氨基糖苷修饰酶对产kpc肺炎克雷伯菌血症的微生物学和临床影响。

IF 1.8 4区医学 Q3 INFECTIOUS DISEASES

Diagnostic microbiology and infectious disease Pub Date : 2025-09-13 DOI:10.1016/j.diagmicrobio.2025.117111

Jae Eun Seong , Sang Min Ahn , Min Han , Yong Seop Lee , Jung Ah Lee , Jae Hoon Kim , Jung Ho Kim , Jin Young Ahn , Su Jin Jeong , Nam Su Ku , Joon Sup Yeom , Hyukmin Lee , Jun Yong Choi

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引用次数: 0

摘要

背景：肺炎克雷伯菌（Klebsiella pneumoniae， KPN）是一种与危及生命的感染相关的主要病原体。碳青霉烯耐药KPN的全球上升，特别是肺炎克雷伯菌碳青霉烯酶（KPC）产生菌株，提出了一个治疗挑战。氨基糖苷类药物对携带氨基糖苷修饰酶（AME）基因的产kpc的KPN菌株的疗效尚不清楚。本研究评估了氨基糖苷治疗AME基因携带kpc产生的KPN菌血症的临床和微生物学效果。方法：我们对韩国某三级医院（2022-2024）阿米卡霉素敏感kpc产生KPN菌血症的成人进行回顾性队列研究。根据临床和实验室标准协会的指南，使用VITEK 2和椎间盘扩散法评估抗菌药物敏感性。通过免疫层析检测blaKPC基因，而全基因组测序鉴定了blaKPC亚型和AME基因。根据氨基糖苷的使用情况分析临床和微生物结果。结果：136例患者（平均年龄：63.6岁）中，98例接受了氨基糖苷治疗，38例未接受治疗。腹腔感染是最常见的感染源。氨基糖苷组一周内微生物清除率显著降低（63.3% vs 84.2%, p = 0.005）。三天内的临床改善也较低（48%对73.7%）。死亡率（28天：26.5%对21.1%,p = 0.660；住院：40.8%对34.2%,p = 0.559）无显著差异。多变量分析发现，氨基糖苷使用与28天死亡率之间无显著关联（优势比0.99；95%可信区间：0.33-3.13,p = 0.988）。结论：尽管存在表型易感性，但氨基糖苷治疗并未改善AME基因携带kpc产生的KPN菌血症的临床或微生物预后。

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Microbiological and clinical impact of aminoglycosides on KPC-producing Klebsiella pneumoniae bacteraemia with aminoglycoside-modifying enzymes

Background

Klebsiella pneumoniae (KPN) is a major pathogen associated with life-threatening infections. The global rise in carbapenem-resistant KPN, particularly Klebsiella pneumoniae carbapenemase (KPC)-producing strains, presents a treatment challenge. The efficacy of aminoglycosides against KPC-producing KPN strains carrying aminoglycoside-modifying enzyme (AME) genes remains unclear. This study evaluated the clinical and microbiological effects of aminoglycoside therapy on AME gene-bearing KPC-producing KPN bacteraemia.

Methods

We conducted a retrospective cohort study on adults with amikacin-susceptible KPC-producing KPN bacteraemia at a South Korean tertiary hospital (2022–2024). Antimicrobial susceptibility was assessed using VITEK 2 and disc diffusion per Clinical and Laboratory Standards Institute guidelines. The bla_KPC gene was detected via immunochromatography, whereas whole-genome sequencing identified bla_KPC subtypes and AME genes. Clinical and microbiological outcomes were analysed based on aminoglycoside use.

Results

Among 136 patients (mean age: 63.6 years), 98 received aminoglycoside therapy, and 38 did not. Intra-abdominal infections were the most common source. Microbiological clearance within one week was significantly lower in the aminoglycoside group (63.3 % vs. 84.2 %, (p = 0.005). Clinical improvement within three days was also lower (48 % vs. 73.7 %). Mortality rates (28-d: 26.5 % vs. 21.1 %, p = 0.660; in-hospital: 40.8 % vs. 34.2 %, p = 0.559) did not differ significantly. Multivariable analysis found no significant association between aminoglycoside use and 28-d mortality (odds ratio 0.99; 95 % confidence interval: 0.33–3.13, p = 0.988).

Conclusion

Aminoglycoside therapy did not improve clinical or microbiological outcomes in AME gene-bearing KPC-producing KPN bacteraemia, despite phenotypic susceptibility.

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来源期刊

Diagnostic microbiology and infectious disease 医学-传染病学

CiteScore

5.30

自引率

3.40%

发文量

149

审稿时长

56 days

期刊介绍： Diagnostic Microbiology and Infectious Disease keeps you informed of the latest developments in clinical microbiology and the diagnosis and treatment of infectious diseases. Packed with rigorously peer-reviewed articles and studies in bacteriology, immunology, immunoserology, infectious diseases, mycology, parasitology, and virology, the journal examines new procedures, unusual cases, controversial issues, and important new literature. Diagnostic Microbiology and Infectious Disease distinguished independent editorial board, consisting of experts from many medical specialties, ensures you extensive and authoritative coverage.