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Abstract：
OBJECTIVE: The aim of this study was to evaluate the characteristics of immunocyte associated with bloodstream infection (BSI) caused by Klebsiella pneumoniae (Kpn).
METHODS: Patients with BSI-Kpn were included from 2015 to 2022 in our hospital. Immunocyte subpopulations of enrolled BSI-Kpn patients were tested on the same day of blood culture using multicolor flow cytometry analysis. Antibiotic susceptibility test was determined by agar dilution or broth dilution method. All included isolates were subjected to whole genome sequencing and comparative genomics analysis. Clinical and genetic data were integrated to investigate the risk factors associated with clinical outcome.
RESULTS: There were 173 patients with non-duplicate BSI-Kpn, including 81 carbapenem-resistant Kpn (CRKP), 30 extended-spectrum β-lactamases producing Kpn (ESBL-Kpn), 62 none CRKP or ESBL-Kpn (S-Kpn). Among 68 ST11-CRKP isolates, ST11-O2v1:KL64 was the most common serotypes cluster (77.9%, 53/68), followed by ST11-OL101: KL47 (13.2%, 9/68). Compared with CSKP group, subpopulations of immunocyte in patients with CRKP were significantly lower (P < 0.01). In patients with ST11-O2v1:KL64 BSI-Kpn, the level of cytotoxic T lymphocytes (CD3 + CD8 +) is the highest, while the B lymphocytes (CD3-CD19 +) was the least. In addition, the level of immunocyte in patients with Kpn co-harbored clpV-ybtQ-qacE were lower than that in patients with Kpn harbored one of clpV, ybtQ or qacE and without these three genes. Furthermore, co-existence of clpV-ybtQ-qacE was independently associated with a higher risk for 30-day mortality.
CONCLUSIONS: The results demonstrate that patients with BSI-CRKP, especially for ST11-O2v1:KL64, exhibit lower leukomonocyte counts. In addition, BSI-Kpn co-harbored clpV-ybtQ-qacE is correlated to higher 30-day mortality.
METHODS: Patients with BSI-Kpn were included from 2015 to 2022 in our hospital. Immunocyte subpopulations of enrolled BSI-Kpn patients were tested on the same day of blood culture using multicolor flow cytometry analysis. Antibiotic susceptibility test was determined by agar dilution or broth dilution method. All included isolates were subjected to whole genome sequencing and comparative genomics analysis. Clinical and genetic data were integrated to investigate the risk factors associated with clinical outcome.
RESULTS: There were 173 patients with non-duplicate BSI-Kpn, including 81 carbapenem-resistant Kpn (CRKP), 30 extended-spectrum β-lactamases producing Kpn (ESBL-Kpn), 62 none CRKP or ESBL-Kpn (S-Kpn). Among 68 ST11-CRKP isolates, ST11-O2v1:KL64 was the most common serotypes cluster (77.9%, 53/68), followed by ST11-OL101: KL47 (13.2%, 9/68). Compared with CSKP group, subpopulations of immunocyte in patients with CRKP were significantly lower (P < 0.01). In patients with ST11-O2v1:KL64 BSI-Kpn, the level of cytotoxic T lymphocytes (CD3 + CD8 +) is the highest, while the B lymphocytes (CD3-CD19 +) was the least. In addition, the level of immunocyte in patients with Kpn co-harbored clpV-ybtQ-qacE were lower than that in patients with Kpn harbored one of clpV, ybtQ or qacE and without these three genes. Furthermore, co-existence of clpV-ybtQ-qacE was independently associated with a higher risk for 30-day mortality.
CONCLUSIONS: The results demonstrate that patients with BSI-CRKP, especially for ST11-O2v1:KL64, exhibit lower leukomonocyte counts. In addition, BSI-Kpn co-harbored clpV-ybtQ-qacE is correlated to higher 30-day mortality.
摘要：
目的：本研究的目的是评估肺炎克雷伯菌（Kpn）引起的血流感染（BSI）相关免疫细胞的特征。
方法：纳入我院2015-2022年BSI-Kpn患者。在血液培养的同一天使用多色流式细胞术分析对登记的BSI-Kpn患者的免疫细胞亚群进行测试。通过琼脂稀释或肉汤稀释法测定抗生素敏感性试验。对所有纳入的分离株进行全基因组测序和比较基因组学分析。整合临床和遗传数据以调查与临床结局相关的危险因素。
结果：有173例非重复BSI-Kpn，包括81种耐碳青霉烯的Kpn（CRKP），30种产超广谱β-内酰胺酶Kpn(ESBL-Kpn),62无CRKP或ESBL-Kpn(S-Kpn)。在68个ST11-CRKP分离株中，ST11-O2v1:KL64是最常见的血清型簇(77.9%,53/68),其次是ST11-OL101：KL47（13.2%，9/68)。与CSKP组相比，CRKP患者的免疫细胞亚群明显降低（P<0.01）。在ST11-O2v1：KL64BSI-Kpn患者中，细胞毒性T淋巴细胞(CD3+CD8+)水平最高,而B淋巴细胞(CD3-CD19+)最少。此外,Kpn伴clpV-ybtQ-qacE患者的免疫细胞水平低于Kpn伴clpV患者，ybtQ或qacE和没有这三个基因。此外，clpV-ybtQ-qacE的共存与30天死亡率的高风险独立相关。
结论：结果表明，BSI-CRKP患者，特别是对于ST11-O2v1：KL64，表现出更低的白细胞计数。此外,BSI-Kpn共同携带clpV-ybtQ-qacE与更高的30天死亡率相关。
方法：纳入我院2015-2022年BSI-Kpn患者。在血液培养的同一天使用多色流式细胞术分析对登记的BSI-Kpn患者的免疫细胞亚群进行测试。通过琼脂稀释或肉汤稀释法测定抗生素敏感性试验。对所有纳入的分离株进行全基因组测序和比较基因组学分析。整合临床和遗传数据以调查与临床结局相关的危险因素。
结果：有173例非重复BSI-Kpn，包括81种耐碳青霉烯的Kpn（CRKP），30种产超广谱β-内酰胺酶Kpn(ESBL-Kpn),62无CRKP或ESBL-Kpn(S-Kpn)。在68个ST11-CRKP分离株中，ST11-O2v1:KL64是最常见的血清型簇(77.9%,53/68),其次是ST11-OL101：KL47（13.2%，9/68)。与CSKP组相比，CRKP患者的免疫细胞亚群明显降低（P<0.01）。在ST11-O2v1：KL64BSI-Kpn患者中，细胞毒性T淋巴细胞(CD3+CD8+)水平最高,而B淋巴细胞(CD3-CD19+)最少。此外,Kpn伴clpV-ybtQ-qacE患者的免疫细胞水平低于Kpn伴clpV患者，ybtQ或qacE和没有这三个基因。此外，clpV-ybtQ-qacE的共存与30天死亡率的高风险独立相关。
结论：结果表明，BSI-CRKP患者，特别是对于ST11-O2v1：KL64，表现出更低的白细胞计数。此外,BSI-Kpn共同携带clpV-ybtQ-qacE与更高的30天死亡率相关。
