Hypervirulent Klebsiella pneumoniae, a 5-year study in a French ICU

Rafat, Cédric; Messika, Jonathan; Barnaud, Guilène; Dufour, Nicolas; Magdoud, Fatma; Billard-Pomarès, Typhaine; Gaudry, Stéphane; Dreyfuss, Didier; Branger, Catherine; Decré, Dominique; Ricard, Jean‐Damien

doi:10.1099/jmm.0.000788

Cited by 47 publications

(41 citation statements)

References 43 publications

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“…Global dissemination of hvKp. Following early reports of hvKp in Asia, it is now apparent that hvKp has spread globally, including India [163,164], Europe [32,34,35,37,[165][166][167][168], Australia [169,170] and the United States [5,30,31,36,53,171,172] and healthcare providers worldwide should recognize the threat of community-acquired hvKp in otherwise healthy individuals. The rise of hospital-acquired hvKp which may manifest in different presentations, and the convergence of multidrug resistance (MDR) and virulence either in as well as bla SHV-1 and fosA [182] AR, antimicrobial resistance; bla, beta-lactamase provides resistance to penicillins, first-and second-generation cephalosporins; bla CTX-M-24, bla CTX-M-3 and bla CTX-M-4 , ESBLs with particular activity against cefotaxime; bla KPC-2, bla (K. pneumoniae carbapenem resistance) with carbapenemase activity; bla NDM-1 , bla (New Delhi metallo-bla) with carbapenemase activity; bla OXA-32 and bla OXA-9 , ESBLs with particular activity against oxacillin; bla SHV-36 and bla SHV-11 , ESBLs; bla TEM-1A, bla TEM-1, and bla TEM-53 , ESBLs; dfrA14, trimethoprim resistance gene; ESBL, extended-spectrum betalactamase provides additional resistance to monobactams and third-generation cephalosporins; fosA, fosfomycin resistance gene; kb, kilobase, length of DNA molecule; ompK35/36, outer membrane porins that allow entry carbapenems and cephalosporins, reduced expression increases resistance; oqxAB, resistance to olaquindox and some quinolones.…”

Section: Outstanding Questions and Outlookmentioning

confidence: 99%

Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives

2019

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Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a concerning global pathogen. hvKp is more virulent than classical K. pneumoniae (cKp) and capable of causing community‐acquired infections, often in healthy individuals. hvKp is carried in the gastrointestinal tract, which contributes to its spread in the community and healthcare settings. First recognized in Asia, hvKp arose as a leading cause of pyogenic liver abscesses. In the decades since, hvKp has spread globally and causes a variety of infections. In addition to liver abscesses, hvKp is distinct from cKp in its ability to metastasize to distant sites, including most commonly the eye, lung and central nervous system (CNS). hvKp has also been implicated in primary extrahepatic infections including bacteremia, pneumonia and soft tissue infections. The genetic determinants of hypervirulence are often found on large virulence plasmids as well as chromosomal mobile genetic elements which can be used as biomarkers to distinguish hvKp from cKp clinical isolates. These distinct virulence determinants of hvKp include up to four siderophore systems for iron acquisition, increased capsule production, K1 and K2 capsule types, and the colibactin toxin. Additionally, hvKp strains demonstrate hypermucoviscosity, a phenotypic description of hvKp in laboratory conditions that has become a distinguishing feature of many hypervirulent isolates. Alarmingly, multidrug‐resistant hypervirulent strains have emerged, creating a new challenge in combating this already dangerous pathogen.

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Section: Outstanding Questions and Outlookmentioning

confidence: 99%

Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives

2019

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“…In Asian countries, such as Taiwan, Cambodia, and Shanghai, K. pneumoniae has been described as a frequent cause of bacteremia [26,27]. By contrast, CAP caused by K. pneumoniae is generally rare in Europe and USA, despite there being an increasing incidence in these regions over recent years [28,29].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Emerging antibiotics for community-acquired pneumonia

Liapikou

Cillóniz

Palomeque

et al. 2019

Expert Opinion on Emerging Drugs

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Introduction: Community-acquired pneumonia is the most common infection leading to hospitalization and death in all age groups, especially in elderly populations. Increasing antibiotic resistance among the common bacterial pathogens associated with community-acquired pneumonia, especially Streptococcus pneumoniae and staphylococci, has made its empirical treatment increasingly problematic, highlighting the need for effective antibiotic therapy. Areas covered: We searched PubMed and ClinicalTrials.gov for English-language reports of phase III clinical trials conducted between 2000 and 2019 concerning the antibiotic treatment of community-acquired pneumonia. We provide a summary of the latest approved drugs for this indication and highlight emerging drugs with a potential indication. Expert opinion: Ceftaroline (a new cephalosporine) and omadacycline (a cycline alternative), either parenterally or orally, are the only two new antibiotics to have been approved by the FDA for the treatment of community-acquired pneumonia in the last five years. Among the antimicrobials in development, Lefamulin (the first pleuromutilin), is currently in phase III development. Among the known antibiotic classes, solithromycin (a macrolide), nemonoxacin (a quinolone), and delafloxacin and zabofloxacin (both fluoroquinolones), have been studied in phase II and III in clinical trials. The availability of these new antibiotics may offer opportunities to improve the empirical treatment for community-acquired pneumonia.

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“…Although detailed clinical information was not included in all studies (n = 33), we found that this strain was mainly associated with pneumonia (especially CAP) and other infections are described as follows; CAP (n = 9), hospital-acquired pneumonia (n = 4), bacteremic pneumonia (n = 3, the types of pneumonia are unknown), bacteremia (n = 3, infectious origin is unknown), liver abscess (n = 3), meningitis (n = 2), urinary tract infection (n = 2), wound (n = 2), ventilator-associated pneumonia (n = 1), aspiration pneumoniae (n = 1), abscess (n = 1, origin is unknown), endocarditis (n = 1), and biliary tract infection (n = 1). [17][18][19][20][21][22][23][24][25][26][27][28][29][30] Our study has certain limitations. Firstly, this is a single-case report presenting minimal data.…”

Section: Discussionmentioning

confidence: 92%

“…Although data are limited, we found other HV-KP CAP cases in past reports. [17][18][19][20] Including our case, we analyzed ten adult patients with CAP due to HV-KP (Table 1). In our review, the average age was 66.3 (range, 39-90) and the prevalence of CAP due to HV-KP was slightly higher in males (70%).…”

Section: Discussionmentioning

confidence: 99%

<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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Hypervirulent Klebsiella pneumoniae, a 5-year study in a French ICU

Abstract: hvKp represent a potentially underestimated cause of fatal infections in the Western world.

Cited by 47 publications

References 43 publications

Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives

Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives

Emerging antibiotics for community-acquired pneumonia

<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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