Host and pathogen factors in Klebsiella pneumoniae upper urinary tract infections in renal transplant patients

Gołębiewska, Justyna; Krawczyk, Beata; Wysocka, Magdalena; Ewiak, Aleksandra; Komarnicka, Jolanta; Bronk, Marek; Rutkowski, Bolesław; Dębska‐Ślizień, Alicja

doi:10.1099/jmm.0.000942

Cited by 12 publications

(23 citation statements)

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“…Klebsiella pneumoniae (Kp) is responsible for many nosocomial infections, especially in immunocompromised patients [36,57]. Hospital wards with immunocompromised or immunosuppressed patients have reported more frequent outbreaks of Kp [58].…”

Section: Discussionmentioning

confidence: 99%

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Genetic Background and Antibiotic Resistance Profiles of K. pneumoniae NDM-1 Strains Isolated from UTI, ABU, and the GI Tract, from One Hospital in Poland, in Relation to Strains Nationally and Worldwide

Wysocka

Zamudio

Oggioni

et al. 2021

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In recent years, there has been an observed increase in infections caused by carbapenem-resistant Klebsiella pneumonia (Kp) strains. The aim of this study was the phenotypic and genotypic analysis of eight K. pneumoniae NDM (Kp NDM) isolates, recovered in Poland during the years 2016 and 2018 from seven patients with urinary tract infections (UTIs), asymptomatic bacteriuria (ABU), or colonization of the gut. PCR melting profile genotyping indicated a close relationship between the strains derived from 2018, which were not related to the strain isolated in 2016. WGS results were analyzed in relation to international Kp isolates. Clonal and phylogenetic analyses were performed based on multilocus sequence typing (MLST) and single nucleotide polymorphisms (SNPs) of the core genome. The metallo-β-lactamase was assigned to the NDM-1 type and the sequence was identified as ST11. Eleven antimicrobial resistance genes were detected, mostly from plasmid contigs. Unprecedented profiles of plasmid replicons were described with the IncFII/pKPX-1 dominant replicon. In terms of the KL24 and O2v1 capsular antigen profiles, these isolates corresponded to Greek strains. Strains isolated from UTI, ABU, and colonization GI tract patients were not carrying environment-specific virulence genes. Based on the assessment of strain relationships at the genome level and their direction of evolution, the international character of the sublines was demonstrated, with a documented epidemic potential in Poland and Greece. In conclusion, some groups of patients, e.g., renal transplant recipients or those with complicated UTIs, who are frequently hospitalized and undergoing antibiotic therapy, should be monitored not only for the risk of UTI, but also for colonization by Kp NDM strains.

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Section: Discussionmentioning

confidence: 99%

“…A PCR MP method was used according to the procedure described by Stojowska et al [35], with the slight modification described by Gołębiewska et al [36]. Comparisons of electrophoretic profiles, based on band position, were made using Bio-Rad software (FPQuest TM software, BioRad, Ver.…”

Section: Clonal Genetic Relatedness Analysis By Pcr Mp Genotypingmentioning

confidence: 99%

Genetic Background and Antibiotic Resistance Profiles of K. pneumoniae NDM-1 Strains Isolated from UTI, ABU, and the GI Tract, from One Hospital in Poland, in Relation to Strains Nationally and Worldwide

Wysocka

Zamudio

Oggioni

et al. 2021

Genes

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“…Earlier episodes of symptomatic UTIs caused by E. coli and ESBL+ K. pneumoniae were recorded for the two cases of asymptomatic bacteriuria described in this study. Both experienced urine flow impairment, which is a risk factor for the development of recurrent symptomatic upper UTIs in RTx recipients [ 4 ]. The HM phenotype can correlate with a urine flow impairment or difficulty in catheter draining, which could explain the recurrent UTIs in RTx recipients [ 9 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…[ 2 ]. In recent years, the importance of this opportunistic pathogen has increased significantly due to an increase in virulence and resistance to antibiotic therapy [ 3 , 4 ]. K. pneumoniae strains were found to be heterogeneous in terms of virulence factors, and recent studies showed that some virulence factors are important for growth at specific tissue sites (lungs, urinary tract, liver, and blood) [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

The New Klebsiella pneumoniae ST152 Variants with Hypermucoviscous Phenotype Isolated from Renal Transplant Recipients with Asymptomatic Bacteriuria—Genetic Characteristics by WGS

Wysocka

Zamudio

Oggioni

et al. 2020

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Klebsiella pneumoniae (Kp) is one of the most important etiological factors of urinary tract infections in renal transplant (RTx) recipients. We described the antimicrobial susceptibility phenotypes and genomic features of two hypermucoviscous (HM) Kp isolates recovered from RTx recipients with asymptomatic bacteriuria (ABU). Using whole genome sequencing (WGS) data, we showed that the strains belong to the ST152 lineage with the KL149 capsular serotype, but without rmpA/magA genes, which is typical for HM+ hypervirulent Kp. These new strains carried virulence-associated genes that predispose for urinary tract infections (UTIs). Likewise, both strains carried the ecp gene encoding pilus common for extended-spectrum β-lactamase (ESBL) Escherichia coli. Although the two ST152 isolates were closely related and differed by only nine single nucleotide polymorphisms (SNPs) in their chromosomes, they had different plasmid compositions and chromosomal elements, with isolate KP28872 carrying an ESBL plasmid and an integrative conjugative element. These two isolates are an example of the high plasticity of the K. pneumoniae accessory genome. The identification of patients with ABU matched with the correct epidemiological profiling of isolates could facilitate interventions to prevent or rapidly treat K. pneumoniae infections.

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“…Urinary tract infection, a common postoperative infection, may be associated with the use of indwelling urinary catheters. The most frequent type of infection in patients undergoing renal transplantation is urinary tract infection, which is typically caused by Klebsiella pneumoniae and ESBL-producing organisms (20). Simple urinary tract infections have no significant impact on the longterm survival of kidney transplant recipients if managed promptly (21,22).…”

Section: Complications and Outcomes Of Early Postoperative Mdro Infections In Sot Recipientsmentioning

confidence: 99%

Clinical features of multidrug-resistant organism infections in early postoperative solid organ transplantation in a single center

et al. 2021

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Background: The increasing occurrence of multidrug-resistant organisms (MDROs) infections has posed major challenge to solid organ transplantation (SOT). For SOT recipients, high-dose immunosuppressants and broad-spectrum antibiotics can markedly increase the risk of early postoperative MDRO infections and thus have adverse effects on the outcomes of SOT. Here, we analyzed the incidence and clinical features of early MDRO infections after SOT, in an attempt to provide new evidence for the control and treatment of early MDROs. Methods:The clinical data of 133 patients with MDRO infections after SOT in our department from 2017 to 2020 were retrospectively collected, and clinical features including incidence, etiologies, infection sites, and complications, were analyzed. Results:The incidence of MDRO infections after SOT was 9.9%. Simultaneous liver and kidney transplantation patients had the highest incidence of MDRO infections, followed by the recipients of liver transplantation and simultaneous pancreas-kidney transplantation; patients undergoing renal transplantation had the lowest incidence of MDRO infections. The most common pathogen was extended spectrum betalactamase (ESBL)-producing organisms (n=88, 66.2%), the most common infection site was the urinary system (n=58, 43.6%), and the main postoperative complications were urinary tract infections (n=44, 33.1%) and lung infections (n=41, 30.8%). MDRO infections were cured in most cases.Conclusions: A sound knowledge of the clinical features of MDRO infection after SOT is important for the successful prevention and treatment of these infections.

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Host and pathogen factors in Klebsiella pneumoniae upper urinary tract infections in renal transplant patients

Cited by 12 publications

References 50 publications

Genetic Background and Antibiotic Resistance Profiles of K. pneumoniae NDM-1 Strains Isolated from UTI, ABU, and the GI Tract, from One Hospital in Poland, in Relation to Strains Nationally and Worldwide

Genetic Background and Antibiotic Resistance Profiles of K. pneumoniae NDM-1 Strains Isolated from UTI, ABU, and the GI Tract, from One Hospital in Poland, in Relation to Strains Nationally and Worldwide

The New Klebsiella pneumoniae ST152 Variants with Hypermucoviscous Phenotype Isolated from Renal Transplant Recipients with Asymptomatic Bacteriuria—Genetic Characteristics by WGS

Clinical features of multidrug-resistant organism infections in early postoperative solid organ transplantation in a single center

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