Department of Laboratory Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Shanghai Institute of Phage, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
BMC Microbiol. 2023 Nov 13;23(1):338. doi: 10.1186/s12866-023-03022-5.
Ventilator-associated pneumonia (VAP) and pyogenic liver abscess (PLA) due to Klebsiella pneumoniae infection can trigger life-threatening malignant consequences, however, there are few studies on the strain-associated clinical pathogenic mechanisms between VAP and PLA. A total of 266 patients consist of 129 VAP and 137 PLA were included for analysis in this study. We conducted a comprehensive survey for the two groups of K. pneumoniae isolates, including phenotypic experiments, clinical epidemiology, genomic analysis, and instrumental analysis, i.e., to obtain the genomic differential profile of K. pneumoniae strains responsible for two distinct infection outcomes. We found that PLA group had a propensity for specific underlying diseases, especially diabetes and cholelithiasis. The resistance level of VAP was significantly higher than that of PLA (78.57% vs. 36%, P < 0.001), while the virulence results were opposite. There were also some differences in key signaling pathways of biochemical processes between the two groups. The combination of iucA, rmpA, hypermucoviscous phenotype, and ST23 presented in K. pneumoniae infection is more important and highly prudent for timely treatment. The present study may contribute a benchmark for the K. pneumoniae clinical screening, epidemiological surveillance, and effective therapeutic strategies.
呼吸机相关性肺炎（VAP）和肺炎克雷伯菌感染引起的化脓性肝脓肿（PLA）可引发危及生命的恶性后果，但关于 VAP 和 PLA 之间与菌株相关的临床发病机制的研究较少。本研究共纳入 266 例患者，其中 129 例为 VAP，137 例为 PLA。我们对两组肺炎克雷伯菌分离株进行了全面调查，包括表型实验、临床流行病学、基因组分析和仪器分析，即获得导致两种不同感染结果的肺炎克雷伯菌菌株的基因组差异图谱。我们发现 PLA 组有特定基础疾病的倾向，特别是糖尿病和胆结石。VAP 的耐药水平明显高于 PLA（78.57%比 36%，P<0.001），而毒力结果则相反。两组间生化过程关键信号通路也存在一些差异。在肺炎克雷伯菌感染中，iucA、rmpA、高黏液表型和 ST23 的组合更为重要，应高度谨慎，及时治疗。本研究可为肺炎克雷伯菌的临床筛查、流行病学监测和有效治疗策略提供基准。
