简介高粘膜粘性肺炎克雷伯菌(hvKP)与侵袭性感染有关;然而,关于危重患者感染的临床特征和预后的全面报道很少。方法我们在日本的一般重症监护病房进行了回顾性病例系列。纳入2020年1月1日至2022年12月31日期间KP血培养阳性的患者。hvKP由字符串测试中的阳性定义。我们分析了病人的基线特征,包括合并症,脓肿形成,序贯器官衰竭评估(SOFA)评分,急性生理学和慢性健康评估(APACHE)II评分,感染性休克,住院时间,30天死亡率,和感染部位。结果24例患者的血培养KP阳性;9例(37.5%)的字符串测试(hvKP)阳性,15例(62.5%)的阴性(非hvKP)。在这两组中,患者年龄较大(平均年龄,hvKP80.4vs.非hvKP75.7岁),更常见的是男性(五名患者(55.6%)与12例(80.0%)。两组在合并症方面无统计学差异,比如糖尿病,慢性阻塞性肺疾病,慢性肾病,和恶性肿瘤。脓肿形成无统计学差异(两名患者[22.2%]与一名患者(6.7%),SOFA评分(5.2±4.8vs.4.7±3.4),APACHEII得分(19.6(15.0-20.0)vs.17.0(11.2-20.8)),脓毒性休克(5例(55.6%)与四名患者(26.7%),住院时间(37.2(12.0-51.0)vs.32.3(9.5-21.0)),30天死亡率(2例(22.2%)与2例患者(13.3%)。2例hvKP患者在24h内死亡。感染来源无明显差异;呼吸道感染(2(22.2%)与1(6.7%),肝胆感染(2(22.2%)与7(46.7%),和泌尿生殖系统感染(1(11.1%)与5(33.3%))。结论HvKP感染的危重患者表现出与先前报道相似的特征。然而,该疾病可能会迅速变得严重,并且预后不良。
Introduction Hypermucoviscous Klebsiella pneumoniae (hvKP) is related to invasive infections; however, there have been very few comprehensive
reports on the clinical features and prognosis of critically ill patients with the infection. Methods We conducted a retrospective
case series in a general intensive care unit in Japan. Patients with positive blood cultures for KP between January 1, 2020 and December 31, 2022 were included. hvKP was defined by the positivity in the string test. We analyzed the patient\'s characteristics at baseline, including comorbidities, abscess formation, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, septic shock, duration of hospitalization, 30-day mortality, and infection site. Results A total of 24 patients had a positive blood culture for KP; nine patients (37.5%) were positive for the string test (hvKP) while 15 (62.5%) were negative (non-hvKP). In both groups, the patients were old (mean age, hvKP 80.4 vs. non-hvKP 75.7 years) and more often male (five patients (55.6%) vs. 12 patients (80.0%)). No statistically significant difference was found between the two groups in terms of comorbidities, such as diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy. No statistical difference was seen in abscess formation (two patients [22.2%] vs. one patient (6.7%)), SOFA score (5.2±4.8 vs. 4.7±3.4), APACHE II score (19.6 (15.0-20.0) vs. 17.0 (11.2-20.8)), septic shock (five patients (55.6%) vs. four patient (26.7%)), duration of hospitalization (37.2 (12.0-51.0) vs. 32.3 (9.5-21.0)), and 30-day mortality (two patients (22.2%) vs. two patients (13.3%)). Two cases with hvKP died within 24 h. No significant difference was seen in the infection sources; respiratory infection (2 (22.2%) vs. 1 (6.7%)), hepatobiliary infection (2 (22.2%) vs. 7 (46.7%)), and genitourinary infection (1 (11.1%) vs. 5 (33.3%)). Conclusions Critically ill patients with hvKP infection showed characteristics similar to those reported previously. However, the disease could rapidly become severe and have a poor prognostic outcome.