株ST11 Kp（35.3%）菌株。ST11组的Charlson合并症指数高于非ST11组（3.94±1.59 vs. 2.41±1.54，P = 0.001）。更多ST11 Kp感染患者需要入住重症监护病房（46.9% vs. 16.7%，P < 0.001）和接受机械通气（28.6% vs. 10.0%，P = 0.005）。所有ST11分离株均呈现多重耐药（MDR）表型，鉴定出29株（59.2%）高毒力Kp（hvKp）。24株ST11菌株表现出高黏液性。ST11 Kp菌株中K47和K64荚膜型的存在较为常见（P < 0.001）。ST11组中，关键毒力相关基因rmpA、rmpA2、iucABCD、kfu和wabG分别在26.5%、42.9%、59.2%、0和26.5%的分离株中存在。21株ST11分离株携带rmpA + rmpA2组合。ST11 Kp感染患者的30天死亡率和序贯器官衰竭评估（SOFA）评分显著高于非ST11 Kp感染患者（P < 0.01）。ST11 Kp感染似乎是ST11 Kp感染患者死亡的独立危险因素。
结论
在医院中发现ST11克隆株高度流行，这导致抗菌药物耐药性升高，并表现出较高的分子推断毒力。ST11 Kp感染患者有30天死亡率和SOFA评分增加的趋势。ST11 Kp感染是死亡的独立危险因素，提示加强监测和管理至关重要。
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