Emergence of hypervirulent K. pneumoniae causing complicated UTI in kidney stone patients
Emergence of hypervirulent K. pneumoniae causing complicated UTI in kidney stone patients
复制标题
DOI：
10.1016/j.micpath.2019.103647
复制
发表时间：
2019-10-01
影响因子：
3.8
通讯作者：
Faryal, Rani
中科院分区：
文献类型：
--
作者：
Zafar, Sahar;Hanif, Saba;Faryal, Rani
肺炎克雷伯菌被称为经典肺炎克雷伯菌（cKP）和高毒力肺炎克雷伯菌（hvKP）在复杂UTI （cUTI）的致病性中起重要作用。巴基斯坦从未报道过hvKP。本研究旨在确定hvKP在肾结石患者中的患病率及其与cUTI的关系。从两家三级医院（保利诊所和伊斯兰堡巴基斯坦医学研究所医院）收集了总共121份尿液样本。从43.5%（53例）肾结石患者中分离出61株肺炎克雷伯菌（ckp43, hvKP 18）。cUTI肾结石患者肺炎克雷伯菌患病率为67.6%（48例）（hvKP为25%，cKP为75%）。所有肺炎克雷伯菌分离株均为强生物膜形成菌。年龄对31 ~ 50岁患者cUTI的发展有重要影响，其中肺炎克雷伯菌的生物膜形成和杀菌活性显著（P = 0.017和P = 0.05）。经药敏试验，20株（33%）出现耐多药（MDR）。从cUTI中分离出的hvKP表现出相对增强的毒力属性，具有多药耐药，提示其在肾结石患者cUTI的发展中起作用，因此无论何时在这些患者中使用抗菌药物治疗，hvKP也应受到重视。
K. pneumoniae termed as classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP) have significant role in pathogenicity of complicated UTI (cUTI). hvKP has not been ever reported from Pakistan. This study aimed to determine the prevalence of hvKP among kidney stone patients and their association with cUTI. Total 121 urine samples were collected from two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences hospital, Islamabad). From 43.5% (53) kidney stone patients, 61 isolates of K. pneumoniae (cKP 43, hvKP 18) were confirmed through standard microbiological and biochemical characterization methods. K. pneumoniae prevalence in kidney stone patients with cUTI was 67.6% (48) (hvKP 25%, cKP 75%). All K. pneumoniae isolates were strong biofilm formers. Age was important in development of cUTI in patients of age group 31-50 years in which biofilm formation and bactericidal activity of K. pneumoniae was significant with P = 0.017 and P = 0.05 respectively. Antibiotic susceptibility was tested and 20 (33%) isolates showed Multi-drug resistance (MDR). hvKP isolated from cUTI, showed comparatively enhanced virulence attributes with multidrug resistance, suggesting their role in development of cUTI in kidney stone patients, hence there is need for whenever prescribing antimicrobial therapy in these patients, hvKP should also be focused.