一例疑似合并肺癌伴肺内转移的高毒力肺炎克雷伯菌感染报告及文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

董晗 ¹ , 张程 ² , 刘琳 ² , 赵丹 ² ,  张湘燕 ^1,2

1. ;
2. ;

Corresponding author：

张湘燕, Email: zxy35762@126.com

Keywords：

高毒力肺炎克雷伯菌; 肺癌伴肺内转移; 影像学表现

DOI：

10.7507/1671-6205.202208006

Video：

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目的探讨高毒力肺炎克雷伯菌（hypervirulent Klebsilla pneumoniae，hvKP）感染患者的临床特征、诊断方法和治疗过程，提高临床医生对 hvKP的认识。方法回顾性分析1例hvKP感染患者的一般资料、影像学表现和治疗方案，并进行相关文献复习。结果患者男，52岁，因发热1⁺个月入院，入院CT提示：左肺下叶外基底段胸膜下占位伴双肺散在多发结节，周围型肺癌伴转移？炎性？肝S6-7段占位，肝脓肿？痰及肝脓液培养均发现肺炎克雷伯菌，二代测序示肺炎克雷伯菌，故考虑为hvKP感染。根据药敏结果先后调整抗生素为美罗培南（1.0 g 2次/d）联合头孢他啶（3.0 g 2次/d）、左氧氟沙星（0.5 g 1次/d）联合头孢他啶（3.0 g 2次/d）、头孢哌酮钠舒巴坦钠联合阿米卡星治疗，并予引流肝脓肿及胸腔积液后，患者症状、体征和影像学异常均明显好转，随访复查，病灶基本吸收。结论肺炎克雷伯菌肝脓肿合并脓毒性肺栓塞患者，影像表现疑似肺癌伴肺内转移。针对该类患者，临床医生应考虑肺炎克雷伯菌感染可能，尽早获取病原学证据，同时关注hvKP常见的侵袭部位，结合药敏试验及抗生素药效学/药代动力学特点，选用合适的抗生素，从而改善疾病预后。

Citation： 董晗, 张程, 刘琳, 赵丹, 张湘燕. 一例疑似合并肺癌伴肺内转移的高毒力肺炎克雷伯菌感染报告及文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(3): 201-206. doi: 10.7507/1671-6205.202208006 Copy

1.	Chen YT, Chang HY, Lai YC, et al. Sequencing and analysis of the large virulence plasmid pLVPK of Klebsiella pneumoniae CG43. Gene, 2004, 337: 189-198.
2.	Marcoleta AE, Berríos-Pastén C, Nuñez G, et al. Klebsiella pneumoniae asparagine tDNAs are integration hotspots for different genomicislands encoding microcin E492 production deterniants and other putative virulence factors present in hypervirulent strains. Front Microbiol, 2016, 7: 849.
3.	Russo TA, Olson R, Fang CT, et al. Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K. pneumoniae. J Clin Microbiol, 2018, 56(9): e00776-18.
4.	Gu DX, Dong N, Zheng ZW, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis, 2018, 18(1): 37-46.
5.	Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev, 2019, 32(3): e00001-19.
6.	Wang HH, Tsai SH, Yu CY, et al. The association of haemoglobin A_1C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol, 2014, 24(5): 980-989.
7.	戴立波, 孔旭东. 3例高毒力肺炎克雷伯菌致肝脓肿侵袭综合征患者抗感染治疗的药学服务实践. 中南药学, 2020, 18(10): 1759-1763.
8.	Sink JR, Pasculle WA, Shah NB, et al. Disparate domains: cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome. Am J Med, 2017, 130(6): 673-677.
9.	张森森, 张纳新. 肺炎克雷伯菌肝脓肿合并脓毒性肺栓塞30例临床分析. 中国感染与化疗杂志, 2020, 20(6): 607-612.
10.	Li W, Sun GZ, Yu YH, et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis, 2014, 58(2): 225-232.
11.	章顺轶, 陈岳祥. 细菌性肝脓肿诊治进展. 临床肝胆病杂志, 2018, 34(7): 1577-1580.
12.	Cheng HP, Siu LK, Chang FY. Extended-spectrum cephalosporin compared to cefazolin for treatment of Klebsiella pneumoniae-caused liver abscess. Antimicrob Agents Chemother, 2003, 47(7): 2088-2092.
13.	Lee SE, Mushtaq A, Gitman M, et al. Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: a case report and genomic characterization of the isolate. IDCases, 2021, 25: e01173.
14.	Lin YC, Cao X, Mo YC, et al. Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin. IDCases, 2021, 26: e01276.
15.	Roulston KJ, Bharucha T, Turton JF, et al. A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK. JMM Case Reports, 2018, 5(9): e005130.
16.	Hirai J, Sakanashi D, Momose M, et al. Case Report of primary lung abscesses due to hypervirulent Klebsiella pneumoniae (serotype k2, sequence type 375): an emerging isolate in Okinawa, Japan. Infect Drug Resist, 2020, 13: 1691-1695.
17.	Hirai J, Sakanashi D, Kinjo T, et al. The first case of community-acquired pneumonia due to capsular genotype K2-ST86 hypervirulent Klebsiella pneumoniae in Okinawa, Japan: a case report and literature review. Infect Drug Resist, 2020, 13: 2237-2243.
18.	Salawati EM. Fatal disseminated pyogenic infection due to hypermucoviscous hypervirulent Klebsiella pneumoniae: a case report and literature review. Clin Case Rep, 2021, 9(9): e04754.
19.	Yamamoto H, Iijima A, Kawamura K, et al. Fatal fulminant community-acquired pneumonia caused by hypervirulent Klebsiella pneumoniae K2-ST86. Medicine, 2020, 99(21): e20360.
20.	Shi YF, Wang YK, Wang YH, et al. Metastatic infection caused by hypervirulent Klebsiella pneumonia and co-infection with Cryptococcus meningitis: a case report. World J Clin Cases, 2019, 7(22): 3812-3820.
21.	Chen YZ, Chen JH, Zheng N, et al. Contrast-enhanced ultrasound (CEUS) guided drainage in the treatment of a patient with lung abscess secondary to hypervirulent Klebsiella pneumoniae (HvKP) infection: a case report. Respir Med Case Rep, 2021, 32: 101343.
22.	Kaye AJ, Chin AT, Liang MC, et al. Hypervirulent Klebsiella pneumoniae infection in a woman with a CDH1 gene mutation. IDCases, 2021, 23: e01000.
23.	Konagaya K, Yamamoto H, Suda T, et al. Ruptured emphysematous prostatic abscess caused by K1-ST23 hypervirulent Klebsiella pneumoniae presenting as brain abscesses: a case report and literature review. Front Med, 2022, 8: 768042.
24.	Kong LW, Wang Y, Ji HR, et al. A case of forearm soft tissue infection caused by hypervirulent K. pneumoniae in an otherwise healthy 24-year-old woman. Infect Drug Resist, 2022, 15: 63-68.
25.	Neerhut T, Ninan J, Crozier J, et al. Urgent nephrectomy for rapidly progressive disseminated metastatic hypermucoid Klebsiella. Urol Case Rep, 2022, 44: 102157.
26.	Niimi N, Taga K, Miyagami T, et al. Rhabdomyolysis secondary to hypervirulent Klebsiella pneumoniae infection: a case report. Clin Case Rep, 2022, 10(12): e6764.
27.	卢铭, 吕海霞. 高毒力肺炎克雷伯菌引起肝脓肿并脓毒性肺栓塞1例. 西南国防医药, 2019, 29(7): 812-813.
28.	张萍, 许峰, 梁奇明, 等. 高毒力肺炎克雷伯菌致重症颅内感染1例. 中华神经科杂志, 2022, 55(3): 229-233.
29.	叶晨安, 殷杏, 李敏, 等. 高毒力肺炎克雷伯菌引起的严重脓毒症致内源性眼内炎1例. 临床急诊杂志, 2017, 18(5): 395-398.
30.	任泓沁, 赵倩, 杨文, 等. 耐碳青霉烯类高毒力肺炎克雷伯菌致多发脓肿1例并文献复习. 华北理工大学学报(医学版), 2022, 24(4): 319-323.
31.	周健. 1例高毒力肺炎克雷伯菌肝脓肿侵袭综合征诊治报告. 2018年浙江省医学会热带病与寄生虫病学术年会论文汇编, 2018: 14-28.
32.	吴敏, 谢璐涛. 高毒力肺炎克雷伯杆菌颅内感染致死亡1例. 温州医科大学学报, 2022, 52(11): 928-930.
33.	赵飞凡, 郭金玉, 于鹏飞, 等. 1例高毒力侵袭性肺炎克雷伯菌肝脓肿综合征致脓毒症休克的护理. 中西医结合护理(中英文), 2022, 8(4): 196-198.

1. Chen YT, Chang HY, Lai YC, et al. Sequencing and analysis of the large virulence plasmid pLVPK of Klebsiella pneumoniae CG43. Gene, 2004, 337: 189-198.
2. Marcoleta AE, Berríos-Pastén C, Nuñez G, et al. Klebsiella pneumoniae asparagine tDNAs are integration hotspots for different genomicislands encoding microcin E492 production deterniants and other putative virulence factors present in hypervirulent strains. Front Microbiol, 2016, 7: 849.
3. Russo TA, Olson R, Fang CT, et al. Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K. pneumoniae. J Clin Microbiol, 2018, 56(9): e00776-18.
4. Gu DX, Dong N, Zheng ZW, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis, 2018, 18(1): 37-46.
5. Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev, 2019, 32(3): e00001-19.
6. Wang HH, Tsai SH, Yu CY, et al. The association of haemoglobin A_1C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus. Eur Radiol, 2014, 24(5): 980-989.
7. 戴立波, 孔旭东. 3例高毒力肺炎克雷伯菌致肝脓肿侵袭综合征患者抗感染治疗的药学服务实践. 中南药学, 2020, 18(10): 1759-1763.
8. Sink JR, Pasculle WA, Shah NB, et al. Disparate domains: cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome. Am J Med, 2017, 130(6): 673-677.
9. 张森森, 张纳新. 肺炎克雷伯菌肝脓肿合并脓毒性肺栓塞30例临床分析. 中国感染与化疗杂志, 2020, 20(6): 607-612.
10. Li W, Sun GZ, Yu YH, et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis, 2014, 58(2): 225-232.
11. 章顺轶, 陈岳祥. 细菌性肝脓肿诊治进展. 临床肝胆病杂志, 2018, 34(7): 1577-1580.
12. Cheng HP, Siu LK, Chang FY. Extended-spectrum cephalosporin compared to cefazolin for treatment of Klebsiella pneumoniae-caused liver abscess. Antimicrob Agents Chemother, 2003, 47(7): 2088-2092.
13. Lee SE, Mushtaq A, Gitman M, et al. Lemierre's syndrome associated with hypervirulent Klebsiella pneumoniae: a case report and genomic characterization of the isolate. IDCases, 2021, 25: e01173.
14. Lin YC, Cao X, Mo YC, et al. Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin. IDCases, 2021, 26: e01276.
15. Roulston KJ, Bharucha T, Turton JF, et al. A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK. JMM Case Reports, 2018, 5(9): e005130.
16. Hirai J, Sakanashi D, Momose M, et al. Case Report of primary lung abscesses due to hypervirulent Klebsiella pneumoniae (serotype k2, sequence type 375): an emerging isolate in Okinawa, Japan. Infect Drug Resist, 2020, 13: 1691-1695.
17. Hirai J, Sakanashi D, Kinjo T, et al. The first case of community-acquired pneumonia due to capsular genotype K2-ST86 hypervirulent Klebsiella pneumoniae in Okinawa, Japan: a case report and literature review. Infect Drug Resist, 2020, 13: 2237-2243.
18. Salawati EM. Fatal disseminated pyogenic infection due to hypermucoviscous hypervirulent Klebsiella pneumoniae: a case report and literature review. Clin Case Rep, 2021, 9(9): e04754.
19. Yamamoto H, Iijima A, Kawamura K, et al. Fatal fulminant community-acquired pneumonia caused by hypervirulent Klebsiella pneumoniae K2-ST86. Medicine, 2020, 99(21): e20360.
20. Shi YF, Wang YK, Wang YH, et al. Metastatic infection caused by hypervirulent Klebsiella pneumonia and co-infection with Cryptococcus meningitis: a case report. World J Clin Cases, 2019, 7(22): 3812-3820.
21. Chen YZ, Chen JH, Zheng N, et al. Contrast-enhanced ultrasound (CEUS) guided drainage in the treatment of a patient with lung abscess secondary to hypervirulent Klebsiella pneumoniae (HvKP) infection: a case report. Respir Med Case Rep, 2021, 32: 101343.
22. Kaye AJ, Chin AT, Liang MC, et al. Hypervirulent Klebsiella pneumoniae infection in a woman with a CDH1 gene mutation. IDCases, 2021, 23: e01000.
23. Konagaya K, Yamamoto H, Suda T, et al. Ruptured emphysematous prostatic abscess caused by K1-ST23 hypervirulent Klebsiella pneumoniae presenting as brain abscesses: a case report and literature review. Front Med, 2022, 8: 768042.
24. Kong LW, Wang Y, Ji HR, et al. A case of forearm soft tissue infection caused by hypervirulent K. pneumoniae in an otherwise healthy 24-year-old woman. Infect Drug Resist, 2022, 15: 63-68.
25. Neerhut T, Ninan J, Crozier J, et al. Urgent nephrectomy for rapidly progressive disseminated metastatic hypermucoid Klebsiella. Urol Case Rep, 2022, 44: 102157.
26. Niimi N, Taga K, Miyagami T, et al. Rhabdomyolysis secondary to hypervirulent Klebsiella pneumoniae infection: a case report. Clin Case Rep, 2022, 10(12): e6764.
27. 卢铭, 吕海霞. 高毒力肺炎克雷伯菌引起肝脓肿并脓毒性肺栓塞1例. 西南国防医药, 2019, 29(7): 812-813.
28. 张萍, 许峰, 梁奇明, 等. 高毒力肺炎克雷伯菌致重症颅内感染1例. 中华神经科杂志, 2022, 55(3): 229-233.
29. 叶晨安, 殷杏, 李敏, 等. 高毒力肺炎克雷伯菌引起的严重脓毒症致内源性眼内炎1例. 临床急诊杂志, 2017, 18(5): 395-398.
30. 任泓沁, 赵倩, 杨文, 等. 耐碳青霉烯类高毒力肺炎克雷伯菌致多发脓肿1例并文献复习. 华北理工大学学报(医学版), 2022, 24(4): 319-323.
31. 周健. 1例高毒力肺炎克雷伯菌肝脓肿侵袭综合征诊治报告. 2018年浙江省医学会热带病与寄生虫病学术年会论文汇编, 2018: 14-28.
32. 吴敏, 谢璐涛. 高毒力肺炎克雷伯杆菌颅内感染致死亡1例. 温州医科大学学报, 2022, 52(11): 928-930.
33. 赵飞凡, 郭金玉, 于鹏飞, 等. 1例高毒力侵袭性肺炎克雷伯菌肝脓肿综合征致脓毒症休克的护理. 中西医结合护理(中英文), 2022, 8(4): 196-198.

Chinese Journal of Respiratory and Critical Care Medicine

一例疑似合并肺癌伴肺内转移的高毒力肺炎克雷伯菌感染报告及文献复习

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