Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China

Abstract

BackgroundEndogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome. Most HVKP strains display a wild-type susceptibility profile to antibiotics. However, reports of antimicrobial-resistant HVKP have increased over time, which poses a serious therapeutic dilemma.Case presentationA 25-year-old man with a liver abscess and poorly controlled diabetes mellitus was admitted for endophthalmitis due to K. pneumoniae. The isolate displayed hypermucoviscosity as determined by a positive string test and exhibited resistance to ceftazidime, piperacillin-tazobactam and amikacin. Whole genome sequencing (WGS) analysis demonstrated the isolate to be a K1-serotype strain and belong to a novel single locus variant of ST23, ST2922. In addition to the virulence genes linked to HVKP, rmpA, magA, iucABCDiutA (aerobactin), ybtAPSTUX (yersiniabactin) and iroBDN (salmochelin), it was found to harbor extended-spectrum β-lactamase (ESBL) gene (blaCTX-M-14), AmpC β-lactamase gene (blaDHA), and 16S rRNA methylase gene (armA).ConclusionsThis is the first known case of endogenous endophthalmitis caused by a multidrug-resistant HVKP strain ever reported in China. Early diagnosis and treatment with intravenous and intravitreal injection of carbapenem were essential for a favorable visual outcome.

Klebsiella pneumoniae-induced multiple invasive abscesses

“…The K1 serotype of K pneumoniae is the major serotype that induces deep abscesses. [4,11,12] Invasive infection caused by K pneumoniae is common in immunosuppressed patients, but it could also be observed in some immunocompetent patients. It was reported that prevalence of K pneumoniae in healthy adults was 75%, with a high prevalence (23%) of serotype K1 or K2 isolates in Taiwan.…”

“…Other manifestations include lumbar or cervical spondylitis and discitis, septic pulmonary emboli, lung abscesses, splenic abscesses, necrotizing fasciitis, neck abscesses, cerebral abscesses, purulent meningitis, otitis media, osteomyelitis, arthritis, prostate abscesses, pylephlebitis, and psoas muscle abscesses. [10–12,16–18] The outcome of some patients with K pneumoniae -induced endophthalmitis could be complete visual loss. [2,10–12] Furthermore, severe K pneumoniae infection could result in death because of intracranial hypertension, cerebral hernia, and sepsis.…”

“…[10–12,16–18] The outcome of some patients with K pneumoniae -induced endophthalmitis could be complete visual loss. [2,10–12] Furthermore, severe K pneumoniae infection could result in death because of intracranial hypertension, cerebral hernia, and sepsis. [1,17] CT and enhanced CT scans are the best imaging examinations for discovering deep abscesses, especially those in the lungs, brain, pelvis, spine, and abdomen.…”

Renal abscesses and endogenous endophthalmitis due to hypermucoviscous hypervirulent Klebsiella pneumoniae (HVKP)

“…In East Asia, however Gram-negative bacterial particularly Klebsiella pneumoniae (KP) is more common. 3 Arising trend of KP infection has been observed worldwide [ 6 ]. The visual prognosis of Klebsiella infections is poor.…”

Abordaje interdisciplinario de endoftalmitis endógena neonatal. Reporte de caso

“…1 Las endoftalmitis endógenas en niños son raras; constituyen entre el 0,1 % y el 4 % de las endoftalmitis. 2 Los tejidos que primero se ven afectados son la retina, la coroides y el cuerpo ciliar, ya que tienen un alto flujo sanguíneo. Además, pueden estar enmascaradas como una uveítis, una celulitis preseptal, glaucoma congénito, conjuntivitis o un retinoblastoma.…”