Abstract
OBJECTIVE: To analyze the relationship between the distribution of virulence genes and resistance genes and clinical features of lower respiratory tract infections with Acinetobacter baumannii (AB) and Klebsiella pneumoniae (KP). METHODS: Lower respiratory tract specimens from patients with lung infections in the intensive care unit of the Affiliated Hospital of Guizhou Medical University were collected in December 2023, and the study population contained 32 strains of patients with AB infections and 22 strains of patients with KP infections. Target next generation sequencing (tNGS) was used to detect the pathogenic organisms, virulence genes, and drug-resistance genes, and to analyze the changes in the clinical detection indexes of different subgroups of patients. RESULTS: The highest detection rate of adeG and adeF virulence genes of AB was 62.50%; the highest detection rate of ybtE virulence gene of KP was 54.55%. Among the AB with detected virulence genes, the resistance genes OXA23 and TEM had the highest carriage; among the KP with detected virulence genes, the resistance genes KPC, TEM and SHV had the highest carriage. Patients with AB/KP infections in which the virulence gene was detected had lower Albumin (ALB) and hemoglobin (HGB), higher blood glucose (GLU), higher white blood cell (WBC) and neutrophil (NEU), and higher interleukin 6 (IL-6) and procalcitonin (PCT), compared with patients with AB/KP infections in which the virulence gene was not detected (P < 0.05). Patients with KP infections in which virulence genes were detected had higher GLU, higher WBC and NEU, and higher IL-6 and PCT compared with patients with AB infections in which virulence genes were detected (P < 0.05). Patients with KP infection without detectable virulence genes had lower HGB and higher WBC and NEU compared with patients with AB infection without detectable virulence genes (P < 0.05). CONCLUSION: The mechanism of virulence of AB and KP is mainly related to affecting bacterial biofilm formation and iron uptake; patients with AB and KP infections in which virulence genes were detected were more likely to be resistant to penicillins, cephalosporins, and carbapenems, among others; patients with pneumoniae infections of KP appeared to be more severe than patients with pneumoniae infections of AB.