Ukai Kohei, Tomoda Yoshitaka, Ishii Satoe, Nakazato Satoshi, Doi Yohei, Suzuki Masahiro, Harada Sohei
Department of General Internal Medicine, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi-ku, Tokyo, 174-0051, Japan.
Department of General Internal Medicine, Itabashi Chuo Medical Center, 2-12-7 Azusawa, Itabashi-ku, Tokyo, 174-0051, Japan.
J Infect Chemother. 2025 Mar;31(3):102584. doi: 10.1016/j.jiac.2024.12.013. Epub 2024 Dec 15.
A 70-year-old Japanese man with well-controlled diabetes mellitus and chronic kidney disease was hospitalized for an examination of acute renal failure and elevated inflammatory reactions. He had a history of Klebsiella pneumoniae bacteremia without extended-spectrum β-lactamase (ESBL) production five months earlier. The patient was found to have bacteremia due to hypermucoviscous ESBL-producing Klebsiella pneumoniae, and developed septic shock, multiple cerebral infarctions, and an abscess in the left masticatory muscle space. The causative organism was resistant to ampicillin-sulbactam and piperacillin-tazobactam, which were used for empiric therapy, and the patient died despite subsequent definitive treatment with meropenem. Whole genome sequencing analysis showed that the strain of K. pneumoniae was ST412 with capsular genotype K57 and carried virulence genes iroBCDN, iucABCD, iutA, mrkABCDFHIJ, rmpA2, ybtAEPQSTUX. The strain also carried the bla ESBL gene. Although the antimicrobial susceptibility of the causative organisms of hvKp infections in Japan has been favorable in most cases, severe infections caused by ESBL-producing hvKp may increase in the near future considering the recent increase in ESBL-producing K. pneumoniae.
一名70岁的日本男性，患有控制良好的糖尿病和慢性肾脏病，因急性肾衰竭和炎症反应升高入院检查。他五个月前有过无超广谱β-内酰胺酶（ESBL）产生的肺炎克雷伯菌菌血症病史。该患者被发现患有产高黏液性ESBL的肺炎克雷伯菌引起的菌血症，并发展为感染性休克、多发性脑梗死和左咀嚼肌间隙脓肿。病原菌对用于经验性治疗的氨苄西林舒巴坦和哌拉西林他唑巴坦耐药，尽管随后用美罗培南进行了确定性治疗，患者仍死亡。全基因组测序分析显示，肺炎克雷伯菌菌株为ST412，荚膜基因型为K57，并携带毒力基因iroBCDN、iucABCD、iutA、mrkABCDFHIJ、rmpA2、ybtAEPQSTUX。该菌株还携带bla ESBL基因。虽然在日本，hvKp感染的病原菌的抗菌敏感性在大多数情况下是良好的，但考虑到近期产ESBL的肺炎克雷伯菌的增加，由产ESBL的hvKp引起的严重感染在不久的将来可能会增加。
