Department of Emergency and Critical Care Medicine, St. Marianna University Yokohama Seibu Hospital, 1197-1, Yasashi-cho, Asahi-ku, Yokohama, Kanagawa, Japan.
Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan.
BMC Infect Dis. 2023 Mar 29;23(1):184. doi: 10.1186/s12879-023-08128-9.
There is a growing interest in Klebsiella variicola as a causative pathogen in humans, though its clinical features and the impact of co-infection or secondary infection with COVID-19 remain unknown.
A 71-year-old man presented with fever, altered mental status and generalized weakness and was admitted to ICU due to severe COVID-19 pneumonia. He was newly diagnosed with type II diabetes mellitus upon admission. On hospital day 3, his respiratory status deteriorated, requiring invasive mechanical ventilation. On hospital day 10, superimposed bacterial pneumonia was suspected and subsequently, broad-spectrum antibiotics were administered for the associated bloodstream infection. On hospital day 13, despite administration of active antibiotics and appropriate source control, he decompensated and died. The causative organism isolated from blood cultures was initially reported as K. pneumoniae, but it was identified as K. variicola by a genetic analysis. A representative isolate (FUJ01370) had a novel multilocus sequence typing allelic profile (gapA-infB-mdh-pgi-phoE-rpoB-tonB: 16-24-21-27-52-17-152), to which sequence type 5794 was assigned (GenBank assembly accession: GCA_019042755.1).
We report a fatal case of respiratory and bloodstream infection due to K. variicola complicating severe COVID-19. Co-infection or secondary infection of K. variicola in COVID-19 is likely under-recognized and can be fulminant as in this case.
越来越多的人关注变异肺炎克雷伯菌（Klebsiella variicola）作为人类病原体的作用，但其临床特征以及与 COVID-19 的合并感染或继发感染的影响尚不清楚。
一名 71 岁男性，因严重 COVID-19 肺炎而出现发热、精神状态改变和全身无力，入住 ICU。入院时被新诊断为 2 型糖尿病。入院第 3 天，其呼吸状况恶化，需要进行有创机械通气。入院第 10 天，疑诊为细菌性肺炎合并症，随后给予广谱抗生素治疗相关的血流感染。入院第 13 天，尽管给予了积极的抗生素和适当的源头控制，患者仍出现失代偿并死亡。从血培养中分离出的病原体最初报告为肺炎克雷伯菌，但通过基因分析鉴定为变异肺炎克雷伯菌。一个代表性的分离株（FUJ01370）具有新的多位点序列分型等位基因谱（gapA-infB-mdh-pgi-phoE-rpoB-tonB：16-24-21-27-52-17-152），被分配到序列型 5794（GenBank 组装 accession：GCA_019042755.1）。
我们报告了一例因严重 COVID-19 并发变异肺炎克雷伯菌导致呼吸和血流感染的致命病例。COVID-19 中变异肺炎克雷伯菌的合并感染或继发感染可能被低估，并且可能像本例一样迅速发展。
