肺炎克雷伯杆菌肝脓肿与非肺炎克雷伯杆菌肝脓肿的临床比较

目的:总结分析肺炎克雷伯杆菌肝脓肿与非肺炎克雷伯杆菌肝脓肿在临床方面的差异,为临床医生早诊断、早治疗提供依据．方法:总结2000-01／2005-01细菌性肝脓肿住院患者162例,利用统计学方法比较肺炎克雷伯杆菌与非肺炎克雷伯杆菌引起的肝脓肿在自然情况、伴发基础疾病、临床表现及实验室检查、肝脓肿特点、治疗方法及结果等方面的差异．结果:肺炎克雷伯杆菌肝脓肿112例(69．1％), 非肺炎克雷伯杆菌肝脓肿50例(30．9%),两组在年龄上存在统计学差异(P<0．05);两组患者在伴发糖尿病(66．1％vs 38．0％,P<0．01)、胆道疾患(14．3％vs 28．0％,P<0．05)、腹部创伤 (5．4％vs 16．0％,P<0．05)上存在统计学差异; 两组患者在贫血上存在统计学差异(60．7％vs 78％,P<0．05)．肺炎克雷伯杆菌肝脓肿多为单发脓肿,且多为单一病原体,两组间存在统计学差异(75．9％vs 58％,P<0．05;85．7％vs 64％, P<0．01)．两组间在迁徙性感染、死亡率上存在统计学差异(20．5％vs 6％,P<0．05;8．9％vs 26．0％,P<0．01)．结论:与非肺炎克雷伯杆菌肝脓肿组相比,肺炎克雷伯杆菌肝脓肿组发病年龄较低,伴发糖尿病的比例高,多为单发,单病原体,易形成迁徙性感染,死亡率较低．     

Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae

Transmission of pathogens from donor to recipient is a potential complication of organ transplantation. Herein, we describe the clinical course and outcomes of 4 transplant recipients who received tissues from a donor with multi‐organ infection with Klebsiella pneumoniae carbapenemase (KPC)‐producing K. pneumoniae. Recipient 1 underwent simultaneous liver and kidney transplantation for alpha‐1 antitrypsin deficiency and alcohol‐related cirrhosis, and acute tubular necrosis, respectively. Soon after transplantation, he developed an infected hematoma and peritonitis due to KPC‐producing K. pneumoniae despite receiving tigecycline prophylaxis. He was treated with a prolonged course of tigecycline, amikacin, and meropenem, in conjunction with surgical evacuation and percutaneous drainage of the infected fluid collections. Recipient 2 underwent living‐donor liver transplantation for cholangiocarcinoma and primary sclerosing cholangitis using vein graft from the donor infected with KPC‐producing K. pneumoniae. Culture of the preservation fluid containing the vein graft was positive for KPC‐producing K. pneumoniae. The patient received preemptive amikacin and tigecycline, and he did not develop any infection (as evidenced by negative surveillance blood cultures). The isolates from the donor and Recipients 1 and 2 were indistinguishable by pulsed‐field gel electrophoresis. Recipients 3 and 4 underwent kidney and heart transplantation, respectively; both patients received perioperative tigecycline prophylaxis and did not develop infections due to KPC‐producing K. pneumoniae. All transplant recipients had good short‐term outcomes. These cases highlight the importance of inter‐institutional communication and collaboration to ensure the successful management of recipients of organs from donors infected with multidrug‐resistant organisms.     

高毒力肺炎克雷伯杆菌的临床特征和高毒力机制

高毒力肺炎克雷伯杆菌是近年发现的具有高侵袭性、高毒力的肺炎克雷伯杆菌,能感染年轻人群导致化脓性肝脓肿、社区获得性肺炎、眼内炎以及其他部位血行播散性感染并可遗留严重后遗症,其中高黏表型和摄铁系统与其高毒力的特性密切相关,文章对近几年的高毒力肺炎克雷伯杆菌的临床特征及高毒力致病机制做总结,希望对以后的临床诊治和研究有帮助.     

肺炎克雷伯菌肝脓肿的临床及影像学特征

目的 通过全面评价肺炎克雷伯菌所致肝脓肿(KLA)患者的临床及影像学特征,使之能及时得到针对性治疗.方法 收集2001年3月至2009年1月期间入院的197例细菌性肝脓肿患者,其中KLA 106例,非肺炎克雷伯菌单菌感染所致肝脓肿(NKLA)56例,对其基础疾病、临床表现、实验室检查以及B超、CT等影像学资料进行回顾性分析.结果 在基础疾病方面,KLA患者多伴发糖尿病(53.77%比25.00%,P=0.001)、脂肪肝(16.04%比5.36%,P<0.05).在临床表现方面,KLA患者在腹痛(40.57%比57.14%,P<0.05)、乏力(19.81%比46.43%,P=0.001)、肝肿大(4.72%比14.29%,P<0.05)方面较NKLA患者表现不明显.在实验室检查方面,KLA入院时空腹血糖水平较高[(7.84±0.36)mmol/L比(5.76±0.30)mmol/L,P=0.001].影像学检查方面,两组患者皆多为右叶单发脓肿,CT检查结果提示,KLA的脓肿气腔发生率高(32.88%比13.51%,P<0.05)、边缘更为模糊(71.23%比40.54%,P<0.05),且动脉期多呈现分隔强化(41.10%比16.22%,P<0.01).结论 克雷伯菌已成为细菌性肝脓肿的主要致病菌.KLA多伴发糖尿病、脂肪肝,临床症状轻,脓肿气腔发生率高,通过影像学可对其初步诊断,及时进行针对性治疗.     

Brain abscess due to Klebsiella pneumoniae in a liver-transplanted child

Abstract: Brain abscesses are a rare, severe complication of orthotopic liver transplantation (OLT). They are almost exclusively due to fungi, Nocardia , or Toxoplasma , and usually occur within months of surgery. Here we report the case of an adolescent who developed a brain abscess due to Klebsiella pneumoniae 11.5 years after OLT. Fever was absent and laboratory parameters were not indicative of infectious disease, and therefore the diagnosis of a central nervous system neoplasm was considered. Subsequent magnetic resonance imaging and spectroscopy led to a diagnosis of a brain abscess, and to prompt appropriate antibiotic treatment. This case shows that K. pneumoniae may cause a brain abscess long after liver transplantation. The appearance of neurological symptoms should alert clinicians to consider a brain abscess even in the absence of overt clinical/laboratory signs of inflammation, which may be blunted by chronic immunosuppression.     

不同浓度黄芩苷对高毒力肺炎克雷伯菌生长及生物被膜形成能力影响的初步探讨

目的 研究黄芩苷对高毒力肺炎克雷伯菌体外生长及生物被膜形成能力的影响.方法 以编号为3的高毒力肺炎克雷伯菌临床菌株作为试验菌株,微量稀释法测定黄芩苷最低抑菌浓度(MIC);通过细菌生长曲线观察黄芩苷对高毒力肺炎克雷伯菌生长的影响;连续稀释法检测黄芩苷对高毒力肺炎克雷伯菌生物被膜内活菌计数的影响;结晶紫染色法半定量测定黄...     

Klebsiella pneumoniae invasive liver abscess syndrome with purulent meningitis and septic shock: A case from mainland China

We present a rare case of invasive liver abscess syndrome due to Klebsiella pneumoniae (K. pneumoniae) with metastatic meningitis and septic shock. A previously healthy, 55-year-old female patient developed fever, liver abscess, septic shock, purulent meningitis and metastatic hydrocephalus. Upon admission, the clinical manifestations, laboratory and imaging examinations were compatible with a diagnosis of K. pneumoniae primary liver abscess. Her distal metastasis infection involved meningitis and hydrocephalus, which could flare abruptly and be life threatening. Even with early adequate drainage and antibiotic therapy, the patient’s condition deteriorated and she ultimately died. To the best of our knowledge, this is the first case of K. pneumoniae invasive liver abscess syndrome with septic meningitis reported in mainland China. Our findings reflect the need for a better understanding of the epidemiology, risk factors, complications, comorbid medical conditions and treatment of this disease.     

糖尿病并发系统性肺炎克雷伯杆菌感染3例报道并文献复习

目的 探讨糖尿病合并系统性肺炎克雷伯杆菌感染的诊断及治疗.方法 通过对3份病例进行回顾性分析.结果 其中2例肝脓肿患者经脓肿穿刺引流临床效果良好.1例眼内炎患者经左眼玻璃体切除、激光、硅油填充术治疗效果可.结论 肺炎克雷伯杆菌引起肺脓肿、肝脓肿、眼内炎,起病急骤,进展迅速,预后差,病死率高,但临床表现并不典型,临床医生需提高重视,尤其对患有糖尿病的患者更应提高警惕.     

Natural antioxidants for non‐alcoholic fatty liver disease: molecular targets and clinical perspectives

Non‐alcoholic steatohepatitis (NASH), the progressive form of non‐alcoholic fatty liver disease (NAFLD), is emerging as a main health problem in industrialized countries. Lifestyle modifications are effective in the treatment of NAFLD; however, the long‐term compliance is low. Therefore, several pharmacological treatments have been proposed but none has shown significant efficacy or long‐term safety. Natural polyphenols are a heterogeneous class of polyphenolic compounds contained in vegetables, which are being proposed for the treatment of different metabolic disorders. Although the beneficial effect of these compounds has traditionally related to their antioxidant properties, they also exert several beneficial effects on hepatic and extra‐hepatic glucose and lipid homeostasis. Furthermore, natural polyphenols exert antifibrogenic and antitumoural effects in animal models, which appear relevant from a clinical point of view because of the association of NASH with cirrhosis and hepatocellular carcinoma. Several polyphenols, such anthocyanins, curcumin and resveratrol and those present in coffee, tea, soy are available in the diet and their consumption can be proposed as part of a healthy diet for the treatment of NAFLD. Other phenolic compounds, such as silymarin, are commonly consumed worldwide as nutraceuticals or food supplements. Natural antioxidants are reported to have beneficial effects in preclinical models of NAFLD and in pilot clinical trials, and thus need clinical evaluation. In this review, we summarize the existing evidence regarding the potential role of natural antioxidants in the treatment of NAFLD and examine possible future clinical applications.     

Klebsiella necrotizing soft tissue infections in liver transplant recipients: a case series

Necrotizing soft tissue infections (NSTI) are rare but carry high mortality rates. NSTI with Klebsiella species have been previously described as associated with Klebsiella liver abscesses and endophthalmitis. Here, we describe 6 cases of NSTI in liver transplant recipients associated with Klebsiella pneumoniae, 4 of which were K. pneumoniae carbapenemase (KPC)‐producing K. pneumoniae (CRKP). Increased awareness of this emerging pathogen and its association with necrotizing skin and soft tissue infection is critical, as early recognition and debridement may improve survival. Antimicrobial treatment of CRKP infections remains an ongoing challenge and implementation of enhanced infection control measures is essential.     

Impact of Klebsiella pneumoniae in lower gastrointestinal tract diseases

The 2016 Global Burden of Disease report by WHO revealed that diseases of the gastrointestinal tract (GIT) had one of the highest incidence rates worldwide. The plethora of factors that contribute to the development of GIT‐related illnesses can be divided into genetic, environmental and lifestyle factors. Apart from that, the role that infectious agents play in the development of GIT diseases has piqued the interest of researchers worldwide. The human gut harbors approximately 10¹⁴ bacteria in it with increasing concentration toward the lower GIT. Among the various microbiota that colonize the human gut, Gram‐negative bacteria have been most notoriously linked to GIT‐related diseases such as inflammatory bowel disease (IBD) including Crohn's disease and ulcerative colitis and colorectal cancer (CRC). Some of the notable culprits that have been attributed to these diseases are Bacteroides fragilis, Fusobacterium nucleatum, Escherichia coli and Helicobacter pylori. However, studies in recent years are beginning to recognize a new player, Klebsiella pneumoniae (K. pneumoniae) in the causation and progression of GIT diseases. Once synonymous with infections and diseases of the upper respiratory tract, K. pneumoniae has now emerged as one of the pathogens commonly isolated from patients with GIT diseases. However, extensive studies attributing K. pneumoniae to GIT diseases, particularly that of CRC are scanty. Therefore, this review intends to shed light on the association of K. pneumoniae in gastrointestinal diseases such as Crohn's disease, ulcerative colitis as well as CRC.     

耐碳青霉烯类肺炎克雷伯菌的耐药机制及其分子检测

肺炎克雷伯菌是引起社区获得性感染和医院感染的重要病原体,碳青霉烯类抗生素是目前治疗肺炎克雷伯菌严重感染的重要抗菌药物,而耐碳青霉烯类肺炎克雷伯菌(CR-KP)分离率逐年提升,标志着耐碳青霉烯类肺炎克雷伯菌的耐药情况愈加严峻。耐碳青霉烯类肺炎克雷伯菌可以通过β-内酰胺酶的生成、孔蛋白的改变和外排泵活性的增加导致碳青霉烯的耐药。目前分子检测方法有聚合酶链反应(PCR)类、基质辅助激光解吸电离-飞行时间质谱(MALDI-TOF MS)、下一代测序及环介导等温扩增(LAMP)技术,但部分尚未应用于临床。了解耐碳青霉烯类肺炎克雷伯菌的耐药机制,改进检测方法是非常重要的。     

糖尿病合并肺炎克雷伯杆菌性肝脓肿的临床特点及误诊分析

目的提高对糖尿病合并肺炎克雷伯杆菌肝脓肿的诊治水平。方法回顾性分析16例糖尿病合并肺炎克雷伯杆菌性肝脓肿的临床资料。结果糖尿病合并肺炎克雷伯杆菌性肝脓肿占同期收治糖尿病性细菌性肝脓肿的57.1%。临床主症有畏寒、发热、乏力,腹痛、肝区叩击痛。脓肿多为单发、局限于右肝。首诊确诊率仅37.5%,首次B超误诊率37.5%。本组在有效抗生素及B超引导下经皮肝脓肿穿刺抽脓/置管引流后均好转,无一例死亡。结论糖尿病并发肺炎克雷伯杆菌肝脓肿的临床表现不典型,易漏诊误诊。及时超声引导下行肝脓种穿刺引流,缩短疗程,预后佳。     

Immune response of γδT cells in Schistosome japonicum–infected C57BL/6 mouse liver

Systematic evaluation of the role of γδT cells during the Schistosoma japonicum infection has not been reported, despite the fact that γδT cells contribute to many infectious diseases in innate immunity. Therefore, the aim of this study was to observe the properties of γδT cells in the liver of C57BL/6 mice infected by S. japonicum. In this report, using immuno‐fluorescent histological analysis, γδT cells were found around hepatic granulomatous. Moreover, the flow cytometry results revealed that the percentage of hepatic γδT cells increased significantly after S. japonicum infection. More interestingly, a subset of CD3^?γδTCR⁺ cells were found and markedly increased after infection. Furthermore, expression of activation markers (CD25 and CD69) and cytokine profiles were detected in these hepatic CD3⁺γδTCR⁺and CD3^?γδTCR⁺ cells. The significantly higher level of CD69, IL‐4 and IL‐17 were observed in CD3⁺γδTCR⁺ cells after infection, suggesting that CD3⁺γδTCR⁺ cells instead of CD3^?γδTCR⁺ cells might play a predominant role during the infection. Finally, our results indicated that the expression of NKG2D on CD3⁺γδTCR⁺ cells was higher than that on CD3^?γδTCR⁺ cells. Collectively, γδT cells could play an important role in the liver of C57BL/6 mouse during japonicum infection.