Key Laboratory of Clinical Laboratory Medicine of Guangxi Department of Education, Department of Clinical Laboratory, the First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Antimicrob Resist Infect Control. 2023 Nov 13;12(1):124. doi: 10.1186/s13756-023-01331-y.
Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is gradually becoming the dominant nosocomial pathogens in the healthcare setting.
A retrospective study was conducted on patients with CR-KP from July 2021 to May 2022 in a teaching hospital. We identified bacterial isolates, collected the clinical data, and performed antimicrobial susceptibility testing, hypermucoviscosity string test, antimicrobial and virulence-associated genotype, as well as multi-locus sequence typing. CR-hvKP was defined as the presence of some combination of rmpA and/or rmpA2 with iucA, iroB, or peg-344. SPSS was used for data analysis. Univariate logistic regression analyses were used for risk factor and all statistically significant variables were included in the multivariate model. Statistical significance was taken to be P < 0.05.
A total of 69 non-duplicated CR-KP isolates were collected, 27 of which were CR-hvKP. Out of the 69 CR-KP strains under investigation, they were distributed across 14 distinct sequence types (STs), wherein ST11 exhibited the highest prevalence, constituting 65.2% (45/69) of the overall isolates. The principal carbapenemase genes identified encompassed bla, bla, and bla, with bla prevailing as the predominant type, accounting for 73.9% (51/69). A total of 69 CR-KP strains showed high resistance to common clinical antibiotics, with the exception of ceftazidime/avibactam. The ST11 (P = 0.040), ST65 (P = 0.030) and bla ST11 clones (P = 0.010) were found to be highly related to hvKp. Regarding the host, tracheal intubation (P = 0.008), intracranial infection (P = 0.020) and neutrophil count (P = 0.049) were significantly higher in the patients with CR-hvKP. Multivariate analysis showed tracheal intubation to be an independent risk factor for CR-hvKP infection (P = 0.030, OR = 4.131). According to the clinical data we collected, tracheal intubation was performed mainly in the elderly with severe underlying diseases, which implied that CR-hvKP has become prevalent among elderly patients with comorbidities.
The prevalence of CR-hvKP may be higher than expected in the healthcare setting. CR-hvKP is gradually becoming the dominant nosocomial pathogen, and its prevalence and treatment will be a major challenge. It is essential to enhance clinical awareness and management of CR-hvKP infection.
耐碳青霉烯类高毒力肺炎克雷伯菌（CR-hvKP）逐渐成为医疗机构中主要的医院获得性病原体。
对 2021 年 7 月至 2022 年 5 月在一家教学医院的 CR-KP 患者进行回顾性研究。我们鉴定了细菌分离株，收集了临床数据，并进行了抗菌药物敏感性试验、超粘液丝试验、抗菌和毒力相关基因型以及多位点序列分型。CR-hvKP 定义为存在 rmpA 和/或 rmpA2 与 iucA、iroB 或 peg-344 中的某种组合。使用 SPSS 进行数据分析。采用单因素 logistic 回归分析进行危险因素分析，将所有有统计学意义的变量纳入多因素模型。以 P<0.05 为统计学意义。
共收集了 69 株非重复的 CR-KP 分离株，其中 27 株为 CR-hvKP。在研究的 69 株 CR-KP 菌株中，它们分布在 14 个不同的序列型（ST）中，其中 ST11 最为常见，占总分离株的 65.2%（45/69）。主要的碳青霉烯酶基因包括 bla、bla 和 bla，其中 bla 是主要类型，占 73.9%（51/69）。69 株 CR-KP 对常见临床抗生素均显示出高度耐药性，除头孢他啶/阿维巴坦外。ST11（P=0.040）、ST65（P=0.030）和 bla ST11 克隆（P=0.010）与 hvKp 高度相关。关于宿主，CR-hvKP 患者的气管插管（P=0.008）、颅内感染（P=0.020）和中性粒细胞计数（P=0.049）明显更高。多因素分析显示，气管插管是 CR-hvKP 感染的独立危险因素（P=0.030，OR=4.131）。根据我们收集的临床资料，气管插管主要用于患有严重基础疾病的老年人，这表明 CR-hvKP 在患有合并症的老年患者中更为普遍。
医疗机构中 CR-hvKP 的流行率可能高于预期。CR-hvKP 逐渐成为主要的医院病原体，其流行率和治疗将是一个主要挑战。提高对 CR-hvKP 感染的临床认识和管理至关重要。
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