capsular polysaccharide

荚膜多糖
  • 文章类型: Journal Article
    细菌利用细胞间通讯来协调基本的细胞过程,适应环境变化,发展抗生素耐受性,并增强毒力。这个通讯,称为群体感应(QS),由称为自动诱导物的小信号分子的交换介导。AI-2QS,由代谢酶LuxS(S-核糖基高半胱氨酸裂解酶)调节,作为跨革兰氏阳性和革兰氏阴性细菌的通用细胞间通讯机制,对于不同的细菌过程至关重要。在这项研究中,我们证明了在猪链球菌中(S.suis),一种著名的人畜共患病原体,AI-2QS提高半乳糖利用率,上调荚膜多糖(CPS)前体生产的Leloir途径,并促进CPS合成,导致对巨噬细胞吞噬的抵抗力增加。此外,我们的分子对接和动力学模拟表明,类似于肺炎链球菌,FruA,革兰氏阳性病原体中普遍存在的果糖特异性磷酸烯醇丙酮酸磷酸转移酶系统,也可以作为猪链球菌的AI-2膜表面受体。总之,我们的研究证明了AI-2在猪链球菌半乳糖代谢依赖性CPS合成中的意义。此外,我们对FruA作为猪链球菌AI-2的膜表面受体的潜在作用进行了初步分析。
    Bacteria utilize intercellular communication to orchestrate essential cellular processes, adapt to environmental changes, develop antibiotic tolerance, and enhance virulence. This communication, known as quorum sensing (QS), is mediated by the exchange of small signalling molecules called autoinducers. AI-2 QS, regulated by the metabolic enzyme LuxS (S-ribosylhomocysteine lyase), acts as a universal intercellular communication mechanism across gram-positive and gram-negative bacteria and is crucial for diverse bacterial processes. In this study, we demonstrated that in Streptococcus suis (S. suis), a notable zoonotic pathogen, AI-2 QS enhances galactose utilization, upregulates the Leloir pathway for capsular polysaccharide (CPS) precursor production, and boosts CPS synthesis, leading to increased resistance to macrophage phagocytosis. Additionally, our molecular docking and dynamics simulations suggest that, similar to S. pneumoniae, FruA, a fructose-specific phosphoenolpyruvate phosphotransferase system prevalent in gram-positive pathogens, may also function as an AI-2 membrane surface receptor in S. suis. In conclusion, our study demonstrated the significance of AI-2 in the synthesis of galactose metabolism-dependent CPS in S. suis. Additionally, we conducted a preliminary analysis of the potential role of FruA as a membrane surface receptor for S. suis AI-2.
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  • 文章类型: Journal Article
    肠道菌群在宿主防御非结核性分枝杆菌肺病(NTM-LD)中的作用知之甚少。这里,我们在NTM-LD患者中显示出明显的肠道菌群失调。Prevotellacopri的丰度降低与NTM-LD及其疾病严重程度显着相关。强调了NTM-LD患者粪便和血浆中受损的TLR2活化活性。在抗生素治疗的小鼠作为研究模型,肠道菌群失调与粪便中TLR2活化活性降低,sera,和肺组织发生。转录组分析显示肺部免疫受损,与NTM-LD易感性增加密切相关。口服P.copri或其荚膜多糖可增强TLR2信号传导,恢复免疫反应,改善了NTM-LD敏感性。我们的数据强调了肠道微生物群失调的关联,系统性受损的免疫力和NTM-LD的发展。通过P.copri或其荚膜多糖激活TLR2可能有助于预防NTM-LD。
    The role of gut microbiota in host defense against nontuberculous mycobacterial lung disease (NTM-LD) was poorly understood. Here, we showed significant gut microbiota dysbiosis in patients with NTM-LD. Reduced abundance of Prevotella copri was significantly associated with NTM-LD and its disease severity. Compromised TLR2 activation activity in feces and plasma in the NTM-LD patients was highlighted. In the antibiotics-treated mice as a study model, gut microbiota dysbiosis with reduction of TLR2 activation activity in feces, sera, and lung tissue occurred. Transcriptomic analysis demonstrated immunocompromised in lung which were closely associated with increased NTM-LD susceptibility. Oral administration of P. copri or its capsular polysaccharides enhanced TLR2 signaling, restored immune response, and ameliorated NTM-LD susceptibility. Our data highlighted the association of gut microbiota dysbiosis, systematically compromised immunity and NTM-LD development. TLR2 activation by P. copri or its capsular polysaccharides might help prevent NTM-LD.
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  • 文章类型: Journal Article
    不动杆菌属包括与医院获得性感染相关的环境和临床相关物种。其中,鲍曼不动杆菌是一种重要的重点致病菌,为此,迫切需要研究和开发新的抗菌治疗策略。不动杆菌属。产生各种结构多样的荚膜多糖(CPSs),用一层厚厚的保护层包围着细菌细胞。这些表面结构是胶囊特异性噬菌体的主要受体,也就是说,携带具有CPS解聚/修饰活性的尾钉的噬菌体。噬菌体尾穗蛋白(TSP)表现出水解酶,裂解酶,或针对特定结构的相应CPS的酯酶活性。在这项研究中,感染不动杆菌属的所有裂解胶囊特异性噬菌体的数据。总结了截至2024年1月保存在NCBIGenBank数据库中的基因组。在143个噬菌体基因组中编码的149个鉴定的TSP中,46种蛋白质的囊膜特异性(K特异性)已通过实验确定或先前预测。63个TSP对CPS的特异性,由各种不动杆菌K型产生,在这项研究中使用生物信息学分析进行了预测。全面的系统发育分析证实了这一预测,并揭示了与不同TSP的CPS识别/降解部分相对应的基因区域在囊特异性不动杆菌噬菌体的形态学和分类学上的远缘群体之间进行遗传交换的可能性。
    The genus Acinetobacter comprises both environmental and clinically relevant species associated with hospital-acquired infections. Among them, Acinetobacter baumannii is a critical priority bacterial pathogen, for which the research and development of new strategies for antimicrobial treatment are urgently needed. Acinetobacter spp. produce a variety of structurally diverse capsular polysaccharides (CPSs), which surround the bacterial cells with a thick protective layer. These surface structures are primary receptors for capsule-specific bacteriophages, that is, phages carrying tailspikes with CPS-depolymerizing/modifying activities. Phage tailspike proteins (TSPs) exhibit hydrolase, lyase, or esterase activities toward the corresponding CPSs of a certain structure. In this study, the data on all lytic capsule-specific phages infecting Acinetobacter spp. with genomes deposited in the NCBI GenBank database by January 2024 were summarized. Among the 149 identified TSPs encoded in the genomes of 143 phages, the capsular specificity (K specificity) of 46 proteins has been experimentally determined or predicted previously. The specificity of 63 TSPs toward CPSs, produced by various Acinetobacter K types, was predicted in this study using a bioinformatic analysis. A comprehensive phylogenetic analysis confirmed the prediction and revealed the possibility of the genetic exchange of gene regions corresponding to the CPS-recognizing/degrading parts of different TSPs between morphologically and taxonomically distant groups of capsule-specific Acinetobacter phages.
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  • 文章类型: Journal Article
    早期诊断对于成功治疗假性伯克霍尔德菌感染至关重要。但目前的金标准培养技术无法实现。因此,本研究旨在开发一种针对假单胞菌荚膜多糖的侧流免疫分析法(LFIA)。通过改变硝化纤维素膜反应垫和追踪缓冲液进行显影。原型LFIA由UnisartCN95和包含tris-base的追踪缓冲区组成,酪蛋白,和表面活性剂10G。该分析显示与大肠杆菌没有交叉反应,金黄色葡萄球菌,铜绿假单胞菌,还有P.痤疮.在血液培养培养基和人工尿液中,原型LFIA的检测限(LODs)为107和106CFU/mL。分别。这些LODs表明,该原型可以从阳性血液培养瓶中检测到类lioidosis,但不能直接从尿液中检测到。此外,与活跃性类鼻窦炎检测(AMDM)相比,这些LOD仍然较差。总的来说,该原型具有临床使用血液培养瓶的潜力。然而,应考虑进一步改进,特别是用于尿液样本。
    Early diagnosis is essential for the successful management of Burkholderia pseudomallei infection, but it cannot be achieved by the current gold standard culture technique. Therefore, this study aimed to develop a lateral flow immunoassay (LFIA) targeting B. pseudomallei capsular polysaccharide. The development was performed by varying nitrocellulose membrane reaction pads and chase buffers. The prototype LFIA is composed of Unisart CN95 and chase buffer containing tris-base, casein, and Surfactant 10G. The assay showed no cross-reactivity with E. coli, S. aureus, P. aeruginosa, and P. acne. The limit of detections (LODs) of the prototype LFIA was 107 and 106 CFU/mL B. pseudomallei in hemoculture medium and artificial urine, respectively. These LODs suggest that this prototype can detect melioidosis from positive hemoculture bottles but not straight from urine. Additionally, these LODs are still inferior compared to Active Melioidosis Detect (AMDTM). Overall, this prototype holds the potential to be used clinically with hemoculture bottles. However, further improvements should be considered, especially for use with urine samples.
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  • 文章类型: Journal Article
    肺炎链球菌的血清型6C和6D是在血清群6中与血清型6A和6B一起引起侵袭性肺炎球菌疾病(IPD)的两种主要变体。自从引入肺炎球菌结合疫苗PCV7和PCV13以来,儿童和老年人群中由肺炎球菌引起的IPD的病例数大大减少。然而,随着疫苗的广泛使用,最近在不同血清型中观察到替代效应,并降低了疫苗的有效性。为了研究针对原始血清型的保护,并探索针对变体和替代血清型的保护,我们创建了一个来自血清型6A荚膜多糖重复单元的寡糖片段库,6B,6C,和6D通过化学合成。该文库包括9种具有或不具有暴露的末端磷酸基团的假糖和4种通过磷酸基团桥接的假四糖。制备了与6C和6D相关的六种碳水化合物抗原作为用于免疫原性研究的糖蛋白疫苗。来自先前研究的两种6A和两种6B糖缀合物疫苗包括在免疫原性研究中。我们发现,通过在OPKA杀菌实验中表现出优异的活性和广泛的交叉保护活性,含有四种磷酸桥联假四糖的缀合物能够诱导良好的免疫抗体和交叉免疫原性。
    Serotypes 6C and 6D of Streptococcus pneumoniae are two major variants that cause invasive pneumococcal disease (IPD) in serogroup 6 alongside serotypes 6A and 6B. Since the introduction of the pneumococcal conjugate vaccines PCV7 and PCV13, the number of cases of IPD caused by pneumococcus in children and the elderly population has greatly decreased. However, with the widespread use of vaccines, a replacement effect has recently been observed among different serotypes and lowered the effectiveness of the vaccines. To investigate protection against the original serotypes and to explore protection against variants and replacement serotypes, we created a library of oligosaccharide fragments derived from the repeating units of the capsular polysaccharides of serotypes 6A, 6B, 6C, and 6D through chemical synthesis. The library includes nine pseudosaccharides with or without exposed terminal phosphate groups and four pseudotetrasaccharides bridged by phosphate groups. Six carbohydrate antigens related to 6C and 6D were prepared as glycoprotein vaccines for immunogenicity studies. Two 6A and two 6B glycoconjugate vaccines from previous studies were included in immunogenicity studies. We found that the conjugates containing four phosphate-bridged pseudotetrasaccharides were able to induce good immune antibodies and cross-immunogenicity by showing superior activity and broad cross-protective activity in OPKA bactericidal experiments.
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  • 文章类型: Journal Article
    高毒力和耐碳青霉烯类肺炎克雷伯菌(hv-CRKP)引起的医院感染的出现已成为重大的公共卫生挑战。hv-CRKP中的毒力和抗性质粒的遗传性状已被广泛研究;然而,临床菌株在宿主内部的适应性进化策略研究很少。本研究旨在了解抗生素治疗对hv-CRKP表型和基因型特征的影响。我们调查了从同一患者分离出的hv-CRKP菌株的演变,以阐明医院入侵和定植之间的过渡。进行比较基因组学分析以鉴定rmpA启动子中的单核苷酸多态性。随后通过RNA-seq和基因缺失的验证证实了不同的rmpA启动子序列对粘液表型发挥控制作用。此外,生物膜实验,细胞粘附试验,并建立了动物感染模型来阐明rmpA启动子多样性对毒力变化的影响。我们证明了rmpA的P12T和P11T启动子具有很强的活性,这导致CRKP进化为传染性和毒性菌株。同时,rmpA启动子中polyT基序的特定序列导致hv-CRKP的致死性降低,并增强细胞粘附和定植。总结一下,hv-CRKP的rmpA启动子用于控制胶囊生产,从而改变致病性以更好地适应宿主的生态环境。重要性由高毒力耐碳青霉烯类肺炎克雷伯菌(hv-CRKP)引起的医院获得性疾病的患病率显着,导致长期的抗生素治疗。然而,关于接受抗生素治疗的患者hv-CRKP表型变化的报道很少。我们对从同一患者获得的hv-CRKP的遗传进化特征进行了全面检查,并观察到毒力因子rmpA启动子序列的变化。启动子序列P11T和P12T的强活性增强了胶囊多糖的一致生产,导致侵入性应变。相反,P9T和P10T的弱启动子活性有利于暴露菌毛,从而提高细菌细胞附着能力和促进细菌定植。这一发现也解释了一些携带野生型rmpA但表现出低粘液表型的临床菌株的混淆。这种适应性改变有利于肺炎克雷伯菌在医院环境中的传播。
    The emergence of nosocomial infections caused by hypervirulent and carbapenem-resistant K. pneumoniae (hv-CRKP) has become a significant public health challenge. The genetic traits of virulence and resistance plasmids in hv-CRKP have been extensively studied; however, research on the adaptive evolution strategies of clinical strains inside the host was scarce. This study aimed to understand the effects of antibiotic treatment on the phenotype and genotype characteristics of hv-CRKP. We investigated the evolution of hv-CRKP strains isolated from the same patient to elucidate the transition between hospital invasion and colonization. A comparative genomics analysis was performed to identify single nucleotide polymorphisms in the rmpA promoter. Subsequent validation through RNA-seq and gene deletion confirmed that distinct rmpA promoter sequences exert control over the mucoid phenotype. Additionally, biofilm experiments, cell adhesion assays, and animal infection models were conducted to illuminate the influence of rmpA promoter diversity on virulence changes. We demonstrated that the P12T and P11T promoters of rmpA possess strong activity, which leads to the evolution of CRKP into infectious and virulent strains. Meanwhile, the specific sequence of polyT motifs in the rmpA promoter led to a decrease in the lethality of hv-CRKP and enhanced cell adhesion and colonization. To summarize, the rmpA promoter of hv-CRKP is utilized to control capsule production, thereby modifying pathogenicity to better suit the host\'s ecological environment.IMPORTANCEThe prevalence of hospital-acquired illness caused by hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) is significant, leading to prolonged antibiotic treatment. However, there are few reports on the phenotypic changes of hv-CRKP in patients undergoing antibiotic treatment. We performed a comprehensive examination of the genetic evolutionary traits of hv-CRKP obtained from the same patient and observed variations in the promoter sequences of the virulence factor rmpA. The strong activity of the promoter sequences P11T and P12T enhances the consistent production of capsule polysaccharides, resulting in an invasive strain. Conversely, weak promoter activity of P9T and P10T is advantageous for exposing pili, hence improving bacterial cell attachment ability and facilitating bacterial colonization. This finding also explains the confusion of some clinical strains carrying wild-type rmpA but exhibiting a low mucoid phenotype. This adaptive alteration facilitates the dissemination of K. pneumoniae within the hospital setting.
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  • 文章类型: Journal Article
    这篇叙述性综述描述了基因组特征,血清分型,免疫原性,肺炎链球菌荚膜多糖(CPS)疫苗的研制。CPS是肺炎链球菌的主要毒力因子。肺炎链球菌CPS的基因组特征,包括生物合成基因的作用和cps(荚膜多糖)基因座内可能导致血清型替代的遗传变异仍在研究中。已经通过使用表型和基因型方法的各种血清分型方法鉴定了肺炎链球菌的一百种独特血清型。每种方法的优点和局限性都是多种多样的,强调需要准确和全面的血清分型,以进行有效的疾病监测和疫苗靶向。此外,我们通过提供免疫原性概述来阐述CPS在疫苗开发中的关键作用,正在进行的肺炎球菌疫苗研究,以及对疾病负担的影响。
    This narrative review describes genomic characteristic, serotyping, immunogenicity, and vaccine development of Streptococcus pneumoniae capsular polysaccharide (CPS). CPS is a primary virulence factor of S. pneumoniae. The genomic characteristics of S. pneumoniae CPS, including the role of biosynthetic gene and genetic variation within cps (capsule polysaccharide) locus which may lead to serotype replacement are still being investigated. One hundred unique serotypes of S. pneumoniae have been identified through various methods of serotyping using phenotypic and genotypic approach. The advantages and limitations of each method are various, emphasizing the need for accurate and comprehensive serotyping for effective disease surveillance and vaccine targeting. In addition, we elaborate the critical role of CPS in vaccine development by providing an overview of immunogenicity, ongoing research of pneumococcal vaccines, and the impact on disease burden.
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  • 文章类型: Journal Article
    背景:多重耐药革兰氏阴性菌引起的感染对全球公共卫生构成严重威胁。WHO将耐药肺炎克雷伯菌定义为优先病原体,鉴于该物种有限的治疗选择和快速获得新的耐药机制,需要替代治疗。肺炎克雷伯菌基因组流行病学的纵向描述可以为管理策略提供信息,但缺乏来自撒哈拉以南非洲的数据。
    方法:我们对布兰太尔一家医院的所有侵袭性肺炎克雷伯菌进行了纵向分析,马拉维,南部非洲,从1998年到2020年,将临床数据与分离株的基因组序列分析相结合。
    结果:我们表明,在2016年肺炎克雷伯菌感染数量急剧增加后,由于新生儿感染的增加。基因组数据显示不同的克隆扩展的重复波,通常是病房限制,血统,提示与医院相关的传播。我们描述了抗性和表面抗原的时间趋势,与疫苗开发相关。
    结论:我们的数据表明,在我们的环境中,显然需要新的干预措施来预防而不是治疗肺炎克雷伯菌感染。虽然一种选择可能是疫苗,通过增加对感染预防和控制措施的关注和投资,可以避免大多数病例,这将减少所有与医疗保健相关的感染,而不仅仅是一种感染。
    Infections caused by multidrug-resistant gram-negative bacteria present a severe threat to global public health. The WHO defines drug-resistant Klebsiella pneumoniae as a priority pathogen for which alternative treatments are needed given the limited treatment options and the rapid acquisition of novel resistance mechanisms by this species. Longitudinal descriptions of genomic epidemiology of Klebsiella pneumoniae can inform management strategies but data from sub-Saharan Africa are lacking.
    We present a longitudinal analysis of all invasive K. pneumoniae isolates from a single hospital in Blantyre, Malawi, southern Africa, from 1998 to 2020, combining clinical data with genome sequence analysis of the isolates.
    We show that after a dramatic increase in the number of infections from 2016 K. pneumoniae becomes hyperendemic, driven by an increase in neonatal infections. Genomic data show repeated waves of clonal expansion of different, often ward-restricted, lineages, suggestive of hospital-associated transmission. We describe temporal trends in resistance and surface antigens, of relevance for vaccine development.
    Our data highlight a clear need for new interventions to prevent rather than treat K. pneumoniae infections in our setting. Whilst one option may be a vaccine, the majority of cases could be avoided by an increased focus on and investment in infection prevention and control measures, which would reduce all healthcare-associated infections and not just one.
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  • 文章类型: Journal Article
    人们对开发针对呼吸道感染的新型疫苗越来越感兴趣。由于COVID-19大流行。这里,我们检查了缺乏鞭毛和潜在致癌大肠杆菌素(ΔflhDΔclbP)的新型益生菌大肠杆菌衍生物的粘膜佐剂和膜囊泡(MV)的粘膜增强作用。与单个鞭毛突变株(ΔflhD-MV)相比,ΔflhDΔclbP衍生的MV显示出相当强的粘膜佐剂性。此外,基于生物学和物理化学参数,对显示血清型14肺炎球菌荚膜多糖(CPS14MVs)的糖工程化ΔflhDΔclbP-MVs进行了充分表征。在已经用相同的MV皮下初次免疫的小鼠中评估了CPS14MV对全身和粘膜免疫的皮下(SC)和鼻内(IN)增强作用。用两个剂量的方案,IN加强免疫(SC-IN)比同源初免加强免疫(SC-SC)引起更强的IgA应答。用三剂量方案,所有试验方案的血清IgG水平具有可比性.同源免疫(SC-SC-SC)在所有测试方案中引起最高的IgM应答,而SC-SC-SC未能在血液和唾液中引起IgA反应。此外,血清IgA和唾液SIgA水平随着IN给药剂量的增加而增加。值得注意的是,SC-IN-IN不仅诱导了强烈的IgG应答,而且血清和唾液中IgA反应最高。目前的研究结果表明,异源三剂量给药对建立全身和粘膜免疫的潜力,例如,SC-IN-IN疫苗方案可能是有益的。另一个重要的观察是在MVs中大量包装了colibactin,表明ΔflhDΔclbP-MVs在疫苗安全性方面的适用性增加。
    There is a growing interest in development of novel vaccines against respiratory tract infections, due to COVID-19 pandemic. Here, we examined mucosal adjuvanticity and the mucosal booster effect of membrane vesicles (MVs) of a novel probiotic E. coli derivative lacking both flagella and potentially carcinogenic colibactin (ΔflhDΔclbP). ΔflhDΔclbP-derived MVs showed rather strong mucosal adjuvanticity as compared to those of a single flagellar mutant strain (ΔflhD-MVs). In addition, glycoengineered ΔflhDΔclbP-MVs displaying serotype-14 pneumococcal capsular polysaccharide (CPS14+MVs) were well-characterized based on biological and physicochemical parameters. Subcutaneous (SC) and intranasal (IN) booster effects of CPS14+MVs on systemic and mucosal immunity were evaluated in mice that have already been subcutaneously prime-immunized with the same MVs. With a two-dose regimen, an IN boost (SC-IN) elicited stronger IgA responses than homologous prime-boost immunization (SC-SC). With a three-dose regimen, serum IgG levels were comparable among all tested regimens. Homologous immunization (SC-SC-SC) elicited the highest IgM responses among all regimens tested, whereas SC-SC-SC failed to elicit IgA responses in blood and saliva. Furthermore, serum IgA and salivary SIgA levels were increased with an increased number of IN doses administrated. Notably, SC-IN-IN induced not only robust IgG response, but also the highest IgA response in both serum and saliva among the groups. The present findings suggest the potential of a heterologous three-dose administration for building both systemic and mucosal immunity, e.g. an SC-IN-IN vaccine regimen could be beneficial. Another important observation was abundant packaging of colibactin in MVs, suggesting increased applicability of ΔflhDΔclbP-MVs in the context of vaccine safety.
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  • 文章类型: Case Reports
    背景:耐碳青霉烯肺炎克雷伯菌(CRKP)感染是一个主要的公共卫生问题,需要施用多粘菌素E(粘菌素)作为最后一线抗生素。同时,与粘菌素耐药肺炎克雷伯菌感染相关的死亡率正在严重增加.另一方面,碳青霉烯类抗生素在促进肺炎克雷伯菌粘菌素耐药性中的重要性尚不清楚。
    方法:我们报告一例肺炎克雷伯菌相关化脓性肝脓肿,其中易感肺炎克雷伯菌在亚胺培南治疗期间转化为碳青霉烯和粘菌素耐药的肺炎克雷伯菌。化脓性肝脓肿的病例是一名50岁的患有糖尿病和肝移植的男子,他被送往设拉子的阿布阿里新浪医院。分离并鉴定了负责社区获得性化脓性肝脓肿的肺炎克雷伯菌。在抗菌药物敏感性试验中,除氨苄西林外,肺炎克雷伯菌分离株对所有测试的抗生素均敏感,并被鉴定为非K1/K2经典肺炎克雷伯菌(cKp)菌株。多位点序列分型(MLST)将分离株鉴定为序列类型54(ST54)。根据病人的要求,他出院继续在另一个中心治疗。两个月后,他因发烧和进行性全身症状而再次入院。在用亚胺培南治疗期间,该菌株获得了blaOXA-48,并显示出对碳青霉烯类抗生素的抗性,并被鉴定为多药耐药(MDR)菌株。通过肉汤微量稀释法进行粘菌素的最低抑制浓度(MIC)测试,该菌株对粘菌素敏感(MIC<2µg/mL)。同时,在血琼脂上,菌落具有粘性稠度并粘附于培养基(粘性粘膜粘性菌落)。定量实时PCR和生物膜形成测定显示,CRKP菌株增加了胶囊wzi基因的表达,并产生了响应亚胺培南的粘液。最后,肺炎克雷伯菌相关化脓性肝脓肿对多种抗生素耐药,包括最后一线抗生素粘菌素和替加环素,导致败血症和死亡.
    结论:根据这些信息,我们是否可以有一个理论假设,即亚胺培南是肺炎克雷伯菌对碳青霉烯类和粘菌素耐药的启动子?这需要更多的关注。
    BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections are a major public health problem, necessitating the administration of polymyxin E (colistin) as a last-line antibiotic. Meanwhile, the mortality rate associated with colistin-resistant K. pneumoniae infections is seriously increasing. On the other hand, importance of administration of carbapenems in promoting colistin resistance in K. pneumoniae is unknown.
    METHODS: We report a case of K. pneumoniae-related pyogenic liver abscess in which susceptible K. pneumoniae transformed into carbapenem- and colistin-resistant K. pneumoniae during treatment with imipenem. The case of pyogenic liver abscess was a 50-year-old man with diabetes and liver transplant who was admitted to Abu Ali Sina Hospital in Shiraz. The K. pneumoniae isolate responsible for community-acquired pyogenic liver abscess was isolated and identified. The K. pneumoniae isolate was sensitive to all tested antibiotics except ampicillin in the antimicrobial susceptibility test and was identified as a non-K1/K2 classical K. pneumoniae (cKp) strain. Multilocus sequence typing (MLST) identified the isolate as sequence type 54 (ST54). Based on the patient\'s request, he was discharged to continue treatment at another center. After two months, he was readmitted due to fever and progressive constitutional symptoms. During treatment with imipenem, the strain acquired blaOXA-48 and showed resistance to carbapenems and was identified as a multidrug resistant (MDR) strain. The minimum inhibitory concentration (MIC) test for colistin was performed by broth microdilution method and the strain was sensitive to colistin (MIC < 2 µg/mL). Meanwhile, on blood agar, the colonies had a sticky consistency and adhered to the culture medium (sticky mucoviscous colonies). Quantitative real-time PCR and biofilm formation assay revealed that the CRKP strain increased capsule wzi gene expression and produced slime in response to imipenem. Finally, K. pneumoniae-related pyogenic liver abscess with resistance to a wide range of antibiotics, including the last-line antibiotics colistin and tigecycline, led to sepsis and death.
    CONCLUSIONS: Based on this information, can we have a theoretical hypothesis that imipenem is a promoter of resistance to carbapenems and colistin in K. pneumoniae? This needs more attention.
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