State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Respiratory Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Ann Clin Microbiol Antimicrob. 2024 Jun 20;23(1):56. doi: 10.1186/s12941-024-00721-3.
The aim of this study was to evaluate the characteristics of immunocyte associated with bloodstream infection (BSI) caused by Klebsiella pneumoniae (Kpn).
Patients with BSI-Kpn were included from 2015 to 2022 in our hospital. Immunocyte subpopulations of enrolled BSI-Kpn patients were tested on the same day of blood culture using multicolor flow cytometry analysis. Antibiotic susceptibility test was determined by agar dilution or broth dilution method. All included isolates were subjected to whole genome sequencing and comparative genomics analysis. Clinical and genetic data were integrated to investigate the risk factors associated with clinical outcome.
There were 173 patients with non-duplicate BSI-Kpn, including 81 carbapenem-resistant Kpn (CRKP), 30 extended-spectrum β-lactamases producing Kpn (ESBL-Kpn), 62 none CRKP or ESBL-Kpn (S-Kpn). Among 68 ST11-CRKP isolates, ST11-O2v1:KL64 was the most common serotypes cluster (77.9%, 53/68), followed by ST11-OL101: KL47 (13.2%, 9/68). Compared with CSKP group, subpopulations of immunocyte in patients with CRKP were significantly lower (P < 0.01). In patients with ST11-O2v1:KL64 BSI-Kpn, the level of cytotoxic T lymphocytes (CD3 + CD8 +) is the highest, while the B lymphocytes (CD3-CD19 +) was the least. In addition, the level of immunocyte in patients with Kpn co-harbored clpV-ybtQ-qacE were lower than that in patients with Kpn harbored one of clpV, ybtQ or qacE and without these three genes. Furthermore, co-existence of clpV-ybtQ-qacE was independently associated with a higher risk for 30-day mortality.
The results demonstrate that patients with BSI-CRKP, especially for ST11-O2v1:KL64, exhibit lower leukomonocyte counts. In addition, BSI-Kpn co-harbored clpV-ybtQ-qacE is correlated to higher 30-day mortality.
本研究旨在评估与肺炎克雷伯菌（Kpn）引起的血流感染（BSI）相关的免疫细胞特征。
2015 年至 2022 年期间，我院纳入了 BSI-Kpn 患者。在同一天进行血培养时，使用多色流式细胞术分析检测入组 BSI-Kpn 患者的免疫细胞亚群。药敏试验采用琼脂稀释或肉汤稀释法测定。对所有纳入的分离株进行全基因组测序和比较基因组学分析。整合临床和遗传数据，以探讨与临床结局相关的危险因素。
共有 173 例非重复 BSI-Kpn 患者，包括 81 例耐碳青霉烯肺炎克雷伯菌（CRKP）、30 例产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-Kpn）、62 例非 CRKP 或 ESBL-Kpn（S-Kpn）。在 68 株 ST11-CRKP 分离株中，ST11-O2v1：KL64 是最常见的血清型群（77.9%，53/68），其次是 ST11-OL101：KL47（13.2%，9/68）。与 CSKP 组相比，CRKP 患者的免疫细胞亚群明显较低（P<0.01）。在 ST11-O2v1：KL64 BSI-Kpn 患者中，细胞毒性 T 淋巴细胞（CD3+CD8+）水平最高，而 B 淋巴细胞（CD3-CD19+）水平最低。此外，Kpn 共同携带 clpV-ybtQ-qacE 的患者的免疫细胞水平低于 Kpn 携带 clpV、ybtQ 或 qacE 中的一种且不携带这三种基因的患者。此外，clpV-ybtQ-qacE 的共存与 30 天死亡率升高独立相关。
结果表明，BSI-CRKP 患者，尤其是 ST11-O2v1：KL64 患者，白细胞计数较低。此外，BSI-Kpn 共同携带 clpV-ybtQ-qacE 与较高的 30 天死亡率相关。
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