一例疑似合并肺癌伴肺內轉移的高毒力肺炎克雷伯菌感染報告及文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

董晗 ¹ , 張程 ² , 劉琳 ² , 趙丹 ² ,  張湘燕 ^1,2

1. ;
2. ;

Corresponding?author：

張湘燕, Email: zxy35762@126.com

Keywords：

高毒力肺炎克雷伯菌; 肺癌伴肺內轉移; 影像學表現

DOI：

10.7507/1671-6205.202208006

Video：

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目的探討高毒力肺炎克雷伯菌（hypervirulent Klebsilla pneumoniae，hvKP）感染患者的臨床特征、診斷方法和治療過程，提高臨床醫生對 hvKP的認識。方法回顧性分析1例hvKP感染患者的一般資料、影像學表現和治療方案，并進行相關文獻復習。結果患者男，52歲，因發熱1⁺個月入院，入院CT提示：左肺下葉外基底段胸膜下占位伴雙肺散在多發結節，周圍型肺癌伴轉移？炎性？肝S6-7段占位，肝膿腫？痰及肝膿液培養均發現肺炎克雷伯菌，二代測序示肺炎克雷伯菌，故考慮為hvKP感染。根據藥敏結果先后調整抗生素為美羅培南（1.0 g 2次/d）聯合頭孢他啶（3.0 g 2次/d）、左氧氟沙星（0.5 g 1次/d）聯合頭孢他啶（3.0 g 2次/d）、頭孢哌酮鈉舒巴坦鈉聯合阿米卡星治療，并予引流肝膿腫及胸腔積液后，患者癥狀、體征和影像學異常均明顯好轉，隨訪復查，病灶基本吸收。結論肺炎克雷伯菌肝膿腫合并膿毒性肺栓塞患者，影像表現疑似肺癌伴肺內轉移。針對該類患者，臨床醫生應考慮肺炎克雷伯菌感染可能，盡早獲取病原學證據，同時關注hvKP常見的侵襲部位，結合藥敏試驗及抗生素藥效學/藥代動力學特點，選用合適的抗生素，從而改善疾病預后。

Citation： 董晗, 張程, 劉琳, 趙丹, 張湘燕. 一例疑似合并肺癌伴肺內轉移的高毒力肺炎克雷伯菌感染報告及文獻復習. 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, Nu?ez 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, 孔旭東. 3例高毒力肺炎克雷伯菌致肝膿腫侵襲綜合征患者抗感染治療的藥學服務實踐. 中南藥學, 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.	張森森, 張納新. 肺炎克雷伯菌肝膿腫合并膿毒性肺栓塞30例臨床分析. 中國感染與化療雜志, 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.	章順軼, 陳岳祥. 細菌性肝膿腫診治進展. 臨床肝膽病雜志, 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.	盧銘, 呂海霞. 高毒力肺炎克雷伯菌引起肝膿腫并膿毒性肺栓塞1例. 西南國防醫藥, 2019, 29(7): 812-813.
28.	張萍, 許峰, 梁奇明, 等. 高毒力肺炎克雷伯菌致重癥顱內感染1例. 中華神經科雜志, 2022, 55(3): 229-233.
29.	葉晨安, 殷杏, 李敏, 等. 高毒力肺炎克雷伯菌引起的嚴重膿毒癥致內源性眼內炎1例. 臨床急診雜志, 2017, 18(5): 395-398.
30.	任泓沁, 趙倩, 楊文, 等. 耐碳青霉烯類高毒力肺炎克雷伯菌致多發膿腫1例并文獻復習. 華北理工大學學報(醫學版), 2022, 24(4): 319-323.
31.	周健. 1例高毒力肺炎克雷伯菌肝膿腫侵襲綜合征診治報告. 2018年浙江省醫學會熱帶病與寄生蟲病學術年會論文匯編, 2018: 14-28.
32.	吳敏, 謝璐濤. 高毒力肺炎克雷伯桿菌顱內感染致死亡1例. 溫州醫科大學學報, 2022, 52(11): 928-930.
33.	趙飛凡, 郭金玉, 于鵬飛, 等. 1例高毒力侵襲性肺炎克雷伯菌肝膿腫綜合征致膿毒癥休克的護理. 中西醫結合護理(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, Nu?ez 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, 孔旭東. 3例高毒力肺炎克雷伯菌致肝膿腫侵襲綜合征患者抗感染治療的藥學服務實踐. 中南藥學, 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. 張森森, 張納新. 肺炎克雷伯菌肝膿腫合并膿毒性肺栓塞30例臨床分析. 中國感染與化療雜志, 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. 章順軼, 陳岳祥. 細菌性肝膿腫診治進展. 臨床肝膽病雜志, 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. 盧銘, 呂海霞. 高毒力肺炎克雷伯菌引起肝膿腫并膿毒性肺栓塞1例. 西南國防醫藥, 2019, 29(7): 812-813.
28. 張萍, 許峰, 梁奇明, 等. 高毒力肺炎克雷伯菌致重癥顱內感染1例. 中華神經科雜志, 2022, 55(3): 229-233.
29. 葉晨安, 殷杏, 李敏, 等. 高毒力肺炎克雷伯菌引起的嚴重膿毒癥致內源性眼內炎1例. 臨床急診雜志, 2017, 18(5): 395-398.
30. 任泓沁, 趙倩, 楊文, 等. 耐碳青霉烯類高毒力肺炎克雷伯菌致多發膿腫1例并文獻復習. 華北理工大學學報(醫學版), 2022, 24(4): 319-323.
31. 周健. 1例高毒力肺炎克雷伯菌肝膿腫侵襲綜合征診治報告. 2018年浙江省醫學會熱帶病與寄生蟲病學術年會論文匯編, 2018: 14-28.
32. 吳敏, 謝璐濤. 高毒力肺炎克雷伯桿菌顱內感染致死亡1例. 溫州醫科大學學報, 2022, 52(11): 928-930.
33. 趙飛凡, 郭金玉, 于鵬飛, 等. 1例高毒力侵襲性肺炎克雷伯菌肝膿腫綜合征致膿毒癥休克的護理. 中西醫結合護理(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內轉移的高毒力肺炎克雷伯菌感染報告及文獻復習

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