Chen Qingyun, Zhang Ye, Zhang Lei, Xian Shaojing, Huang Linhui, Ding Xiuxiu, Wu Hua, Xia Han, Yang Xuying, Cai Xingjun
Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China.
Department of Scientific Affairs, Hugobiotech Co., Ltd., Beijing 100176, China.
Open Med (Wars). 2023 Apr 6;18(1):20230694. doi: 10.1515/med-2023-0694. eCollection 2023.
Hypervirulent (hvKp) causes increasing infections in healthy individuals from the community. In severe cases, it can cause multiple organ infection with invasive metastasis of blood sources, seriously threatening the patients' life. Rapid and accurate diagnosis of the pathogen becomes the key to timely antibiotic treatment to improve the prognosis. This article reports a case of liver abscess complicated with multiple organ invasive infection caused by hematogenous-disseminated hvKp. was identified by culture and metagenomic next-generation sequencing (mNGS) using blood and liver abscess drainage fluid. The isolates from the two samples were subsequently identified with high homology (99.999%) by whole genome sequencing. In addition, multiple virulence genes were detected in the two isolates and the string test was positive, indicating hvKp with hypermucoviscosity phenotype. Multiple antibiotic treatments were given. The conditions of the patient were stable but the temperature remained high. Surgical drainage treatment was performed, and the patient's body temperature immediately dropped to normal. He finally recovered after 6 months of follow-up. mNGS using body fluids can facilitate the rapid diagnosis of pathogens. For hvKp infection, choosing a better antibiotic therapy and receiving surgical drainage can significantly improve the prognosis of the patient.
高毒力肺炎克雷伯菌(hvKp)在社区健康个体中引起的感染日益增多。在严重情况下,它可导致多器官感染并伴有血源性侵袭性转移,严重威胁患者生命。快速准确地诊断病原体成为及时进行抗生素治疗以改善预后的关键。本文报道了一例由血行播散性hvKp引起的肝脓肿合并多器官侵袭性感染的病例。通过使用血液和肝脓肿引流液进行培养和宏基因组下一代测序(mNGS)鉴定出该病原体。随后通过全基因组测序确定来自两个样本的分离株具有高度同源性(99.999%)。此外,在这两个分离株中检测到多个毒力基因,并且拉丝试验呈阳性,表明为具有高黏液性表型的hvKp。给予了多种抗生素治疗。患者病情稳定但体温持续升高。进行了手术引流治疗,患者体温立即降至正常。经过6个月的随访,他最终康复。使用体液进行mNGS有助于快速诊断病原体。对于hvKp感染,选择更好的抗生素治疗并接受手术引流可显著改善患者预后。