Article(id=1291704937503805860, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291704892859638107, articleNumber=null, orderNo=null, doi=10.13699/j.cnki.1001-6821.2025.19.011, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754582400000, receivedDateStr=2025-08-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1785896055818, onlineDateStr=2026-08-05, pubDate=1760630400000, pubDateStr=2025-10-17, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1785896055818, onlineIssueDateStr=2026-08-05, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1785896055818, creator=13701087609, updateTime=1785896055818, updator=13701087609, issue=Issue{id=1291704892859638107, tenantId=1146029695717560320, journalId=1246415772164075586, year='2025', volume='41', issue='19', pageStart='2701', pageEnd='2850', issueExtLink='null', onlineDate='null', pubDate='1760630400000', pubDateStr='2025-10-17', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1785896045171, creator='13701087609', updateTime=1785896787712, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1291708007352656266, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291704892859638107, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1291708007352656267, tenantId=1146029695717560320, journalId=1246415772164075586, issueId=1291704892859638107, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2760, endPage=2766, ext={EN=ArticleExt(id=1291704937742881189, articleId=1291704937503805860, tenantId=1146029695717560320, journalId=1246415772164075586, language=EN, title=Clinical characteristics, virulence factors, and drug resistance analysis of hypervirulent Klebsiella pneumoniae from emergency, columnId=1246531407326105792, journalTitle=Chinese Journal of Clinical Pharmacology, columnName=Clinical and Basic Bridging Research, runingTitle=null, highlight=null, articleAbstract=
Objective To characterize the clinical manifestations, virulence factors, and antimicrobial resistance profiles of hypervirulent Klebsiella pneumoniae (hvKp) infections, thereby improving the understanding of hvKp and informing evidence-based strategies for early diagnosis and precise antimicrobial therapy.
Methods A retrospective analysis of 14 patients with hvKp infection admitted to the emergency department of peking university first hospital between April 2021 and May 2023 was performed. Data on clinical characteristics, laboratory results, virulence genes, and antimicrobial susceptibility were collected and analyzed.
Results All 14 patients with hvKp infections had community-acquired cases, predominantly male (71.43%, 10 cases/14 cases), with a median age of 69 years. Diabetes mellitus was present in 78.57% (11 cases/14 cases) of the patients. Clinical features included varying degrees of liver injury and bacteremia in all cases, with 71.43% (10 cases/14 cases) complicated by liver abscesses, 78.57% (11 cases/14 cases) by pulmonary infections, 57.14% (8 cases/14 cases) by acute kidney injury, 35.71% (5 cases/14 cases) requiring mechanical ventilation, and 35.71% (5 cases/14 cases) resulting in mortality. Laboratory findings showed significantly elevated C-reactive protein (CRP) and neutrophil to lymphocyte ratio (NLR) levels, which were 150.00~356.00 mg·L-1and 9.04%~66.97%, respectively. 92.86% (13 cases/14 cases) exhibiting decreased albumin levels upon admission, of which 50% demonstrated a >20% decline by the next day. The string test was positive in 69.23% (9 cases/13 cases) of cases. Virulence and resistance profiling via mNGS on three isolated strains revealed the presence of iutA, iucABD, fimH, and gaLF genes in all isolates, with two (66.67%) carrying rmpA2. Among the 14 isolates, antimicrobial susceptibility testing of 12 hvKp strains indicated high susceptibility to most antibiotics; however, two (14.29%) were identified as multidrug-resistant (MDR) including one extended spectrumβ lactamases (ESBLs) producing strain and one carbapenem resistant carbapenem resistant klebsiella pneumoniae (CRKP) strain.
Conclusion HvKp infections predominantly affect male patients with diabetes, characterized by liver abscesses leading to metastatic infections at multiple sites, rapid progression, and high mortality. Dynamic monitoring of albumin levels, the string test, and imaging studies facilitate early detection. Although most hvKp strains remain highly susceptible to commonly used antibiotics, vigilance against MDR strains is essential. Enhanced surveillance of high-risk populations and individualized antimicrobial strategies are recommended.
, authors=Qing-yun PENG
1a, Xiao-jing LI
1a, Li-ying SUN
1b, authorsList=Qing-yun PENG, Xiao-jing LI, Li-ying SUN, authorCompany=null, correspAuthors=Xiao-jing LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1291704938082619814, articleId=1291704937503805860, tenantId=1146029695717560320, journalId=1246415772164075586, language=CN, title=急诊分离高毒力肺炎克雷伯菌的患者临床特征、毒力因子及耐药性分析, columnId=1246531407485489349, journalTitle=中国临床药理学杂志, columnName=临床与基础桥接研究, runingTitle=null, highlight=null, articleAbstract=
目的 分析高毒力肺炎克雷伯菌（hvKp）感染的临床特征、毒力因子及耐药性，提高对hvKp的认识，为早期识别和精准抗感染治疗提供依据。
方法 回顾性分析2021年4月~2023年5月北京大学第一医院急诊科收治的14例hvKp感染患者的临床特征、实验室检查、毒力因子及耐药性特点。
结果 14例hvKp感染患者均为社区获得性感染，男性为主（71.43%，10例/14例），中位年龄69岁；78.57%（11例/14例）合并糖尿病。14例患者均存在不同程度的肝损伤及菌血症，71.43%（10例/14例）伴肝脓肿，78.57%（11例/14例）合并肺部感染，57.14%（8例/14例）发生急性肾损伤，35.71%（5例/14例）需机械通气，35.71%（5例/14例）患者死亡。患者的C-反应蛋白（CRP）和中性粒细胞淋巴细胞比（NLR）分别为150.00~356.00 mg·L-1和9.04%~66.97%，均显著升高；92.86%（13例/14例）入院白蛋白降低且50%次日下降幅度>20%；拉丝试验阳性率69.23%（9例/13例）。对3株分离菌株进行了宏基因组测序（mNGS），结果显示3株菌均携带iutA、iucABD、fimH、gaLF基因，其中2例（66.67%）携带rmpA2；在分离出的14株菌株中，12株hvKp体外药敏试验显示对多数抗菌药物高度敏感，有2株（14.29%）为多重耐药菌（MDR），其中1株产超广谱β-内酰胺酶（ESBLs），另1株碳青霉烯类耐药（CRKP）。
结论 hvKp感染好发于合并糖尿病的男性患者，以肝脓肿继发多部位迁徙性感染为特征，病情进展迅猛且病死率高。动态监测白蛋白水平、拉丝试验及影像学检查有助于早期筛查；尽管多数hvKp菌株对常用抗菌药物高度敏感，仍需警惕多重耐药菌可能。建议强化高危人群监测并个体化制定抗感染方案。
, authors=彭晴云
1a, 李晓晶
1a, 孙立颖
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彭晴云（2000-），女，住院医师，主要从事急诊危重症研究
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