Infection最新文献

{"title":"Primary HIV-1 infection presenting with nephrotic-range proteinuria and severe acute kidney injury mimicking imported Lassa fever.","authors":"Frieder Pfäfflin, Ralf Schindler, Miriam Songa Stegemann, Wolfgang Schneider, Leif Erik Sander, Philipp Enghard, Stephan Achterberg, Dirk Schürmann","doi":"10.1007/s15010-024-02466-9","DOIUrl":"https://doi.org/10.1007/s15010-024-02466-9","url":null,"abstract":"<p><strong>Purpose: </strong>Primary HIV-1 infection (PHI) can present with protean clinical manifestations. We report a rare presentation of PHI that underscores that a high index of suspicion is required for diagnosis of PHI.</p><p><strong>Methods: </strong>We report on a 54-yearold previously healthy woman of African descent who presented with sudden-onset nephrotic-range proteinuria and acute kidney injury (AKI) requiring hemodialysis in the setting of febrile multiple organ dysfunction syndrome. Both the epidemiological and clinical features initially pointed to imported Lassa fever, but this was ruled out. She was eventually diagnosed with PHI. We reviewed the literature for other patients who presented with PHI and AKI requiring hemodialysis.</p><p><strong>Results: </strong>Kidney biopsy evaluation, including conventional and electron microscopy, revealed minimal change disease (MCD) and diffuse tubular damage leading to AKI. To date, MCD has not been reported to be associated with PHI and severe AKI. A literature search revealed six additional cases of severe PHI-associated AKI requiring hemodialysis. In four cases, severe rhabdomyolysis with tubulotoxic myoglobinuria played the primary causative role, while in one case each AKI was associated with HIV-associated nephropathy (HIVAN) and hemolytic uremic syndrome, respectively.</p><p><strong>Conclusions: </strong>Severe AKI requiring hemodialysis is a rare manifestation of PHI and may be associated with several conditions, most commonly PHI-associated rhabdomyolysis with tubulotoxic myoglobinuria. Severe AKI in PHI may also occur as a complication of MCD manifesting with nephrotic-range proteinuria. PHI should be considered in the differential diagnosis in patients presenting with severe proteinuria and AKI in the setting of febrile multiple organ dysfunction syndromes, including hemorrhagic fever diseases.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Viral sepsis - pathophysiology and disease manifestation.","authors":"Lutz G Gürtler, Wolfgang Schramm, Rainer Seitz","doi":"10.1007/s15010-025-02486-z","DOIUrl":"https://doi.org/10.1007/s15010-025-02486-z","url":null,"abstract":"<p><p>Viral infection is found in approximately 30% of all sepsis cases and may be followed by bacterial infection in organs such as the lungs. Sepsis manifests as fever, hemorrhagic lesions and cell death. Organ dysfunction caused by sepsis, such as meningitis and encephalitis, can lead to organ damage. Sepsis is induced by various viral components, host cells and cellular mediators, such as cytokines and chemokines. Cytokines are secreted from stimulated macrophages, monocytes, dendritic cells and T lymphocytes.Further contributors to sepsis are the cleavage products after activation of the complement cascade with anaphylatoxin generation and peptides of the activated clotting cascade, thrombocytopenia and thrombocyte function alteration, intravasal clotting and/or endothelial leakage. The cells involved in viral sepsis are neutrophil granulocytes, monocytes and macrophages, dendritic cells and thrombocytes, and finally, endothelial cells and epithelial cells.Prolonged cytokine release leads to cell damage, immune cell dysfunction and exhaustion, and either impairs or hyperactivates immune cells. The course of viral sepsis may be enhanced by some patient conditions including age, underlying diseases such as diabetes, obesity; and immunodeficiency. Viral sepsis, similar to bacterial sepsis, is an extremely complex disorder, and the involvement of the abovementioned cellular and humoral components can present quite divergent biological and clinical patterns.Examples of viral sepsis discussed in the manuscript include three viruses causing Dengue fever - an emerging infection, COVID-19 - a disease with a prolonged course, Ebola disease - a disease with typically complete viral clearance, while rabies virus - induces a disease that causes coma and death before signs of viral sepsis are apparent.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the in vitro activities and resistance mechanisms against imipenem-relebactam and ceftazidime-avibactam in clinical KPC-producing Klebsiella pneumoniae isolated in China.","authors":"Yingyi Guo, Likang Yao, Jiong Wang, Yan Zhang, Chuyue Zhuo, Yijing Wang, Xu Yang, Jiahui Li, Nanhao He, Jiakang Chen, Yexin Lin, Shunian Xiao, Zhiwei Lin, Chao Zhuo","doi":"10.1007/s15010-025-02474-3","DOIUrl":"https://doi.org/10.1007/s15010-025-02474-3","url":null,"abstract":"<p><strong>Background: </strong>Ceftazidime-avibactam (CAZ-AVI) and imipenem-relebactam (IMI-REL) are both antibiotics with promising prospects for treating Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) infections. However, differences in the in vitro activities and resistance mechanisms to CAZ-AVI and IMI-REL in clinical KPC-Kps have not been described.</p><p><strong>Methods: </strong>In this study, KPC-Kp isolates from hospitalized patients in China were collected and subjected to antimicrobial susceptibility testing of IMI-REL and CAZ-AVI using the broth microdilution method. Whole-genome sequencing (WGS) and functional validation of mutations were performed on resistant strains, and RT-qPCR was used to determine the expression levels of bla_KPC.</p><p><strong>Results: </strong>The results showed that 21 (2.7%) of 782 clinical KPC-Kp strains were CAZ-AVI-resistant, 6 (0.8%) of 782 strains were IMI-REL-resistant, and 5 strains among them were resistant to both CAZ-AVI and IMI-REL. Strains resistant to both CAZ-AVI and IMI-REL can be effectively inhibited by tigecycline and polymyxin B. WGS and complementation experiments showed that KPC mutations are linked to high-level resistance to CAZ-AVI; while OmpK36 mutations may be the vital mechanism of IMI-REL resistance, confers resistance to CAZ-AVI simultaneously. Furthermore, RT-qPCR indicated that elevated bla_KPC expression may play an important role in both CAZ-AVI and IMI-REL resistance.</p><p><strong>Conclusions: </strong>In summary, this study suggested that IMI-REL may have superior inhibitory effects in vitro on KPC-Kps than CAZ-AVI, and described the differences in resistance mechanisms between the two antibiotics.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological diversity among patients with Lemierre syndrome and clinical implications: an individual patient-level analysis.","authors":"Maurus Frehner, Riccardo M Fumagalli, Silvio D Brugger, Silvia Cardi, Filippo Catalani, Alice Trinchero, Alessandro Pecci, Nils Kucher, Luca Valerio, Stefano Barco","doi":"10.1007/s15010-025-02489-w","DOIUrl":"https://doi.org/10.1007/s15010-025-02489-w","url":null,"abstract":"<p><strong>Purpose: </strong>Lemierre syndrome is a rare condition traditionally defined by bacterial infection of the head/neck region, local thrombophlebitis, and septic embolism. Although in most cases Fusobacterium necrophorum is isolated, it is questionable whether the presence of this microbe is mandatory for diagnosis. In this study, we investigated microorganisms isolated in cases of Lemierre syndrome and their association with demographical and clinical features.</p><p><strong>Methods: </strong>We conducted an analysis of individual patient data from 712 patients diagnosed with Lemierre syndrome. Demographics, clinical presentation, treatment strategies, and outcomes according to different pathogens were evaluated.</p><p><strong>Results: </strong>Among a total of 712 patients, in 574 cases bacterial growth was detected. In 415 patients Fusobacterium spp. was isolated, in 108 either Streptococcus spp. or Staphylococcus spp., and in 51 other bacteria. Patients with different bacteria differed markedly in age, site of preceding infections, clinical presentation, and treatment. Fusobacterium spp. was typically isolated in younger patients (69% of patients aged 16 to 30 years) while Streptococcus spp. and Staphylococcus spp. were more prevalent in older subjects (30% of patients aged over 45 years). Of all cases with Fusobacterium spp., 63% had a thrombosis of the internal jugular vein and 91% septic embolism, compared with 94% and 69%, respectively, in cases with Streptococcus spp. or Staphylococcus spp.</p><p><strong>Conclusion: </strong>In contrast to the available literature, our study suggests that Lemierre syndrome may be caused by multiple bacterial species, and that the clinical presentation and course may vary according to the specific bacterial species involved.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Images in infectious diseases: milker's nodule with erythema multiforme after calf bite in a 23-year-old patient.","authors":"Benjamin T Schleenvoigt, Christine Kletta, Christine Zollmann, Stefan Hagel, Stefan Glöckner, Eva Krause, Janine Michel, Carlotta Helbig, Andrea Vanegas-Ramirez","doi":"10.1007/s15010-025-02475-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02475-2","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Panoramic quantitative and visualization-based bibliometric analysis of Mycoplasma pneumoniae.","authors":"Jun Wang, Mo Wu, Mei Liu, Wenbin Tuo, Yu Shang, Yuxuan Tao, Tian Chen, Cong Yao, Zhen Xie, Yun Xiang, Qinzhen Cai, Chunhui Yuan","doi":"10.1007/s15010-025-02482-3","DOIUrl":"https://doi.org/10.1007/s15010-025-02482-3","url":null,"abstract":"<p><strong>Purpose: </strong>Severe pneumonia, refractory pneumonia and extrapulmonary complications caused by mycoplasma pneumoniae infection were increasing, posing a serious threat to health. This study aimed to explore a breakthrough for further investigations in further.</p><p><strong>Methods: </strong>The Web of Science Core Collection was queried using the search term TS = \"mycoplasma pneumoniae\" for articles from January 1, 2009, to September 24, 2024. Bibliometric indicators were analyzed using VOSviewer, Pajek, and Scimago Graphica, while CiteSpace was utilized for visual analyses, including the contributions of different countries/regions, institutions, authorship patterns, journals, co-citations, keywords, and genes.</p><p><strong>Results: </strong>3,093 articles were collected and showed an increase interest in MPP research. China was the most prolific contributor, and the USA demonstrated the strongest collaboration willingness. The USA and China had the highest cooperation frequency and closest research relationship. The UK had the highest single-article citation count. Fudan University had the greatest total link strength. The top keywords were \"Mycoplasma Pneumoniae\" and \"community-acquired pneumonia\", with \"children\" being particularly prominent throughout the literatures. \"risk factors\" and \"plastic bronchitis\" may represent emerging hotspots in MPP research. Antibiotic therapy, herpes simplex virus infections, and serology detection were the high interest surrounding topics over past decade. mNGS, severe community-acquired pneumonia, co-infections of adenovirus or RSV may become focal points in future. CRP and IL-17 A represented significant genes among MP infection. Positive regulation of cytokine production played a critical role in MP infection.</p><p><strong>Conclusion: </strong>This bibliometric analysis provides insights into its status, frontiers, and hotspots, offering essential guidance to address challenges in MP.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of systemic inflammatory response following transcatheter aortic valve replacement: a pathway to rational antibiotic use.","authors":"Henning Guthoff, Valerie Lohner, Ute Mons, Julia Götz, Hendrik Wienemann, Jan Wrobel, Stephan Nienaber, Sascha Macherey-Meyer, Philipp von Stein, Stephan Baldus, Matti Adam, Maria Isabel Körber, Norma Jung, Victor Mauri","doi":"10.1007/s15010-025-02485-0","DOIUrl":"https://doi.org/10.1007/s15010-025-02485-0","url":null,"abstract":"<p><strong>Purpose: </strong>Elevations in inflammatory markers after transcatheter aortic valve replacement (TAVR) often lead to preemptive antibiotic therapy (ABT). Distinguishing between physiological inflammatory reaction and true infection is crucial for rational ABT use.</p><p><strong>Methods: </strong>This retrospective study included 1275 consecutive TAVR patients from January 2020 to July 2022. Infectious foci, ABT administration, and inflammatory markers over seven days post-procedure were evaluated. Using multivariable logistic regression, predictors for infection were identified and integrated into the Risk of Infection After TAVR (RIAT) score.</p><p><strong>Results: </strong>An infectious focus was retrospectively identified in 2.6% of patients, while 11.4% received ABT. Distinct trends in body temperature (BT), white blood cells (WBC), and C-reactive protein (CRP) were noted, with BT and WBC peaking on day 1 and CRP on day 3. Significant predictors of infection included a rise in BT of ≥ 0.2 °C between day 1 and 3 (odds ratio [OR] 3.08, 95% confidence interval [CI] 1.38-6.88, p = 0.006), elevated WBC counts ≥ 12 × 10⁹/L (OR 3.77, 95% CI 1.67-8.48, p = 0.001), and CRP levels ≥ 80 mg/L (OR 5.72, 95% CI 2.59-12.64, p < 0.001) within three days after TAVR. Integrating these into the RIAT score revealed an infection probability of 1.5% for scores 0-3 points, 9.2% for scores 4-6 points, and 54.5% for scores 7-8 points.</p><p><strong>Conclusion: </strong>Our findings indicate significant ABT overuse among TAVR recipients, likely due to misinterpretation of postoperative physiological reactions. Incorporating specific changes and thresholds of BT, WBC, and CRP post-TAVR into the RIAT score improved risk prediction for infection, underscoring its utility in enhancing antibiotic stewardship in this growing patient population.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echovirus serotype 11 induced sepsis in a young female patient with multiple sclerosis treated with anti-CD20 monoclonal antibody ocrelizumab.","authors":"A D Starosta, J Ehler, B Löffler, A Tannapfel, A Zipprich, P A Reuken, A Stallmach","doi":"10.1007/s15010-025-02479-y","DOIUrl":"https://doi.org/10.1007/s15010-025-02479-y","url":null,"abstract":"<p><strong>Background: </strong>Enterovirus infection has been described as a cause of severe viral sepsis in humorally immunosuppressed patients.</p><p><strong>Case presentation: </strong>A 20-year-old female with a history of multiple sclerosis on ocrelizumab therapy with persistent agammaglobulinemia and autoimmune hepatitis treated with azathioprine/budesonide presented with subacute sensorineural hearing loss, hepatitis, pneumonia, enterocolitis and pancreatitis. Molecular pathological techniques detected enterovirus RNA in samples from the liver, blood, ascites fluid, and pleural effusions, confirming Echovirus serotype 11. The case was managed successfully with supportive care and high-dose intravenous immunoglobulins in addition to fluoxetine.</p><p><strong>Discussion and conclusions: </strong>This patient's unique presentation and clinical course presents important implications for the care of immunosuppressed patients with cryptic complaints.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting the risk of invasive fungal infections in ICU sepsis population: the AMI risk assessment tool.","authors":"Wenyi Jin, Donglin Yang, Zhe Xu, Jiaze Song, Haijuan Jin, Xiaoming Zhou, Chen Liu, Hao Wu, Qianhui Cheng, Jingwen Yang, Jiaying Lin, Liang Wang, Chan Chen, Zhiyi Wang, Jie Weng","doi":"10.1007/s15010-024-02465-w","DOIUrl":"https://doi.org/10.1007/s15010-024-02465-w","url":null,"abstract":"<p><strong>Background: </strong>Invasive fungal infections (IFI) represent a significant contributor to mortality among sepsis patients in the Intensive Care Unit (ICU). Early diagnosis of IFI is challenging, and currently, there are no predictive tools for identifying sepsis patients who may develop IFI. Our study aims to develop a predictive scoring system to assess the risk of IFI in patients with sepsis admitted to the ICU.</p><p><strong>Methods: </strong>A retrospective collection of data from a total of 549 patients was conducted. Data-driven, clinically knowledge-driven, and decision tree models were used to identify predictive variables for risk of IFI in ICU patients with sepsis. Demographic data, vital signs, laboratory values, comorbidities, medication use, and clinical outcomes were all collected. The optimal model was selected based on model performance and clinical utility to establish a risk score.</p><p><strong>Results: </strong>Among adult patients with sepsis admitted to the ICU, 127 patients (23.1%) developed IFI. The final data-driven model included four predictive factors, the clinically knowledge-driven model included three predictive factors, and the decision tree model included two. Based on the good performance and clinical utility of the clinically knowledge-driven model, it was chosen as the optimal risk scoring model (C-statistics: 0.79 (95% confidence interval (CI): 0.75-0.83); Hosmer-Lemeshow (H-L) test P = 0.884). The ICU sepsis patient invasive fungal infection risk (AMI) score, created based on the clinically knowledge-driven model, includes mechanical ventilation, application of immunosuppressants, and the types of antibiotics used. The C-statistics for this risk score was 0.79 (95% CI:0.75-0.84) with good calibration (H-L test P = 0.992 and see calibration curve: Fig. 2). Moreover, in terms of clinical utility, the decision curve analysis for AMI showed a favorable net benefit.</p><p><strong>Conclusions: </strong>The application of the AMI score can effectively distinguish whether ICU sepsis patients will develop IFI, which is beneficial for clinicians to formulate targeted and timely preventive and treatment measures based on the risk of IFI.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The type VI secretion system as a potential predictor of subsequent bloodstream infection of carbapenem-resistant Klebsiella pneumoniae strains on intestinal colonization.","authors":"Chenfeng Zhao, Pingjuan Liu, Xiaoshu Lin, Chenyu Wan, Kang Liao, Penghao Guo, Jiankai Deng, Zhongwen Wu, Yaqin Peng, Junqi Huang, Yili Chen","doi":"10.1007/s15010-024-02456-x","DOIUrl":"https://doi.org/10.1007/s15010-024-02456-x","url":null,"abstract":"<p><strong>Background: </strong>The type VI secretion system (T6SS) has been recognized as a novel virulence factor in Klebsiella pneumoniae. This study investigated the occurrence of T6SS genes in carbapenem-resistant Klebsiella pneumoniae (CRKP) strains during intestinal colonization and evaluated their effect on the development of bloodstream infections.</p><p><strong>Methods: </strong>The study encompassed 2,385 patients admitted to the intensive care unit (ICU) and subjected to routine screening for intestinal colonization with CRKP. PFGE was employed on CRKP strains isolated from both the patients' intestine and blood cultures, confirming their genetic similarity. PCR was employed to detect the presence of carbapenemase genes, T6SS genes, and virulence genes. Quantitative real-time PCR was conducted to assess the expression levels of the core genes associated with the T6SS. The correlation between T6SS expression and sBSI was further investigated.</p><p><strong>Results: </strong>Approximately 10% (238/2385) of ICU patients tested positive for CRKP colonization. Among patients who tested positive, 10.1% (24/238) developed CRKP-sBSI. Patients carrying T6SS-positive CRKP isolates were more commonly linked to a history of invasive procedures, antibiotic use, and immunosuppression (P < 0.05), and were strongly associated with 28-day mortality (P < 0.001). It indicated that T6SS-positive CRKP strains exhibited a higher prevalence of virulence genes, such as rmpA and iucA, compared to T6SS-negative ones (P < 0.001). Compared to the strains isolated from simple colonization group, there was a significant increase in the mRNA expression of both hcp and vgrG genes (P < 0.05) of strains from the sBSI group, suggesting the key genes of the T6SS may play a significant role in the occurrence and progression of sBSI caused by CRKP.</p><p><strong>Conclusion: </strong>The presence of the T6SS in a CRKP strain from intestinal colonization can serve as a promising predictive marker for sBSI. Conducting screenings for CRKP in patients' intestinal flora and monitoring T6SS carriage can improve the prevention and management of CRKP bloodstream infections.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}