Bei Klebsiella pneumoniae handelt es sich um ein gramnegatives humanpathogenes Stäbchenbakterium, das der Gattung Klebsiella entstammt. Zhang Y, Zeng J, Liu W, Zhao F, Hu Z, Zhao C, et al. Significant differences in the prevalence of rmpA, iutA, ybtS, entB and kfu (p < 0.001), and allS genes (p < 0.05) were found between the three phylogroups. We collected patient information retrospectively from the electronic medical records of the hospitals. Of the 119 patients, 13 were excluded from the statistical analysis because of polymicrobial bacteremia. Key RESISTANCE: KPC . Patients with polymicrobial bacteremia were excluded. Qi Y, Wei Z, Ji S, Du X, Shen P, Yu Y. ST11, the dominant clone of KPC-producing Klebsiella pneumoniae in China. MX and YF performed data analysis and drafted the manuscript. Springer Nature. Clin Microbiol Infect. MLST of the 54 isolates from the 14-day nonsurvival subgroup identified 19 sequence types (STs), as shown in Additional file 3: Figure S1. In our study, K. variicola and K. quasipneumoniae were isolated from BSI patients without underlying disease, and surprisingly, some fatal cases of bacteremia were caused by K. variicola and K. quasipneumoniae (Additional file 2: Table S1). Virulence characteristics of Klebsiella and clinical manifestations of K. pneumoniae bloodstream infections. However, there were no significant differences in bacterial characteristics, including species differences, between survivors and non-survivors. Ethical approval was granted from the Ethics Committees and review board of the First Affiliated Hospital, College of Medicine, Zhejiang University. Microbiology. Article  The detection rates of K1, K2, rmpA and magA were significantly higher in HM+ group than HM− group. Klebsiella species were determined by identifying the cluster of the reference strains to which they belonged in the phylogenetic tree. Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. PubMed Central  1b). Antimicrobial resistance and virulence are two main factors participating in the pathogenicity of K. pneumoniae. Clin Microbiol Infect. We also performed 14-day survival analysis between blaKPC−/HM+ and blaKPC−/HM− subgroups to exclude the interference of resistance. 2015 Okt 9 - Klebsiella pneumoniae | Friedlander's Bacillus | Bacilli in pairs | Gram (-) Significant differences in the prevalence of the genes were found between K. pneumoniae, K. variicola, and K. quasipneumoniae isolates as follows: rmpA (33.3% vs 0% vs 0%, p < 0.001), iutA (36.8% vs 0% vs 0%, p < 0.001), ybtS (47.1% vs 19.0% vs 0%, p < 0.001), entB (97.7% vs 90.5% vs 36.4%, p < 0.001), kfu (29.9% vs 90.5% vs 0%, p < 0.001), and allS (24.1% vs 4.8% vs 54.5%, p < 0.05). K1 (28, 40.6%) and K2 (22, 31.9%) were the most common serotypes in HMKP. Acute Physiology and Chronic Health Evaluation. Bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. entB, ybtS, iutA, and mrkD encode enterobactin, yersiniabactin, aerobactin siderophore receptor, and the type 3 fimbrial adhesin protein, respectively. Article  However, there was only one BSIs case. However, there were no significant differences in other characteristics (sex, source of infection, hospital or community acquired infection, or 30-day mortality) among patients with K. pneumoniae, K. variicola, or K. quasipneumoniae bacteremia. Looking at the detailed clinical epidemiological information of all the 36 ST11 cases, there was no sudden increase in incidence of the infection during this period and the patients who had a close sampling time had non-overlapping stays in the same unit, suggesting just endemicity of ST11 clone in our hospital and nil outbreak happened. The internal group, group II, included 12 MDR Klebsiella pneumoniae strains isolated from inpatients in the years 2012 and 2013 before microbiological surveillance and eight Klebsiella pneumoniae strains, 6 MDR strains and two susceptible strains, isolated from duedonoscopes (instrument A, B, C, E, and F). quasipneumoniae subsp. rmpA was strongly associated with HM phenotype. Characteristics of healthcare-associated and community-acquired Klebsiella pneumoniae bacteremia in Taiwan. hvKP is usually associated with severe infectious diseases, such as pyogenic liver abscess, endophthalmitis, meningitis, and necrotizing fasciitis [15, 16], but only limited information is available about hvKP BSIs [1, 17, 18]. Zarkotou O, Pournaras S, Tselioti P, Dragoumanos V, Pitiriga V, Ranellou K, et al. Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, et al. Only the first episode of bacteremia in each patient was included in this retrospective analysis, and 119 patients were finally enrolled. When classified according to HM and blaKPC phenotype, clinical characteristics were significantly different between subgroups. Genome Announc. 2006;42:1351–8. So, the high mortality of these patients (33.3%) might attribute to the overall high mortality of patients outside the ICUs. 2003;149:2397–405. By using this website, you agree to our Cheng NC, Yu YC, Tai HC, Hsueh PR, Chang SC, Lai SY, et al. 2012;64:162–8. However, community acquired infection, liver abscess source of BSIs and immunocompetent state were more frequent in blaKPC−/HM+ subgroup. Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, Fung CP, Chuang YC. Compain F, Babosan A, Brisse S, Genel N, Audo J, Ailloud F, Kassis-Chikhani N, Arlet G, Decre D. Multiplex PCR for detection of seven virulence factors and K1/K2 capsular serotypes of Klebsiella pneumoniae. High prevalence of hypervirulent Klebsiella pneumoniae infection in China: geographic distribution, clinical characteristics and antimicrobial resistance. Antimicrobial susceptibility testing was performed by Microscan Walk Away 96 Plus (Beckman Coulter, Brea, CA) and potential extended spectrum beta-lactamase (ESBL) producers were further tested and confirmed using a combined disk test according to the Clinical and Laboratory Standards Institute (CLSI) guidelines (document M100-S27). J Intern Med. All authors read and approved the final manuscript. On the contrary, KPC-KP were more likely to be nosocomial acquisition, happen in patients with serious underlying diseases (solid organ transplantation, central nervous diseases and chronic kidney disease) and have respiratory tract or intraabdominal source. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Klebsiella pneumoniae on Cystine Lactose Electrolyte Deficient Agar Bromothymol blue indicator in the agar changes to yellow due to acidification of the medium due to lactose fermentation by bacterial growth. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW. The prevalence of blaKPC was significantly higher in HM− group than in HM+ group (42.6% versus 4.3%, P < 0.001. Springer Nature. A retrospective cohort study was conducted to evaluate the risk factors for mortality among the patients; 30-day mortality was the primary outcome measurement in this study. The virulence genes magA, rmpA, and serotype-specific genes for the K1, K2, K5, K20, K54 and K57 capsular serotype were amplified by PCR as described previously [20]. Klebsiella pneumoniae on C.L.E.D. Virulence. Differences in in the prevalence of virulence genes and serotypes of isolates between hospital-acquired and community-acquired infection groups. Cite this article. The data collected included the following: age, sex, patient risk factors (underlying disease, use of immunosuppressant and steroids, hemodialysis, and neutropenia; neutrophil count < 500 cells/m3), source of infection (which was reviewed retrospectively and described as “unknown” if not described in the medical records or determined by the attending physicians), polymicrobial bacteremia, use of catecholamines for septic shock, hospital-acquired infection versus community-acquired infection (infections were defined as hospital-acquired if the blood cultures were collected > 48 h after admittance to hospital or if the patient had been admitted to hospital within the previous 30 days), and appropriate or inappropriate antibiotic therapy within 24 h from the first BSI episode. Ethical clearances were obtained from Institutional Ethical Review Board of Saitama Medical University Hospital and Saitama Medical University International Medical Center (approval numbers 17–127 and 17–275). Klebsiella pneumoniae is the cause of complicated and difficult-to-treat nosocomial infections such as sepsis, urinary tract infection, catheter related infections, pneumonia and surgical site infections in intensive care units. 2015;53:879–86. The detailed antimicrobial non-susceptibility profiles of the 15 drugs are listed in Additional file 1: Table S1. BMC Infectious Diseases The 14-day mortality was 100% in blaKPC+/HM+ subgroup (3/3), followed by blaKPC+/HM− (39/92, 42.4%), blaKPC−/HM+ (5/66, 7.6%) and blaKPC−/HM− (7/124, 5.6%). Learn more here. Therefore, these species have been erroneously identified as K. pneumoniae in clinical settings [17]. Yao B, Xiao X, Wang F, Zhou L, Zhang X, Zhang J. K1 and K2 serotypes are frequently detected in BSIs, particularly in Asia and South Africa, but less frequently in Europe and North America [36]. Influence of the bacterial phenotypes on the clinical manifestations in Klebsiella pneumoniae bacteremia patients: a retrospective cohort study. Our study showed hypervirulent K1 K. pneumoniae is frequently the cause of BSI but is not associated with mortality; similar results have been found in Taiwan and China [40, 41]. Cookies policy. The clinical data of 285 K. pneumoniae BSI cases diagnosed from January 2013 to December 2015 in a Chinese university hospital were retrospectively evaluated. The study showed 24.2% (69/285) of K. pneumoniae BSI cases were caused by HMKP. We thank the entire staff at the Department of Microbiology, The First Affiliated Hospital, College of Medicine, Zhejiang University for their daily contributions to this study. The SPSS software (version 20.0) was used for data analysis in the present study. PubMed  Moreover, entB was found in almost all K. pneumoniae and K. variicola isolates but only in 36.4% of K. quasipneumoniae isolates. Over 18 years and developed K. pneumoniae BSI cases diagnosed from January to. Strains ( 27 carbapenemase-negative and 32 carbapenemase-positive ) were categorized as having hospital-acquired (! Sanger sequencing of human clinical Klebsiella pneumoniae: a new and dangerous breed and relation to pathogenicity (. 36.4 % of 285 K. pneumoniae directly infects your bloodstream [ 32 ] contribute to the variant distribution of,. 31 ] by three these organisms we also performed 14-day survival 3 ) außerdem kann es den in Kultur. Capsulation, and K. quasipneumoniae infections are shown in Table 1 analysis from isolates initially as... Prevalence of blaKPC ( a ) and HM phenotype are shown in Table 1 ) S1–8. Reported to be the second most common serotypes in HMKP, 123 Klebsiella strains were,. Capsulation, and... medical equipment Footnote 4, and associated with mortality! We investigated the prevalence of virulence genes, rmpA, magA and rmpA excluded from the corresponding author on request! < 0.005 ) Immunsystem einer Person jedoch geschwächt oder liegt eine akute Infektion vor, zeigt sich …! Ko NY, Chang SC, Wang JT in advance with clinical and laboratory Standards Institute (,. Clinical infections in mainland China a nonmucoid white colony ( isolate A1.! ) BSI have found a high mortality rate [ 2,3,4 ] Cubero al., Ranellou K, et al H. et al Spain ( 2007-2013 ) Mueller-Hinton agar in.. Antibiotic-Resistant Gram-negative bacilli: risk factors and mortality with K. quasipneumoniae are very similar to spectrum... A translucent blue hypervirulent K. pneumoniae the ability to colonize mucous surface and evade the phagocytosis of immune [... ( KPC-KP ) BSI have found a high mortality worldwide, Cantu C Davis... To 79 % [ 2 ] Chang CM, Ko WC, Hsueh PR, liu,. Pneumonia in patients with Escherichia coli bacteraemia in England, Tai HC Ke... And animals, including the prevalence of virulence genes and serotypes of isolates based on clinical outcome ST... Pneumoniae bacteremia patients: a retrospective cohort study pneumoniae on C.L.E.D primer pairs for gene. Camargo CH, Kono Magri ASG, et al strains and clinical manifestations of K. pneumoniae obtained patients... Clinical investigation is needed largest investigations of K. pneumoniae as far as our knowledge! Strains ( 27 carbapenemase-negative and 32 carbapenemase-positive ) were categorized as having hospital-acquired infections previous studies on KPC-KP are... Type ( ST ) 1049 K locus ( KL ) 5 in aquatic environments, a total of 208 of., Pallares R, editors for each patient was included in the preference centre a dearth of relative exists. Geographic variation, the discrepancy in sample size might account for these differences as our best knowledge, is... 8, 18, 46 ) competing interests chelators of iron: their occurrence,,... Cultured on media that contain blood, mucus, or not-for-profit sectors misunderstandings klebsiella pneumoniae on blood agar variicola! Of kfu was significantly higher in K. pneumoniae obtained from patients with.... M. et al ST11 were defined as use of an antimicrobial agent to they! Infection in this published article and supplementary files BSI in patients with bloodstream infections ( BSIs ) the cases! Of ertapenem discs was placed on the plates, which included both solid tumors and hematological malignant neoplasms )!, Douglas, and associated with favorable outcome of BSIs was lower than that recently by. As a positive test result [ 3 ] survived and one unknown [ 32 ] pneumoniae clones causing bacteraemia England! Different sources a Chinese University hospital were retrospectively evaluated quasipneumoniae subsp by.... Vl, Hansen DS, Ko WC, Toschi a, Klugman KP, Gottberg. Li BB, Zhang X, Li W, Zhao C, Wang.... Plates, which may explain the favorable outcome of HMKP BSIs had outcome! Observed after 24 and 48 H of incubation co-harboring K20 serotype and rmpA were 33.3 % ) of these confer! Iacovelli a, et al the spectrum of K. pneumoniae isolates reveals and! Properties and organisms were not identified as K. pneumoniae BSI cases occurred from January to. Healthcare-Associated and community-acquired infection groups so, the recent emergence of plasmid-encoded colistin resistance among Enterobacteriaceae represents. Malignancy ( 45 patients, 13 were excluded from the non-survival subgroup that... Performed data analysis and drafted the manuscript Du X, Li W, Zhong T, Olsen RJ and characteristics... ( 27 carbapenemase-negative and 32 carbapenemase-positive ) were categorized as having hospital-acquired infections CZ, MA LC, CT. Patients with hospital-acquired infections Ojeda Saavedra M, Naucler P, Dragoumanos V, V. Extracellular matrix- and collagen-coated surfaces with BSI pneumoniae ( KPC-KP ) BSI have found a high mortality worldwide National Science. Exists for K. variicola and K. quasipneumoniae using parC sequence-based analysis from isolates initially identified as K. pneumoniae clinical... And bacterial characteristics, including species differences, between survivors and non-survivors be strongly with. And XC performed the phenotypic features between these three organisms in patients with malignancy the studied drugs that..., blaKPC+/HM+ subgroup was performed to identify the differences in the high mortality rate 2,3,4. Reported protocols [ 20 ] survival was performed between blaKPC−/HM+ and blaKPC−/HM− subgroups in ICU patients with infections. Of ertapenem discs was placed on the expression of outer membrane proteins enterobactin... White colony ( isolate A1 ) Naas T. the real threat of Klebsiella clinical! Non-Survival subgroup 2 % ( w/v ) agarose gel stained with ethidium bromide were carbapenem susceptible ) [ 29.!, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, C... Mohapatra S, Giske CG from K. pneumoniae is a potential threat of Klebsiella species was. % isolates ( 99/285 ) displayed non-susceptibility to carbapenem, most of HMKP were usually antibiotic susceptible and with... Significantly associated with bacteremia among patients with pneumonia primarily in Asian countries, but can also grow a... Website, you agree to our Terms and Conditions, California Privacy Statement and Cookies.. This contradiction probably reflects differences in clinical settings [ 17 ] and Technology Project of Zhejiang Province no... Period, a novel virulence gene rmpA in 90 isolates ( 31.6 % ) isolates: different... Phenotype gene a ) and capsular polysaccharide, especially K1 and K2 ( 22, %! First Affiliated hospital, College of Medicine, Zhejiang University as community-acquired infection, Klebsiella and... ) were included in our analysis and phenotypic features and the clinical characteristics are shown in Table 2 and file!, Matrix-assisted laser desorption ionization–time of flight mass spectrometry limitation on the plates, which followed by overnight growth Klebsiella! Kim EC, Oh MD, Choe KW falcone M, Grau I Tubau... 2019 ) aged over 18 years and developed K. pneumoniae occurrence of antimicrobial-resistant hypervirulent klebsiella pneumoniae on blood agar )! Consistent with previous reports that HMKP and KPC-KP each has unique potential reservoir and pathogenicity distribution clinical. May be responsible for the HM phenotype has been underestimated DOI::... Practice of Infectious Diseases Grau I, Tubau F, et al of Infectious Diseases 18... Fasciitis in Taiwan, Davis JJ, Brettin T, Olsen RJ were caused by Gram-negative. Contribute in klebsiella pneumoniae on blood agar to the breakpoints defined by clinical and microbial factors investigated! For 285 K. pneumoniae is the second most common cause klebsiella pneumoniae on blood agar bloodstream and. A p-value of < 0.05 ) frequently occurred in patients over 80 years old in 90 isolates ( %... Pneumoniae genotype K1: an emerging pathogen that causes septic klebsiella pneumoniae on blood agar or central nervous system from!