Background
Methods
Patients
Clinical Kp strains
Antimicrobial susceptibility testing and phenotypic detection of ESBLs
Detection of virulence-associated gene
Name | sequence |
---|---|
rmpA
| |
Forward | 5-ACTGGGCTACCTCTGCTTCA-3 |
Reverse | 5-CTTGCATGAGCCATCTTTCA-3 |
rmpA2
| |
Forward | 5-CTTTATGTGCAATAAG-GATGTT-3 |
Reverse | 5-CCTCCTGGAGAGTAAGCATT-3 |
magA
| |
Forward | 5-GGTGCTCTTTACATCATTGC-3 |
Reverse | 5-GCAATGGCCATTTGCGTTAG-3 |
aerobactin
| |
Forward | 5-GCATAGGCGGATACGAACAT-3 |
Reverse | 5-CACAGGGCAATTGCTTACCT-3 |
K1
| |
Forward | 5-GTAGGTATTGCAAGCCATGC-3 |
Reverse | 5-GCCCAGGTTAATGAATCCGT-3 |
K2
| |
Forward | 5-GGAGCCATTTGAATTCGGTG-3 |
Reverse | 5-TCCCTAGCACTGGCTTAAGT-3 |
K5
| |
Forward | 5-GCCACCTCTAAGCATATAGC-3 |
Reverse | 5-CGCACCAGTAATTCCAACAG-3 |
K20
| |
Forward | 5-CCGATTCGGTCAACTAGCTT-3 |
Reverse | 5-GCACCTCTATGAACTTTCAG-3 |
K54
| |
Forward | 5-CATTAGCTCAGTGGTTGGCT-3 |
Reverse | 5-GCTTGACAAACACCATAGCAG-3 |
K57
| |
Forward | 5-CGACAAATCTCTCCTGACGA-3 |
Reverse | 5-CGCGACAAACATAACACTCG-3 |
rpoB
| |
Forward | 5-GGCGAAATGGCWGAGAACCA-3 |
Reverse | 5-GAGTCTTCGAAGTTGTAACC-3 |
gapA
| |
Forward | 5-TGAAATATGACTCCACTCACGG-3 |
Reverse | 5-CTTCAGAAGCGGCTTTGATGGCTT-3 |
mdh
| |
Forward | 5-TGAAATATGACTCCACTCACGG-3 |
Reverse | 5-CTTCAGAAGCGGCTTTGATGGCTT-3 |
pgi
| |
Forward | 5-GAGAAAAACCTGCCTGTACTGCTGGC-3 |
Reverse | 5-CGCGCCACGCTTTATAGCGGTTAAT-3 |
phoE
| |
Forward | 5-ACCTACCGCAACACCGACTTCTTCGG-3 |
Reverse | 5-TGATCAGAACTGGTAGGTGAT-3 |
infB
| |
Forward | 5-CTCGCTGCTGGACTATATTCG-3 |
Reverse | 5-CGCTTTCAGCTCAAGAACTTC-3 |
tonB
| |
Forward | 5-CTTTATACCTCGGTACATCAGGTT-3 |
Reverse | 5-ATTCGCCGGCTGRGCRGAGAG-3 |
Multilocus sequence typing (MLST) for Kp
Statistical analysis
Results
Clinical characteristics
Characteristic | HvKp(34) | cKp(39) | P value |
---|---|---|---|
Basic demographics | |||
Age | 83.06 ± 8.55 | 86.62 ± .87 | 0.068 |
Male | 31 (91.2%) | 35 (89.7%) | 1.000 |
Underlying diseases | |||
Pulmonary disease | 31 (91.2%) | 32 (82.1%) | 0.321 |
Diabetes | 19 (55.9%) | 18 (46.2%) | 0.407 |
Cardiovascular disease | 12 (35.3%) | 17 (43.6%) | 0.470 |
Cerebrovascular disease | 11 (32.4%) | 15 (38.5%) | 0.587 |
Cancer |
13 (38.2%)
|
3 (7.7%)
|
0.004
|
Surgery within 1 mo |
8 (23.5%)
|
2 (5.1%)
|
0.023
|
Digestive disease |
10 (29.4%)
|
4 (10.3%)
|
0.038
|
Infection type | |||
Sepsis | 30 (88.2%) | 37 (94.9%) | 0.408 |
Septic shock |
16 (47.1%)
|
8 (20.5%)
|
0.016
|
Host responsibility | |||
WBC | 12.57 ± 4.47 | 11.68 ± 4.36 | 0.397 |
NEU% | 78.99 ± 9.54 | 77.13 ± 7.14 | 0.344 |
Nutrition status | |||
TP | 63.38 ± 6.34 | 61.88 ± 6.02 | 0.304 |
ALB | 33.33 ± 3.75 | 32.51 ± 3.39 | 0.326 |
SOFA score |
8.94 ± 3.03
|
6.62 ± 2.09
|
0.000
|
Infection occurred in ICU | 11 (32.4%) | 10 (25.6%) | 0.527 |
Mortality in 30 days | 14 (41.2%) | 14 (35.9%) | 0.644 |
Genetic and phenotype characteristics: hvKp vs cKp
Characteristic | HvKp(34) | cKp(39) | P value |
---|---|---|---|
K serotype | |||
K1 |
17 (50.0%)
|
1 (2.6%)
|
0.000
|
K2 | 7 (2.9%) | 2 (5.1%) | 0.073 |
K5 | 2 (5.9%) | 0 (0%) | 0.213 |
K20 | 2 (5.9%) | 2 (5.1%) | 1.000 |
K54 | 3 (8.8%) | 0 (0%) | 0.096 |
K57 | 4 (11.8%) | 3 (7.7%) | 0.849 |
rmpA |
27 (79.4%)
|
4 (10.3%)
|
0.000
|
rmpA2 |
28 (82.4%)
|
5 (12.8%)
|
0.000
|
magA |
30 (88.2%)
|
17 (43.6%)
|
0.000
|
Hypermucoviscosity |
29 (85.3%)
|
8 (20.5%)
|
0.000
|
Antimicrobial resistance analysis and detection rate of ESBL-producing Kp isolates
Antibiotic agent | HvKp(34) | cKp(39) | P value |
---|---|---|---|
MDR |
14 (41.2%)
|
29 (74.4%)
|
0.004
|
ESBLs |
13 (38.2%)
|
27 (69.2%)
|
0.008
|
Ampicillin | 34 (100%) | 39 (100%) | NA |
Amikacin | 6 (17.6%) | 12 (30.8%) | 0.194 |
Gentamicin |
8 (23.5%)
|
21 (53.8%)
|
0.008
|
Ampicillin/Sulbactam |
13 (38.2%)
|
27 (69.2%)
|
0.008
|
Aztreonam |
10 (29.4%)
|
21 (53.8%)
|
0.035
|
Cefazolin |
14 (41.2%)
|
28 (71.8%)
|
0.008
|
Cefotetan |
8 (23.5%)
|
16 (41.0%)
|
0.112
|
Cefepime | 9 (26.5%) | 18 (46.2%) | 0.082 |
Ceftriaxone | 13 (38.2%) | 23 (59.0%) | 0.077 |
Ceftazidime |
10 (29.4%)
|
23 (59.0%)
|
0.011
|
Ciprofloxacin | 10 (29.4%) | 20 (51.3%) | 0.058 |
Levofloxacin | 9 (26.5%) | 19 (48.7%) | 0.051 |
Trimethoprim/Sulfamethoxazole |
7 (20.6%)
|
22 (56.4%)
|
0.002
|
Piperacillin/Tazobactam |
8 (23.5%)
|
18(46.2%)
|
0.044
|
Imipenem | 8 (23.5%) | 10(25.6%) | 0.835 |
Meropenem | 9 (26.5%) | 10(25.6%) | 0.936 |
Tobramycin |
10 (29.4%)
|
21(53.8%)
|
0.027
|
Risk factors for VAP-hvKp
Variable | Univariate OR (95% CI) | P value | Multivariate OR (95% CI) | P value |
---|---|---|---|---|
Infection occurred in ICU | 1.387 (0.502–3.832) | 0.528 | ||
Male | 1.181 (0.245–5.694) | 0.836 | ||
Pulmonary diseases | 2.260 (0.536–9.539) | 0.267 | ||
Diabetes | 1.478 (0.586–3.725) | 0.408 | ||
Cardiovascular disease | 0.706 (0.274–1.818) | 0.471 | ||
Cerebrovascular disease | 0.765 (0.291–2.010) | 0.587 | ||
Cancer |
7.429 (1.895–29.114)
|
0.004
|
5.365 (1.199–24.007)
|
0.028
|
Surgery within 1 mo |
5.692 (1.117–29.013)
|
0.036
| ||
Digestive diseases |
3.646 (1.023–12.990)
|
0.046
| 3.713 (0.970–14.212) | 0.055 |
MLST genotypic analysis
ST2906(3) | ST37(3) | ST17(4) | ST412(5) | ST23(15) | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Na = 0 | Nb = 3 | Na = 2 | Nb = 1 | Na = 2 | Nb = 2 | Na = 2 | Nb = 3 | Na = 10 | Nb = 5 | |
K serotype | ||||||||||
K1 | 0 | 0 | 0 | 0 | 0 | 2 | 0 | 1 | 9 | 0 |
K2 | 0 | 1 | 1 | 1 | 0 | 2 | 0 | 1 | 0 | 0 |
K5 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
K20 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
K54 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
K57 | 0 | 0 | 1 | 0 | 2 | 1 | 1 | 0 | 0 | 0 |
rmpA
| 0 | 0 | 1 | 0 | 2 | 2 | 2 | 0 | 10 | 0 |
rmpA2
| 0 | 0 | 1 | 0 | 2 | 2 | 2 | 1 | 9 | 0 |
magA
| 0 | 0 | 2 | 0 | 2 | 2 | 2 | 1 | 9 | 1 |
Hmv | 0 | 0 | 0 | 0 | 2 | 2 | 2 | 1 | 9 | 0 |
hvKp (aerobactin) | 0 | 1 | 0 | 0 | 2 | 2 | 2 | 1 | 10 | 1 |
Sepsis Shock | 0 | 3 | 0 | 1 | 2 | 1 | 0 | 1 | 8 | 1 |
Died in 30 Days | 0 | 3 | 2 | 1 | 2 | 0 | 0 | 0 | 8 | 1 |