Distinguishing between hypervirulent Klebsiella pneumoniae (hvKp) and classical Klebsiella pneumoniae (cKp) is a challenge to clinical laboratories. The aim of this study was to determine the practicability of combining the G. mellonella killing assay with a string test to differentiate hvKp from cKp. One hundred and three clinical K. pneumoniae isolates were collected. PCR amplification and wzi sequencing were used to determine the capsular serotype. Virulence genes allS, iro, iuc, and rmpA2, used frequently to identify hvKp, were detected by PCR. The virulence of K. pneumoniae isolates was evaluated using the following assays in parallel: molecular markers detection, G. mellonella killing assay alone, G. mellonella killing assay combined with the string test, and mouse infection. The results showed that the sensitivity, specificity, positive predictive value, and negative predictive value of combining the G. mellonella killing assay with a string test were 95.56%, 94.83%, 93.48%, and 96.49%, respectively, compared with mouse infection used as a positive reference. These values were significantly greater than those obtained using the G. mellonella killing assay only. The sensitivity, specificity, positive predictive value, and negative predictive value of allS, iro, iuc, and rmpA2 were greater than 77.78%, but less than combining the G. mellonella killing assay and string test. G. mellonella killing assay used in conjugation with the string test is a relatively simple and accurate method to assess K. pneumoniae virulence and differentiate between hvKp and cKp.

中文翻译：

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使用细线试验结合梅勒菌种的传染性，鉴定高毒肺炎克雷伯菌。

区分高毒性肺炎克雷伯菌和经典肺炎克雷伯菌对临床实验室构成了挑战。这项研究的目的是确定结合的G. mellonella杀灭测定与字符串测试以区分hvKp和cKp的实用性。收集了一百三十三临床肺炎克雷伯菌分离物。PCR扩增和wzi测序用于确定荚膜血清型。通过PCR检测经常用于鉴定hvKp的毒力基因allS，iro，iuc和rmpA2。并行使用以下测定法评估肺炎克雷伯菌的毒力：分子标记物检测，单独的沙门氏菌杀灭测定，结合线试验的沙门氏菌杀灭测定和小鼠感染。结果表明，敏感性，特异性，与用小鼠感染作为阳性参考相比，梅毒杆菌杀死试验与线试验相结合的阳性预测值和阴性预测值分别为95.56％，94.83％，93.48％和96.49％。这些值显着大于仅使用G.mellonella杀灭测定获得的值。allS，iro，iuc和rmpA2的敏感性，特异性，阳性预测值和阴性预测值均大于77.78％，但不及梅毒杆菌杀死试验和线试验的总和。与弦试验结合使用的沙门氏菌杀死试验是评估肺炎克雷伯菌毒力并区分hvKp和cKp的相对简单准确的方法。与将小鼠感染作为阳性参考相比，分别为56％，94.83％，93.48％和96.49％。这些值显着大于仅使用G.mellonella杀灭测定获得的值。allS，iro，iuc和rmpA2的敏感性，特异性，阳性预测值和阴性预测值均大于77.78％，但不及梅毒杆菌杀死试验和线试验的总和。与弦试验结合使用的沙门氏菌杀死试验是评估肺炎克雷伯菌毒力并区分hvKp和cKp的相对简单准确的方法。与将小鼠感染作为阳性参考相比，分别为56％，94.83％，93.48％和96.49％。这些值显着大于仅使用G.mellonella杀灭测定获得的值。allS，iro，iuc和rmpA2的敏感性，特异性，阳性预测值和阴性预测值均大于77.78％，但不及梅毒杆菌杀死试验和线试验的总和。与弦试验结合使用的沙门氏菌杀死试验是评估肺炎克雷伯菌毒力并区分hvKp和cKp的相对简单准确的方法。allS，iro，iuc和rmpA2的阳性预测值和阴性预测值均大于77.78％，但小于梅毒杆菌杀死试验和线试验的总和。与弦试验结合使用的沙门氏菌杀死试验是评估肺炎克雷伯菌毒力并区分hvKp和cKp的相对简单准确的方法。allS，iro，iuc和rmpA2的阳性预测值和阴性预测值均大于77.78％，但小于梅毒杆菌杀死试验和线试验的总和。与弦试验结合使用的沙门氏菌杀死试验是评估肺炎克雷伯菌毒力并区分hvKp和cKp的相对简单准确的方法。