Emerging Severe and Fatal Infections Due to Klebsiella pneumoniae in Two University Hospitals in France

Decré, Dominique; Verdet, Charlotte; Emirian, A.; Gourrierec, Thibault Le; Petit, Jean‐Claude; Offenstadt, G.; Maury, Éric; Brisse, Sylvain; Arlet, Guillaume

doi:10.1128/jcm.00676-11

Cited by 152 publications

(160 citation statements)

References 18 publications

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“…One study characterizing HV K. pneumoniae strains isolated from 4 different continents found that these strains were almost exclusively K1 strains (93%), while the remaining minority were K2 strains (235), a finding consistent with results of previous studies (18,(236)(237)(238)(239)(240)(241). Interestingly, in one study, 27/28 of the K1 HV K. pneumoniae isolates belonged to the same clonal complex (CC23), while the two K2 HV strains examined were genetically unrelated and arose from two distinct clonal lineages (ST25 and ST86) (235).…”

Section: Capsulesupporting

confidence: 81%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,357

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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Section: Capsulesupporting

confidence: 81%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,357

1,345

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“…17 With this in mind, it is of great concern that 11 fatal cases in one clinical center were connected to CRKP28 as well as 5 deaths in France. 29 In 2004, the intrinsic contamination of a 2% chlorhexidine hand soap with K. pneumonia was reported. 30 In the current study, K. pneumonia was the most prominent pathogen cultured pre-cleaning (22 of the total of 50 cases) and 13 (59.1%) were resistant to chlorhexidine.…”

Section: Pathogen (N) Antibiotic Resistant Cases (N)mentioning

confidence: 99%

“…1,23,24,27,31 Resistance to the more commonly used antimicrobials equates to the following with number of pathogens out of the total of 113 indicated in brackets: ampicillin (20), amoxicillin-clavulanic acid (25), cefuroxime (18), cotrimoxazole (29) and erythromycin (14).…”

Section: Pathogen (N) Antibiotic Resistant Cases (N)mentioning

confidence: 99%

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

Roode¹,

Bütow²

2018

Clin Med Res

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Objectives:Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. Design:A descriptive observational study. Settings:A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.Participants: All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. Inclusion criteria: written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. Exclusion criteria: patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.Methods: Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.Results: Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. Conclusions:This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

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“…It initially manifested as the cause of community-acquired primary liver abscesses, sometimes complicated by metastatic meningitis and/or endophthalmitis, and it has been described by numerous investigators in Asian countries (1). Sporadic cases of severe infections have been reported throughout the world and are now increasingly recognized in Western countries (2)(3)(4)(5)(6)(7). The reasons for this epidemiological change and global differences remain unexplained.…”

mentioning

confidence: 99%