2017 年中国一家三级医院的化脓性肝脓肿所致肺炎克雷伯菌：产超广谱β-内酰胺酶碳青霉烯耐药强毒株的影响。
Pyogenic liver abscess-caused Klebsiella pneumoniae in a tertiary hospital in China in 2017: implication of hypervirulent carbapenem-resistant strains.
机构信息
Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China.
Department of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310006, China.
出版信息
BMC Infect Dis. 2022 Aug 9;22(1):685. doi: 10.1186/s12879-022-07648-0.
BACKGROUND
To investigate the epidemiology of Klebsiella pneumoniae (K. pneumoniae) inducing pyogenic liver abscess (PLA) in east China and the role of hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP).
METHODS
Forty-three K. pneumoniae strains were collected from 43 patients with PLA at Hangzhou, China in 2017. Antimicrobial susceptibility tests, string test, multilocus sequence typing, pulsed-field gel electrophoresis, mobile genetic elements typing, regular PCR and sequencing, and Galleria mellonella (G. mellonella) lethality test were used to elucidate the epidemiology. Clinical data were collected.
RESULTS
K. pneumoniae strains with serotypes K1 and K2 accounted for 69.8%, which shared 46.5% and 23.3% respectively. K. pneumoniae strains with clonal group 23 were predominant with a rate of 34.9%. Such antimicrobials showed susceptible rates over 80.0%: cefuroxime, cefotaxime, gentamycin, ticarcillin/clavulanate, ceftazidime, cefoperazone/tazobactam, cefepime, aztreonam, imipenem, meropenem, amikacin, tobramycin, ciprofloxacin, levofloxacin, doxycycline, minocycline, tigecycline, chloramphenicol, and trimethoprim-sulfamethoxazole. PFGE dendrogram showed 29 clusters for the 43 K. pneumoniae strains. Three Hv-CRKP strains were confirmed by G. mellonella lethality test, showing a constituent ratio of 7.0% (3/43). Totally three deaths were found, presenting a rate of 7.0% (3/43). The three died patients were all infected with Hv-CRKP.
CONCLUSIONS
K1 and K2 are the leading serotypes of K. pneumoniae causing PLA, which show highly divergent genetic backgrounds. Aminoglycosides, Generation 2 to 4 cephalosporins, β-lactamase/β-lactamase inhibitors, carbapenems, fluoroquinolones are empirical choices. Hv-CRKP may confer an urgent challenge in the future.
背景
为了研究华东地区肺炎克雷伯菌（K. pneumoniae）引起化脓性肝脓肿（PLA）的流行病学和高毒力碳青霉烯耐药肺炎克雷伯菌（Hv-CRKP）的作用。
方法
2017 年，从中国杭州的 43 例 PLA 患者中收集了 43 株肺炎克雷伯菌。使用抗菌药敏试验、串试验、多位点序列分型、脉冲场凝胶电泳、移动遗传元件分型、常规 PCR 和测序以及金龟子幼虫（G. mellonella）致死试验来阐明流行病学。收集临床数据。
结果
血清型为 K1 和 K2 的肺炎克雷伯菌占 69.8%，分别占 46.5%和 23.3%。克隆群 23 的肺炎克雷伯菌占优势，占 34.9%。对头孢呋辛、头孢噻肟、庆大霉素、替卡西林/克拉维酸、头孢他啶、头孢哌酮/他唑巴坦、头孢吡肟、氨曲南、亚胺培南、美罗培南、阿米卡星、妥布霉素、环丙沙星、左氧氟沙星、多西环素、米诺环素、替加环素、氯霉素和复方磺胺甲噁唑等抗生素的敏感率均超过 80.0%。PFGE 树状图显示 43 株肺炎克雷伯菌有 29 个簇。通过金龟子幼虫致死试验证实了 3 株 Hv-CRKP，构成比为 7.0%（3/43）。共发现 3 例死亡，病死率为 7.0%（3/43）。这 3 例死亡患者均感染了 Hv-CRKP。
结论
K1 和 K2 是引起 PLA 的主要肺炎克雷伯菌血清型，具有高度不同的遗传背景。氨基糖苷类、第 2 代至第 4 代头孢菌素、β-内酰胺酶/β-内酰胺酶抑制剂、碳青霉烯类、氟喹诺酮类是经验性选择。Hv-CRKP 可能在未来带来紧迫挑战。
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