Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Juan, Chih Han; Fang, Shih; Chou, Chia Hsin; Tsai, Tsung‐Yen; Lin, Yi Tsung

doi:10.1186/s13756-019-0660-x

Cited by 20 publications

(24 citation statements)

References 29 publications

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“…In this study, K. pneumoniae was isolated from 9% of diseased chickens and 16.7% of environment samples, which is inconsistent with the findings reported in a previous study in Egypt, where K. pneumoniae was recovered from 35% of broiler chickens and 25% of water samples [ 42 ]. However, the prevalence of K. pneumoniae among contact poultry workers (22.7%) and hospitalized patients (14.4%) in the same region was lower than lately published reports in Egypt [ 7 , 42 , 43 ] or abroad, both in China [ 44 ] and Taiwan [ 45 ]. Hence, the direct transmission may be facilitated via close contact between chickens and humans as evidenced previously by Davis et al [ 46 ].…”

Section: Discussionmentioning

confidence: 63%

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Elmonir

El-Aziz

Tartor

et al. 2021

Biology

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This study investigated the frequency of carbapenem and colistin resistance in ESBL-producing K. pneumoniae (ESBLK) isolates recovered from chickens and their environment, contact farm workers and hospitalized patients in Egypt. Further, the phenotypic and genotypic relationships between the community and hospital-acquired K. pneumoniae isolates in the same geographical area were investigated. From 272 total samples, 37 (13.6%) K. pneumoniae isolates were identified, of which 20 (54.1%) were hypervirulent. All isolates (100%) were multidrug-resistant (MDR) with multiple antibiotic resistance (MAR) indices ranging from 0.19 to 0.94. Colistin-resistant isolates (18.9%) displayed colistin MIC values >2 μg/mL, all harbored the mcr-1 gene. All isolates from patients (13/90, 14.4%), workers (5/22, 22.7%), chickens (9/100, 9%) and the environment (10/60, 16.7%) harbored a single or multiple β-lactamase genes, blaSHV, blaTEM, blaCTX-M1 and blaOXA-1, often in combination with carbapenemase genes (blaVIM, blaNDM-1 or blaIMP; 45.9%), the mcr-1 gene (18.9%) or both (13.5%). Enterobacterial repetitive intergenic consensus (ERIC)–PCR genotyping revealed 24 distinct ERIC types (ETs) with a discrimination index of 0.961. Six ETs showed clusters of identical isolates from chicken and human sources. The increased frequency and genetic relatedness of ESBLK and carbapenemase-producing K. pneumoniae (CPK) from chickens and humans pose a public health threat that urge more prudent use of antimicrobials in chicken farms to avoid the propagation and expansion of both ESBLK and CPK from the chicken sources to humans.

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Section: Discussionmentioning

confidence: 63%

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Elmonir

El-Aziz

Tartor

et al. 2021

Biology

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“…A more recent report by Harada et al demonstrated that more than half of hvKp infections from seven different hospitals in Japan were healthcare-associated or nosocomial [ 31 ]. Additionally, Chih-Han Juan, et al reported that hvKp were prevalent in community-acquired, healthcare-associated and hospital-acquired pneumonia patients [ 32 ]. These data are consistent with our findings that hvKp appears to be infiltrating into our healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China

Liu

Xiao

et al. 2020

Virulence

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Objectives Hypervirulent Klebsiella pneumoniae(hvKp) is an increasingly important pathogen. Tracking its epidemiology and evolving antimicrobial resistance will facilitate care. Methods A retrospective study was conducted in two hospitals. We collected the clinical data. Antimicrobial and virulence-associated phenotype and genotype, sequence type, and whole genome sequencing of selected strains were performed. HvKp was defined by the presence of some combination of p rmpA, p rmpA2, iucA, iroB, and peg-344, genes shown to accurately identify hvKp. Results Of 158 Kp clinical isolates, 79 (50%) were hvKp. Interestingly, 53/79 (67.1%) of hvKp strains were isolated from patients with nosocomial infection and 19/79 (24.1%) from patients with healthcare-associated infection, but only 7/79 (8.8%) from patients with community-acquired infections. Importantly, 27/53 (50.9%) and 4/19 (21.1%) of hvKp nosocomial and healthcare-associated isolates, respectively, were multi-drug-resistant (MDR); 25/53 (47.2%) and 5/19 (26.3%) expressed ESBLs and 14/53 (26.4%) and 2/19 (10.5%) were carbapenem-resistant. Of the hvKp isolates from community-acquired infection, 0/7 (0%) were MDR and 0/7 (0%) were carbapenem-resistant. Additionally, unique characteristics of nosocomial, healthcare-associated, and community-acquired hvKp infection were identified. In summary, 50% of K. pneumoniae infections were caused by hvKp. A concerning, novel finding from this report is a major shift in hvKp epidemiology. Ninety-one percent of hvKp infections were nosocomial or healthcare-associated, and 43.1% of these isolates were MDR. Conclusions These data suggest that hvKp may be replacing classical K. pneumoniae as the dominant nosocomial and healthcare-associated pathotype. Ongoing surveillance is needed to determine if this trend is occurring elsewhere.

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“…11 A recent study that assessed CAP due to K. pneumoniae (isolated HV-KP accounted for 54 of 68 patients; 79.4%) also reported chronic kidney disease (66.2%) and malignancy (38.2%) as being common co-morbidities. 14 However, the present case was not complicated by other conditions, and the patient was an elderly woman, suggesting that the HV-KP strain causing CAP might have different clinical characteristics from those of the typical HV-KP strain that causes liver abscess, meningitis, and endophthalmitis. 2 In this case, the patient had bacteremia in addition to septic shock and respiratory failure in the initial presentation.…”

Section: Discussionmentioning

confidence: 67%

“…The Characteristics of Nine Adult Cases with Community-Acquired Pneumonia Due to Hypervirulent Klebsiella pneumoniae Including the Present Case[14][15][16] …”

mentioning

confidence: 97%

<p>The First Case of Community-Acquired Pneumonia Due to Capsular Genotype K2-ST86 Hypervirulent <em>Klebsiella pneumoniae</em> in Okinawa, Japan: A Case Report and Literature Review</p>

Hirai¹,

Sakanashi²,

Kinjo³

et al. 2020

IDR

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Hypervirulent Klebsiella pneumoniae (HV-KP) typically causes pyogenic liver abscess and bacteremia with metastatic infections. Community-acquired pneumonia (CAP) due to HV-KP is uncommon and details of its clinical and microbiological features are limited. We report the first case of CAP due to capsular genotype K2-ST86 HV-KP in Okinawa, Japan and review infections caused by the K2-ST86 strain. A 79-year-old woman presenting with fever and productive cough persisting for the past three days was admitted to hospital. Her vital signs indicated septic shock. Lung examination by auscultation revealed holo-crackle and lobar pneumonia in chest radiography, and Streptococcus pneumoniae was suspected. However, sputum and blood cultures revealed Gram-negative coccus identified as K. pneumoniae. Genetic analysis identified the isolated strain as the K2 serotype harboring rmpA, iutA, entB, and mrkD. Therefore, we identified the isolated strain as hypervirulent. The isolate belonged to ST86 as determined by multilocus sequence typing. The case was not complicated by predisposing factors such as diabetes mellitus and malignancy related to HV-KP infection; thus, this CAP-causing HV-KP strain may differ from the typical HV-KP strain that induces liver abscess. A literature review identified only nine cases with CAP due to HV-KP. In all cases, the disease mainly occurred in older males with diabetes mellitus, which makes the present case unusual, and had high rates of septic shock and death. No case, including ours, was complicated by metastatic infection, suggesting that CAP due to HV-KP poses little distant metastasis risk, even in patients with bloodstream infection. In our review, consistent with our case, K2-ST86 was the most common strain of HV-KP in patients with CAP. Therefore, studies are needed to elucidate the clinical and microbiological features of HV-KP CAP, with a focus on the K2-ST86 strain. Physicians should always consider K. pneumoniae in cases of sepsis CAP with lobar pneumonia.

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Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Cited by 20 publications

References 29 publications

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Emergence of Colistin and Carbapenem Resistance in Extended-Spectrum β-Lactamase Producing Klebsiella pneumoniae Isolated from Chickens and Humans in Egypt

Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China

<p>The First Case of Community-Acquired Pneumonia Due to Capsular Genotype K2-ST86 Hypervirulent <em>Klebsiella pneumoniae</em> in Okinawa, Japan: A Case Report and Literature Review</p>

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