Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates:: association with invasive syndrome in patients with community-acquired bacteraemia
Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates:: association with invasive syndrome in patients with community-acquired bacteraemia
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DOI：
10.1111/j.1365-2796.2006.01641.x
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发表时间：
2006-06-01
影响因子：
11.1
通讯作者：
Ko, W. -C.
中科院分区：
文献类型：
--
作者：
Lee, H. -C.;Chuang, Y. -C.;Ko, W. -C.
肺炎克雷伯菌是一种革兰氏阴性杆菌，在培养皿上形成粘稠的粘液样菌落，是临床常见的致病菌。本研究的目的是探讨克雷伯氏菌菌血症分离株中高粘液粘滞性（HV）的发生率。肺炎克雷伯氏菌感染的临床研究，并确定HV和各种临床表现之间的任何关联的意义。收集1999年6月至2001年6月间在某社区大学医院发生的肺炎菌血症患者的临床资料。K.使用改良的弦试验检查肺炎菌血症分离株中HV的存在。使用统计分析评估HV的临床影响和侵袭性综合征的风险因素。应用聚合酶链反应（PCR）检测与HV表型相关的基因magA。肺炎菌血症是社区获得性感染。与医院获得性K.肺炎菌血症（HA-KpB）、社区获得性肺炎克雷伯氏菌（K.肺炎菌血症（CA-KpB）本质上更可能是单一微生物（83.5% vs.64.8%; P < 0.001），并且更可能由HV菌株引起（41.5% vs.14.8%; P < 0.001）。HV表型K.肺炎菌占24.1%。感染HV阳性菌株的患者比感染HV阴性变异株的患者更容易出现独特的侵袭性综合征（即肝脓肿、脑膜炎、胸腔积脓或眼内炎）（37.3% vs. 6.8%; P < 0.001）。多因素Logistic回归分析显示，K.肺炎克雷伯氏菌的HV表型与CA-KpB患者侵袭性综合征的发生呈正相关（OR 8.86，95% CI 3.70-21.25，P < 0.001）。肺炎菌血症分离株与一种独特的侵袭性综合征的发展有关。HV表型的鉴定应促使临床医生对侵袭性疾病进行积极的研究。
Klebsiella pneumoniae, a Gram-negative bacillus usually forming glistening mucoid colonies with viscid consistency on the culture plate, is a common pathogen causing various clinical infection patterns. However, little is known about the clinical implications of this mucoid character.The purposes of this study, therefore, were to investigate the frequency of hypermucoviscosity (HV) in bacteraemic isolates of K. pneumoniae, and determine the significance of any association between HV and various clinical manifestations.Retrospective observational study.Patients diagnosed with K. pneumoniae bacteraemia at a community-based university hospital between June 1999 and June 2001 were enrolled in this analysis.Clinical data concerning comorbid diseases and infection patterns was collected. K. pneumoniae bacteraemic isolates were examined for the presence of HV using a modified string test. The clinical impact of HV and risk factors for the invasive syndrome were assessed using statistical analysis. Polymerase chain reaction (PCR) was performed to detect magA, a gene related to HV phenotype.Overall, 200 (64.9%) of the 308 cases of K. pneumoniae bacteraemia were community-acquired infections. Compared with hospital-acquired K. pneumoniae bacteraemia (HA-KpB), community-acquired K. pneumoniae bacteraemia (CA-KpB) was more likely to be monomicrobial in nature (83.5% vs. 64.8%; P < 0.001) and caused by HV strains (41.5% vs. 14.8%; P < 0.001). The prevalence rate of magA among HV phenotypical K. pneumoniae strains was 24.1%. Patients infected with HV-positive strains were more likely to have the distinctive invasive syndrome (i.e. liver abscess, meningitis, pleural empyaema or endophthalmitis) than those infected with HV-negative variants (37.3% vs. 6.8%; P < 0.001). Multivariate logistic regression analysis, adjusted for age, showed that HV phenotype in K. pneumoniae strains (OR 8.86; 95% CI, 3.70-21.25; P < 0.001) was positively associated with the development of the invasive syndrome in CA-KpB cases.The HV phenotype of K. pneumoniae bacteraemic isolates was associated with the development of a distinctive invasive syndrome. Identification of the HV phenotype should prompt clinicians to initiate aggressive investigations for invasive diseases.