Clinical features and virulence gene distribution of Klebsiella pneumoniae multi-site infection in patients with hospital-acquired pneumonia

Yunling GENG; Chao LIU; Ping YANG; Jiajia ZHENG; Ning SHEN; Yipeng DU

doi:10.19723/j.issn.1671-167X.2026.01.027

Journal of Peking University(Health Sciences) >

2026 , Vol. 58 >Issue 1: 201 - 207

DOI: https://doi.org/10.19723/j.issn.1671-167X.2026.01.027

Clinical features and virulence gene distribution of Klebsiella pneumoniae multi-site infection in patients with hospital-acquired pneumonia

Yunling GENG ,
Chao LIU ,
Ping YANG ,
Jiajia ZHENG ,
Ning SHEN ,
Yipeng DU ^,*

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Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China

DU Yipeng, e-mail, yipengdu1980@sina.com

Received date: 2024-05-03

Online published: 2025-01-26

Supported by

National Key Research and Development Program(2022YFC2303200)

Key Research and Development Project of Peking University Third Hospital(BYSYZD2022007)

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Abstract

Objective: To analyze the clinical features and virulence gene characteristics of Klebsiella pneumoniae multi-site infections in patients with hospital-acquired pneumonia, as well as the risk factors for death within 30 days in patients with multi-site infections, in order to provide help for clinical anti-infective treatment. Methods: The case data of hospital-acquired pneumonia patients with Klebsiella pneumoniae isolated in sputum culture from March 2018 to June 2023 in Peking University Third Hospital were selected for retrospective analysis, and a total of 128 consecutive patients were enrolled, of whom 35 were in the multi-site infection group and 93 were in the lung infection group, and the clinical data, strain sequence typing, and virulence-related genes of the patients in the two groups were analyzed and compared. Results: The differences in age, gender, proportion of the patients with length of hospital stay ≥30 days, antibiotic exposure rate within 90 days and 30-day mortality rate between the two groups were statistically significant (all P < 0.05); the differences in the proportions of combined interstitial lung disease, myocardial infarction, peripheral vascular disease, peptic ulcer, diabetes mellitus and hemiplegia between the two groups were statistically significant (all P < 0.05). The proportions of patients with Glasgow coma scale (GCS) scores < 8 points, the proportion of the patients who underwent peripherally inserted central catheter (PICC) and gastric tube invasive operation, the proportion of the presence of pleural effusion and infectious shock in the multi-site infection group were significantly higher than those of the pulmonary infection group (all P < 0.05). The blood procalcitonin (PCT) level in the multi-site infection group was significantly higher than that of the pulmonary infection group (P=0.004), and the red blood cell count and hemoglobin level were significantly lower than those of the pulmonary infection group (P < 0.001). The proportion of ST11 and the detection rates of virulence genes iroB, ybtA, irp1 and fyuA in Klebsiella pneumoniae strains in the multi-site infection group were significantly higher than those in the pulmonary infection group (P < 0.05). According to the occurrence of death within 30 days, the patients in the multi-site infection group were further divided into the multi-site infection survival group (n=21) and the non-survival group (n=14). Multivariate analysis showed that septic shock was an independent risk factor for death within 30 days of multi-site infection (P=0.045, OR=38.510). Conclusion: Patients with Klebsiella pneumoniae multi-site infection were mainly found in patients with advanced age, female, more comorbidities, performing invasive operation and having history of antimicrobial drug exposure within 90 days. They had lower erythrocyte counts, hemoglobin levels and higher PCT levels, and were prone to pleural effusion, infectious shock. Infectious shock was an independent risk factor for death within 30 days in patients with Klebsiella pneumoniae multi-site infection. ST11 type was the most prevalent type of multi-site infectious strains, and the virulence genes iroB, ybtA, irp1, fyuA were more prevalent.

Key words： Hospital-acquired pneumonia; Klebsiella pneumoniae; Virulence; Bacterial genes; Multi-site infection

Cite this article

Yunling GENG , Chao LIU , Ping YANG , Jiajia ZHENG , Ning SHEN , Yipeng DU . Clinical features and virulence gene distribution of Klebsiella pneumoniae multi-site infection in patients with hospital-acquired pneumonia[J]. Journal of Peking University(Health Sciences), 2026 , 58(1) : 201 -207 . DOI: 10.19723/j.issn.1671-167X.2026.01.027

肺炎克雷伯菌(Klebsiella pneumoniae，KP)属于肠杆菌科克雷伯菌属，作为一种革兰阴性兼性厌氧杆菌，其广泛存在于人体上呼吸道、肠道和皮肤，是引起社区和医院获得性感染的常见致病菌之一，近年来感染率显著升高^[1-2]。高毒力KP(hypervirulent KP，hvKP)是KP的一个变种，主要发生在亚洲地区，我国也有散发病例报道^[3-4]。有学者发现，一些hvKP菌株可引起侵袭性感染，除可以引起多种原发性感染外，同时可以出现转移性扩散感染，包括肺炎、尿路感染、菌血症、化脓性肝脓肿、化脓性脑膜炎、脑脓肿、眼内炎、甲状腺脓肿等^[5-7]，这些hvKP具有侵袭性强、转移率高、致死率高等特点，对人类生命健康造成巨大威胁。

本研究拟探讨医院获得性肺炎患者KP多部位感染的临床特征及毒力基因特征，并分析这部分患者30 d内死亡的危险因素，以协助临床医生对该疾病早发现、早诊断、早治疗，改善患者预后。

1 资料与方法

1.1 病例选择

回顾性收集北京大学第三医院2018年3月至2023年6月痰培养或肺泡灌洗液培养中分离出KP的医院获得性肺炎患者的临床资料。纳入标准：(1)年龄≥65岁；(2)符合《中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南(2018年版)》的医院获得性肺炎诊断标准^[8]，胸部X线或CT显示新出现或进展性的浸润影、实变影或磨玻璃影，同时存在下列3种临床症候中的2种或以上：①发热且体温＞38 ℃，②脓性气道分泌物，③外周血白细胞计数＞10×10⁹/L或＜4×10⁹/L；(3)痰培养中分离出KP，半定量细菌菌落计数≥2+，且未分离到其他细菌。排除标准：(1)社区获得性肺炎；(2)缺失详细的临床信息；(3)临床考虑标本污染或为定植菌。

本研究获得北京大学第三医院医学科学研究伦理委员会审查批准(批准号：IRB 00006761M2021545)。

1.2 资料收集

收集患者的一般资料、合并症、疾病严重程度评分、是否接受侵入性操作、实验室检验结果以及并发症情况。一般资料包括年龄、性别、住院时长、是否入住重症监护室(intensive care unit，ICU)、90 d内抗菌药物暴露史、是否在感染后30 d内死亡、入住科室、标本来源及药敏结果；合并症包括间质性肺病、心肌梗死、周围血管疾病、脑血管疾病、消化性溃疡、糖尿病、偏瘫；疾病严重程度评分包括格拉斯哥昏迷评分(Glasgow coma scale，GCS)、Charlson合并症指数(Charlson comorbidity index，CCI)；侵入性操作包括中心静脉导管(central venous catheter，CVC)、外周静脉置入中心静脉导管(peripherally inserted central catheter，PICC)、尿管、气管插管、胃管、引流管。实验室检验包括血常规、肝功能、肾功能、降钙素原(procalcitonin，PCT)、凝血酶原时间(prothrombin time，PT)、国际标准化比值(international normalized ratio，INR)、D-二聚体(D-dimer)、糖化血红蛋白、空腹血糖(fasting blood glucose，FBG)；并发症包括胸腔积液、感染性休克、呼吸衰竭。

1.3 分组方法

本研究将患者分为多部位感染组和单纯肺部感染组进行分析。根据菌株基因组的单核苷酸基因多态性(single nucleotide polymorphism，SNPs)来确定同源菌株，研究将基因组差异＜100个SNPs的菌株定义为同源菌株。多部位感染的定义: 除痰培养外，其他体液标本(包括尿液、血液或分泌物等)KP培养阳性, 且有合并感染的临床表现，同时菌株的基因组差异＜100个SNPs。其中，尿路感染需同时满足如下条件：(1)新鲜中段尿KP培养计数>10⁵ CFU/mL(CFU为菌落形成单位，colony forming units)；(2)同时存在发热、寒战、腰痛、尿频、尿急或尿痛等泌尿系感染症状；(3)尿液浑浊或尿常规每个高倍镜视野下白细胞数＞5个。

1.4 实验方法

采用全基因组测序(whole genome sequencing，WGS)分析荚膜血清型、毒力相关基因和多位点序列分型(multilocus sequence typing，MLST)。采用拉丝试验确定KP是否为高黏液表型。hvKP定义为高黏液表型或peg-344、iroB、iucA、rmpA、rmpA2基因阳性。

DNA提取和全基因组测序：采用GenePure Pro全自动核酸纯化系统(NPA-32P，Bioer Technology，中国)和MagaBio细菌DNA快速纯化试剂盒(BSC45S1E，Bioer Technology，中国)提取DNA，采用Nanodrop(ThermoFisher，美国)评估DNA浓度和纯度。所有菌株均采用Illumina HiSeq 2500平台构建配对文库进行全基因组测序，获得150 bp读长。采用快速质量控制软件(Fast QC v12.0)获得数据，并按默认参数使用SPAdes(v3.13)进行组装。

拉丝试验：所有KP菌株均用羊血(PB0123A，OXOID，北京，中国)接种于哥伦比亚琼脂培养基，37 ℃条件下孵育过夜。使用细菌接种环竖直向上轻轻蘸起琼脂平板上的单个菌落，若菌落拉丝长度≥5 mm即为拉丝试验阳性，即菌株具有高黏液表型。

单核苷酸基因多态性测定：应用KP菌株HS11286(GenBank登录号：NC_016845.1，ST11型KP)作为全基因组学分析参考序列, 将测序获得的数据片段使用Bowtie 2 v2.2.8软件比对至参考序列上，并使用Samtools v1.9识别单核苷酸基因多态性。

1.5 统计学分析

利用Excel软件建立数据库，使用SPSS 26.0统计软件进行分析，检验水准为α=0.05。符合正态分布的计量资料以均数±标准差表示，两组间比较采用独立样本t检验；不符合正态分布的计量资料以中位数(P₂₅，P₇₅)表示，两组间比较采用Mann-Whitney U检验。计数资料以例数(%)描述，两组间比较采用χ²检验，1≤期望频数≤5时选用连续校正卡方，样本量＜40或至少1个期望频数＜1时选用Fisher精确检验。对多部位感染存活组和死亡组数据进行Logistic回归分析。P＜0.05为差异有统计学意义。

2 结果

2.1 两组一般资料比较

本研究共连续纳入患者128例，包括多部位感染组35例和单纯肺部感染组93例。两组除入住ICU患者比例差异无统计学意义外，年龄、性别、住院时长≥30 d患者比例、90 d内抗菌药物暴露率、30 d死亡率差异均有统计学意义(P＜0.05，表 1)。多部位感染组患者更多分布在ICU和急诊科病房，标本来自尿液(19例)、血液(13例)、外科手术伤口分泌物(2例)和腹水(1例)。除四环素类、厄他培南、复发新诺明外，多部位感染组KP表现出更强的耐药性(P＜0.05，表 2)。

表1 多部位感染组与单纯肺部感染组一般资料比较

Table 1 Comparison of general information between the multi-site infection group and lung infection group

Items	Multi-site infection group (n=35)	Lung infection group (n=93)	Z/χ²	P
Age/years	85 (82, 88)	79 (69, 85)	2.513	0.012
Sex (male/female)	15/20	67/26	9.409	0.002
Length of hospitalization ≥30 d	29 (82.9)	35 (37.6)	20.802	< 0.001
Admission to intensive care unit	24 (68.6)	59 (63.4)	0.221	0.638
History of antimicrobial exposure within 90 d	34 (97.1)	75 (80.6)	5.476	0.019
30-day mortality	14 (40.0)	14 (15.1)	9.260	0.002
Distribution of specimens
Sputum and pulmonary alveolar lavage fluid	35 (100.0)	93 (100.0)
Urine	19 (54.3)	0 (0)
Blood	13 (37.1)	0 (0)
Surgical wound discharge	2 (5.7)	0 (0)
Ascites	1 (2.9)	0 (0)
Distribution of departments
Intensive care unit	20 (57.1)	36 (38.7)	3.511	0.061
Emergency department ward	7 (20.0)	7 (7.5)	2.882	0.090
Respiratory medicine department	1 (2.9)	16 (17.2)	3.385	0.066
Other internal medicine wards	6 (17.1)	21 (22.6)	0.452	0.501
Other surgical wards	1 (2.9)	13 (14.0)	2.188	0.139

Data are expressed as M (P₂₅, P₇₅), n or n(%).

表2 多部位感染组与单纯肺部感染组菌株耐药情况

Table 2 Drug resistance of the multi-site infection group and lung infection group

Items	Multi-site infection group (n=35)	Lung infection group (n=93)	P
Amoxicillin / Clavulanate	22 (73.3)	34 (47.2)	0.016
Piperacillin / Tazobactam	27 (79.4)	37 (42.0)	< 0.001
Cefatriaxone	27 (79.4)	43 (49.4)	0.003
Cefepime	28 (80.0)	42 (45.7)	0.001
Ceftazidime	28 (80.0)	42 (45.7)	0.001
Ceftazidime / Avibactam	13 (37.1)	1 (1.8)	< 0.001
Cefoperazone / Sulbactam	25 (71.4)	39 (41.9)	0.003
Levofloxacin	28 (80.0)	42 (45.7)	0.001
Ciprofloxacin	28 (82.4)	44 (51.2)	0.002
Minocycline	14 (40.0)	23 (25.0)	0.096
Doxycycline	10 (37.0)	19 (29.2)	0.463
Tigecycline	0 (0)	0 (0)
Meropenem	22 (62.8)	33 (36.3)	0.007
Imipenem	22 (62.8)	34 (37.0)	0.009
Ertapenem	20 (57.1)	35 (38.5)	0.058
Amikacin	18 (51.4)	22 (23.9)	0.003
Aztreonam	19 (73.1)	30 (43.5)	0.010
Cotrimoxazole	12 (34.2)	30 (32.6)	0.858
Colistin	4 (16.0)	1 (1.6)	0.024
Tobramycin	14 (53.8)	18 (26.5)	0.012

Data are expressed as n(%).

2.2 两组患者合并症、疾病严重程度评分、侵入操作、并发症情况比较

多部位感染组和单纯肺部感染组患者合并间质性肺病、心肌梗死、周围血管病、消化性溃疡、糖尿病、偏瘫比例差异均有统计学意义(P＜0.05)，多部位感染组GCS评分＜8分、行PICC及胃管侵入操作，以及出现胸腔积液、感染性休克的患者比例均显著高于单纯肺部感染组(P＜0.05，表 3)。

表3 多部位感染组与单纯肺部感染组合并症、疾病严重程度评分、侵入操作、并发症比较

Table 3 Comparison of comorbidities, disease severity score, invasive procedures, and complications between the multi-site infection group and lung infection group

Items	Multi-site infection group (n=35)	Lung infection group (n=93)	χ²	P
Comorbidities
Interstitial lung disease	5 (14.3)	3 (3.2)	5.309	0.021
Myocardial infarction	9 (25.7)	6 (6.5)	9.121	0.003
Peripheral vascular disease	19 (54.3)	14 (15.1)	20.455	< 0.001
Peptic ulcer	17 (48.6)	1 (1.1)	47.469	< 0.001
Diabetes mellitus	1 (2.9)	33 (35.5)	13.877	< 0.001
Hemiplegia	13 (37.1)	1 (1.1)	33.960	< 0.001
Disease severity score
CCI score>4	8 (22.9)	9 (9.7)	3.835	0.076
GCS score < 8	15 (42.9)	16 (17.2)	9.118	0.003
Invasive procedures
CVC	18 (51.4)	40 (43.0)	0.727	0.394
PICC	15 (42.9)	11 (11.8)	15.126	< 0.001
Catheter	29 (82.9)	6 (17.1)	0.175	0.676
Tracheal intubation	13 (37.1)	29 (31.2)	0.410	0.522
Gastric tube	32 (91.4)	62 (66.7)	7.993	0.005
Drainage tube	7 (20.0)	17 (18.3)	0.049	0.824
Complications
Pleural effusion	21 (60.0)	36 (38.7)	4.667	0.031
Infectious shock	13 (37.1)	8 (8.6)	15.104	< 0.001
Respiratory failure	14 (40.0)	39 (41.9)	0.039	0.843

Data are expressed as n(%). CCI, Charlson comorbidity index; GCS, Glasgow coma scale; CVC, central venous catheter; PICC, peripherally inserted central catheter.

2.3 两组实验室检验结果比较

多部位感染组患者血红细胞计数、血红蛋白水平显著低于单纯肺部感染组(P＜0.001)，但PCT水平显著高于单纯肺部感染组(P=0.004，表 4)。

表4 多部位感染组与单纯肺部感染组实验室检验结果比较

Table 4 Comparison of the laboratory test results between the the multi-site infection group and lung infection group

Items	Multi-site infection group (n=35)	Lung infection group (n=93)	t/Z	P
WBC/(×10⁹/L)	8.94 (6.88, 12.13)	9.44 (6.28, 14.25)	1.251	0.211
RBC/(×10¹²/L)	2.94±0.68	3.64±0.82	4.595	< 0.001
HB/(g/L)	89.17±19.91	110.74±25.50	4.799	< 0.001
HCT	0.28±0.07	0.34±0.08	0.438	0.662
PLT/(×10⁹/L)	195.17±114.03	207.91±96.68	1.842	0.068
NEUT/%	80.65 (69.25, 87.75)	78.45 (70.73, 83.80)	1.756	0.079
NEUT/(×10⁹/L)	6.36 (4.81, 10.30)	7.51 (4.39, 12.11)	1.016	0.310
TB/(μmol/L)	13.25 (10.10, 17.03)	12.70 (8.93, 24.63)	0.380	0.704
Cr/(μmol/L)	69.00 (37.00, 179.50)	72.50 (48.50, 98.50)	0.527	0.598
ALB/(g/L)	32.70 (29.35, 36.25)	32.15 (28.36, 35.45)	0.782	0.434
ALT/(U/L)	19.00 (13.00, 36.75)	22.50 (12.75, 42.50)	0.354	0.724
AST/(U/L)	29.00 (22.00, 37.75)	26.00 (19.00, 43.00)	1.261	0.207
ALP/(U/L)	117.00 (76.25, 141.25)	89.50 (71.75, 128.25)	1.450	0.147
PCT/(μg/L)	0.27 (0.13, 2.61)	0.11 (0.05, 0.50)	2.887	0.004
PT/s	12.90 (11.18, 14.85)	12.40 (11.48, 14.23)	0.830	0.407
INR	1.21 (1.04, 1.38)	1.15 (1.07, 1.32)	0.788	0.431
D-dimer/(mg/L)	0.71 (0.42, 1.23)	0.68 (0.28, 1.49)	1.677	0.094
HbA1C/%	6.07±0.75	6.34±0.72	0.312	0.756
FBG/(mmol/L)	5.79 (5.23, 7.54)	6.10 (5.60, 7.20)	0.538	0.591

Data are expressed as M(P₂₅, P₇₅) or $\bar x \pm s$. WBC, white blood cell; RBC, red blood cell; HB, hemoglobin; HCT, hematocrit; PLT, platelet; NEUT, neutrophil; TB, total bilirubin; Cr, creatinine; ALB, albumin; ALT, alanine aminotransferase; AST, aspartic transaminase; ALP, alkaline phosphatase; PCT, procalcitonin; PT, prothrombin time; INR, international normalized ratio; HbA1C, glycated hemoglobin; FBG, fasting blood glucose.

2.4 两组菌株序列分型及毒力基因情况比较

多部位感染组所分离出的KP中ST11型占比显著高于单纯肺部感染组(P=0.01)；iroB、ybtA、irp1、fyuA毒力基因检出率显著高于单纯肺部感染组(P均＜0.05，表 5)，但两组hvKP分布差异无统计学意义。

表5 多部位感染组与单纯肺部感染组菌株序列分型及毒力基因比较

Table 5 Comparison of sequence typing and virulence genes between the multi-site infection group and lung infection group

Items	Multi-site infection group (n=35)	Lung infection group (n=93)	χ²	P
Sequence typing			6.616	0.01
ST11	20 (57.1)	30 (32.3)
Non-ST11	15 (42.9)	63 (67.7)
Virulence genes
iucA	19 (54.3)	40 (43.0)	1.301	0.254
iroB	6 (17.1)	36 (38.7)	5.365	0.021
rmpA	9 (25.7)	38 (40.9)	2.511	0.113
rmpA2	16 (45.7)	36 (38.7)	0.517	0.472
peg-344	9 (25.7)	39 (41.9)	2.855	0.091
ybtA	30 (85.7)	61 (65.6)	5.011	0.025
irp1	30 (85.7)	61 (65.6)	5.011	0.025
fyuA	30 (85.7)	61 (65.6)	5.011	0.025
String test	12 (34.3)	28 (30.1)	0.207	0.649
hvKP	22 (62.9)	62 (66.7)	0.164	0.686

Data are expressed as n(%). The 15 non-ST11 cases in the multi-site infection group include 3 cases of ST23, 2 cases each of ST307, ST15, ST65, 1 case each of ST299, ST967, ST3336, ST375, ST792, ST395; the 63 non-ST11 cases in the lung infection group include 10 cases of ST23, 7 cases of ST412, 5 cases of ST86, 3 cases of ST307, 2 cases each of ST1049, ST22, ST25, ST592, 1 case each of ST1031, ST111, ST147, ST15, ST161, ST1699, ST17, ST1764, ST225, ST2513, ST273, ST280, ST299, ST3247, ST360, ST374, ST375, ST39, ST397, ST45, ST461, ST469, ST485, ST556, ST660, ST815, ST876, ST893, ST895, ST948. hvKP, hypervirulent Klebsiella pneumoniae.

2.5 多部位感染组30 d内死亡的危险因素分析

根据感染后是否出现30 d内死亡将多部位感染组进一步分为多部位感染存活组(n=21)和多部位感染死亡组(n=14)，多因素分析表明，感染性休克是多部位感染30 d内死亡的独立危险因素(P=0.045，OR=38.510，表 6)。

表6 多部位感染存活组与死亡组多因素分析

Table 6 Multivariate analysis of survivors and deaths in the multi-site infection group

Items	B	Standard error of B	Wald χ²	P	OR
RBC	6.229	4.929	1.597	0.206	507.157
HB	-0.316	0.209	2.271	0.132	0.729
PLT	-0.013	0.009	1.905	0.168	0.987
D-dimer	0.400	0.358	1.245	0.265	1.492
Infectious shock	3.651	1.819	4.027	0.045	38.510
hvKP	-0.147	1.312	0.013	0.911	0.863

RBC, red blood cell; HB, hemoglobin; PLT, platelet; hvKP, hypervirulent Klebsiella pneumoniae.

3 讨论

KP作为一种院内感染的重要条件致病菌，可导致呼吸系统、泌尿系统、血液系统、消化系统及中枢神经系统等多部位感染^[9]。本研究共收集北京大学第三医院2018—2023年医院获得性肺炎KP多部位感染患者35例和单纯肺部感染患者93例，其中，多部位感染KP的患者主要分布于ICU和急诊科(77.1%)，标本主要来源于患者的痰液、尿液和血液，这与其他研究一致^[10]。本研究中呼吸系统及泌尿系统共感染KP的患者占比54.3%(19/35)，而已有的其他研究报道呼吸系统及血液系统共感染的患者较多^[9]，提示临床医生在发现KP肺部感染时，同时要注意有无泌尿系统或血液系统感染，并及时留取标本培养，以指导后续治疗。

本研究发现KP多部位感染多发生在高龄、女性、住院时长≥30 d，合并有间质性肺病、心肌梗死、周围血管病、消化性溃疡、偏瘫，治疗过程中进行了侵入性操作及有90 d内抗菌药物暴露史的患者，考虑与这部分患者免疫力低下、基础疾病多、病情严重及可能存在抗菌药物耐药等相关。刘秀凤等^[11]报道院内感染KP的危险因素为多病共存及侵入性操作病史，本研究与其结果一致。本研究中，多部位感染组糖尿病患者所占比例较单纯肺部感染组少，与其他研究结果不一致^[12-13]，考虑与本研究样本量较少有关。

本研究发现多部位感染组具有更低的红细胞计数、血红蛋白水平，更高的PCT水平，易出现胸腔积液、感染性休克，说明多部位感染患者更易出现贫血，感染程度也更重，从而并发症发生率也更高。在多部位感染组内以是否出现30 d内死亡为结局事件，将患者分为多部位感染存活组和死亡组，多因素回归分析发现感染性休克是医院获得性肺炎KP多部位感染患者30 d内死亡的独立危险因素，出现感染性休克的KP多部位感染患者30 d内死亡风险是未出现感染性休克患者的38.510倍。

hvKP作为高毒力菌株，我们推测其侵袭能力可能高于非高毒力菌株，但对本研究中128株KP进行hvKP鉴定后发现，多部位感染组中hvKP有22株(占62.9%)，单纯肺部感染组hvKP有62株(占66.7%)，两组间差异并无统计学意义。进一步分析发现多部位感染组菌株以ST11型为主，与马海艳等^[14]研究结果一致，且多部位感染组菌株iroB、ybtA、irp1、fyuA基因携带率更高，提示对于序列分型为ST11且检出以上毒力基因的KP，需警惕是否合并多部位感染，从而早期干预，改善预后。另外，高龄、合并疾病多及侵入性操作多，也可能导致多部位感染风险增加。

本研究存在一定局限性，作为一项单中心回顾性研究，本研究病例数较少，且代表性有限，今后的研究将收集更多病例，进一步探讨KP感染的毒力基因与临床转归的关系，为临床治疗提供更有说服力的数据。

综上所述，与单纯肺部感染相比，KP多部位感染的患者多见于高龄、女性，多有基础疾病史、侵入性操作史及90 d内抗菌药物暴露史，具有更低的红细胞计数、血红蛋白水平及更高的PCT水平，易出现胸腔积液、感染性休克。感染性休克是KP多部位感染患者30 d内死亡的独立危险因素。致多部位感染菌株中以ST11型为主，iroB、ybtA、irp1、 fyuA基因携带率更高。

References

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