| Background To understand the clinical characteristics and risk factors of Hypervirulent Klebsiella Pneumonia infection.The resistance of hv KP of commonly used antibiotics and the genotypes of carbapenem-resistant antibiotics were analyzed,and the capsule serotype and virulence gene of hv KP were discussed.The study provides a basis for clinical diagnosis and treatment of Klebsiella pneumoniae infection and prevention and control of multidrug resistance Hypervirulent Klebsiella pneumoniae infection.Methods Ninety-three strains of Klebsiella pneumonia isolated from the microbial Department were continuously collected with its clinical data from June 1,2019,to June 1,2020.Matrix-assisted laser desorption mass-time of flight mass spectrometry(MALDI-TOF-MS)was used to identification of bacteria.A string test and iut A were performed to detect Hypervirulent Klebsiella Pneumonia.Multivariate Logistic regression analysis was used to analyze the independent risk factors of hv KP infection.Vitek 2 compact automatic microbial analyzer was used for identification and drug sensitivity test,and polymerase chain reaction(PCR)was used to detect carbapenems resistance genes,Six capsular serotypes(K1,K2,K5,K54,and K57),and five virulence genes(rmp A,aerobactin,mag A,iro N,and ybt S).The virulence gene and drug resistance gene of CR-hv KP were analyzed by whole gene sequencing.χ2 or Fisher exact probability method was used for comparison of technical data,independent T-test was used for comparison of quantitative data,and Mann-Whitney U test was used for the analysis of non-normally distributed data.Results Among the 93 strains of Klebsiella pneumoniae,31 strains were hv KP strains,accounting for 33.3%(31/93).The hv KP strains were mainly derived from sputum,pus,and blood,accounting for 41.9%(13/31),22.6%(7/31),and 16.1%(5/31),respectively.The main examination departments were the Department of Critical Care Medicine,the Department of Infection,and the Department of Hepatobiliary Surgery,accounting for 19.3%(6/31),16.1%(5/31),and 12.9%(4/31),respectively.Multivariate regression analysis found that length of hospital stay(OR=6.591),diseases of the hepatobiliary system(OR=6.591),diabetes mellitus(OR=4.282),and admission to the surgical department(OR=4.264)were independent risk factors for hv KP infection(P<0.05).The main carbapenem resistant gene of hv KP was bla KPC.The resistance rate to the antimicrobials tested is low.,and the resistance rates of imipenem and ertapenem were 6.5% and 9.7%.hv KP had significantly lower drug resistance rates to commonly used antibiotics except for imipenem,ertapenem,cefotetan and piperacillin-tazobactam than c KP(P<0.05).The capsular types of Thirty-one hv KP strains were mainly K1 and K2,which accounted for 35.5%(11/31)and 22.6%(7/31)respectively.The positive rates of rmp A,aerobaction、iro N and ybt S were 96.8%(30/31)、80.6%(25/31)、71.0%(22/31)and 67.7%(21/31),respectively.The detection rate of CR-hv KP was 16.1%(5/31),which was only found in intensive care medicine and hepatobiliary surgery.CR-hv KP mainly carried the capsular serotype K64,had a variety of virulence factors,were resistant to common antibiotics,and carried the gene of bla KPC resistance.Conclusions hv KP in our hospital was mainly distributed in intensive care medicine and infection wards.Length of stay,hepatobiliary diseases,diabetes and admission to surgical departments are the high risk factors of hv KP infection.hv KP is sensitive to commonly used antibiotics,but there are strains resistant to carbapenem.hv KP strains isolated in our hospital carry many virulence genes.CR-hv KP strains all belong to K64 capsular serotype.The production of KPC enzyme is the main carbapenem-resistant mechanism of CR-hv KP.The co-existence of many virulence genes and drug resistance genes may be the main pathogenic mechanism of CR-hv KP.Our results can provide a basis for clinical diagnosis and treatment of hv KP infection and prevention and control of multidrug resistance hv KP infection. |
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