Yu Xiaofeng, Zhao Yi, Sun Xiao, Luan Jiahui, Wang Haiyan, Sun Tianyu, Lin Tongtong, Zhou Xia, Yang Wei, Deng Ziguang, Liu Bo, Cao Hongyun
Department of Clinical Microbiology, Zibo City Key Laboratory of Respiratory Infection and Clinical Microbiology, Zibo Municipal Hospital, Zibo, 255400, China.
Science and Education Department, Zibo Municipal Hospital, Zibo, 255400, China.
BMC Microbiol. 2024 Dec 30;24(1):552. doi: 10.1186/s12866-024-03714-6.
Klebsiella pneumoniae bloodstream infection (KP BSI) is a severe clinical condition characterized by high mortality rates. Despite the clinical significance, accurate predictors of mortality in KP BSI have yet to be fully identified.
A retrospective analysis was conducted on the clinical data of 90 cases of KP BSI. The clinical data was extracted from electronic medical records. Antimicrobial susceptibility testing, string testing, and whole-genome sequencing (WGS) were performed on all isolates. Additionally, relevant bioinformatics analyses, such as phylogenetic analysis and assessment of resistance and virulence genes, were carried out. Logistic regression modeling was employed to evaluate the risk factors associated with 28-day mortality in patients with KP BSI, considering both host characteristics and the characteristics of the causative Klebsiella pneumoniae (KP) isolates.
Among the 90 patients included in this study, the 28-day mortality rate for those with KP BSI was 30.00% (27/90). Multivariate analysis revealed several host-related factors associated with an increased risk of 28-day mortality. These factors included an elevated qSOFA score (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.21-7.31, p = 0.017), presence of septic shock (OR 8.21, 95% CI 1.63-41.93, p = 0.008), and nosocomial infection (OR 7.72, 95% CI 1.71-34.74, p = 0.002). Regarding bacterial factors, the presence of the virulence genes rfbA/B/D (OR 8.53, 95% CI 1.41-51.57, p = 0.020) was identified as an independent risk factor, particularly for nosocomial infection patients. However, hypermucoviscosity phenotype, ST type, serotype, and resistance genes were not associated with an increased risk of 28-day mortality.
The carriage of virulence genes rfbA/B/D, which is responsible for the synthesis of O-antigen, was associated with poor prognosis of KP BSI. It may facilitate the clinical management of patients with bloodstream infection (BSI) caused by hypervirulent KP strains, especially those with rfbA/B/D genes.
Not applicable.
肺炎克雷伯菌血流感染（KP BSI）是一种严重的临床病症，死亡率很高。尽管具有临床重要性，但KP BSI死亡率的准确预测指标尚未完全确定。
对90例KP BSI患者的临床资料进行回顾性分析。临床资料从电子病历中提取。对所有分离株进行药敏试验、拉丝试验和全基因组测序（WGS）。此外，还进行了相关的生物信息学分析，如系统发育分析以及耐药和毒力基因评估。采用逻辑回归模型评估KP BSI患者28天死亡率的相关危险因素，同时考虑宿主特征和致病肺炎克雷伯菌（KP）分离株的特征。
本研究纳入的90例患者中，KP BSI患者的28天死亡率为30.00%（27/90）。多因素分析显示了几个与28天死亡风险增加相关的宿主相关因素。这些因素包括qSOFA评分升高（比值比[OR]2.98，95%置信区间[CI]1.21 - 7.31，p = 0.017）、感染性休克（OR 8.21，95% CI 1.63 - 41.93，p = 0.008）和医院感染（OR 7.72，95% CI 1.71 - 34.74，p = 0.002）。关于细菌因素，毒力基因rfbA/B/D的存在（OR 8.53，95% CI 1.41 - 51.57，p = 0.020）被确定为独立危险因素，尤其对于医院感染患者。然而，高黏液性表型、ST型、血清型和耐药基因与28天死亡风险增加无关。
负责O抗原合成的毒力基因rfbA/B/D的携带与KP BSI的不良预后相关。这可能有助于临床上对由高毒力KP菌株引起的血流感染（BSI）患者进行管理，特别是那些携带rfbA/B/D基因的患者。
不适用。
