Characterization of carbapenem-resistant Klebsiella pneumoniae in bloodstream infections: antibiotic resistance, virulence, and treatment strategies.

IF 4.8 2区 医学 Q2 IMMUNOLOGY Frontiers in Cellular and Infection Microbiology Pub Date : 2025-03-07 eCollection Date: 2025-01-01 DOI:10.3389/fcimb.2025.1541704
Chenglin Zhong, Shaohua Lin, Zeqi Li, Xuejing Yang
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Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections pose a major clinical challenge due to multidrug resistance. This study evaluated the clinical features, antibiotic resistance mechanisms, virulence factors, and the potential therapeutic impact of berberine hydrochloride (a traditional Chinese medicine) in CRKP infections.

Methods: Ninety-four CRKP isolates from bloodstream infections at the First Affiliated Hospital of Zhejiang Chinese Medical University were characterized for carbapenemase genes, antibiotic susceptibility, and virulence determinants. Clinical data were analyzed to identify risk factors for CRKP infection, and the in vitro antibacterial activity of berberine hydrochloride was assessed.

Results: Most of the isolates (71.3%) were from the intensive care unit (ICU) patients. The bla KPC gene was the predominant resistance mechanism (62.77%), while the virulence genes uge (93.62%) and wabG (92.55%) were highly prevalent. ICU admission, male sex, respiratory diseases, invasive procedures, prior use of third-generation cephalosporinase inhibitors, and absence of traditional Chinese medicine treatment were linked to poorer outcomes. Importantly, berberine hydrochloride inhibited CRKP growth in vitro, with a minimum inhibitory concentration (MIC) of 125 mg/mL.

Conclusion: Our study reveals the multifaceted resistance and virulence profiles of CRKP in bloodstream infections and highlights the potential clinical value of berberine hydrochloride as an adjunctive therapeutic agent. These findings support further clinical investigations into incorporating traditional Chinese medicine to improve outcomes in patients with CRKP bloodstream infections.

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血液感染中碳青霉烯耐药肺炎克雷伯菌的特征:抗生素耐药性、毒力和治疗策略。
背景:耐碳青霉烯肺炎克雷伯菌(CRKP)感染由于多药耐药而成为一个重大的临床挑战。本研究评估了盐酸小檗碱(一种中药)治疗CRKP感染的临床特征、抗生素耐药机制、毒力因素以及潜在的治疗效果。方法:对浙江中医药大学第一附属医院血液感染的94株CRKP进行碳青霉烯酶基因、抗生素敏感性和毒力决定因素的鉴定。分析临床资料,确定CRKP感染的危险因素,并评价盐酸小檗碱的体外抗菌活性。结果:大多数分离株(71.3%)来自重症监护病房(ICU)患者。抗性机制以bla KPC基因为主(62.77%),毒力基因uge(93.62%)和wabG(92.55%)居多。ICU住院、男性、呼吸系统疾病、侵入性手术、既往使用第三代头孢菌素酶抑制剂和缺乏中药治疗与预后较差有关。重要的是,盐酸小檗碱在体外抑制CRKP的生长,最低抑制浓度(MIC)为125 mg/mL。结论:我们的研究揭示了CRKP在血流感染中的多重耐药和毒力特征,并强调了盐酸小檗碱作为辅助治疗剂的潜在临床价值。这些发现支持进一步的临床研究,以结合中药来改善CRKP血流感染患者的预后。
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来源期刊
CiteScore
7.90
自引率
7.00%
发文量
1817
审稿时长
14 weeks
期刊介绍: Frontiers in Cellular and Infection Microbiology is a leading specialty journal, publishing rigorously peer-reviewed research across all pathogenic microorganisms and their interaction with their hosts. Chief Editor Yousef Abu Kwaik, University of Louisville is supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. Frontiers in Cellular and Infection Microbiology includes research on bacteria, fungi, parasites, viruses, endosymbionts, prions and all microbial pathogens as well as the microbiota and its effect on health and disease in various hosts. The research approaches include molecular microbiology, cellular microbiology, gene regulation, proteomics, signal transduction, pathogenic evolution, genomics, structural biology, and virulence factors as well as model hosts. Areas of research to counteract infectious agents by the host include the host innate and adaptive immune responses as well as metabolic restrictions to various pathogenic microorganisms, vaccine design and development against various pathogenic microorganisms, and the mechanisms of antibiotic resistance and its countermeasures.
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