Klebsiella Bacteremia: An Analysis of 100 Episodes

Torre, Manuel García; Romero-Vivas, J; Martı́nez-Beltrán, J; Guerrero, Antonio; Meseguer, María Antonia; Bouza, Emilio

doi:10.1093/clinids/7.2.143

Cited by 89 publications

(47 citation statements)

References 34 publications

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“…This agrees with de la Torre et al (de la Torre et al, 1985 ) who had stated that Klebsiella infections are caused mainly by K.pneumoniae and K.oxytoca in the ratio of 4:1. This finding may be related to the pathogenic potentials and hence medical importance of these species of Klebsiella compared with others (Podschun and Ullmann, 1998).…”

Section: Antibiotics Esbl Producers N=50supporting

confidence: 93%

Prevalence and antibiotic susceptibility pattern of ESBL producing Klebsiellae isolated from clinical specimens in a Nigerian tertiary hospital

Fadeyi¹,

Zumuk²,

Raheem³

et al. 2015

African Journal of Infectious Diseases

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Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria. Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified KirbyBaeur method with the organism tested against ceftazidime (30µg), cefotaxime (30µg), amoxicillin-clavulinic acid (20/10µg), cefepime (30µg), ciprofloxacin (5µg), gentamicin (10µg), trimethoprim-sulphamethoxazole (23.75/1.25µg), imipenem (10µg) and doripenem (10µg) (Oxoid, UK). Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem. Conclusion:The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies.

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Section: Antibiotics Esbl Producers N=50supporting

confidence: 93%

Prevalence and antibiotic susceptibility pattern of ESBL producing Klebsiellae isolated from clinical specimens in a Nigerian tertiary hospital

Fadeyi¹,

Zumuk²,

Raheem³

et al. 2015

African Journal of Infectious Diseases

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“…The first is that Lcn2 is produced at normal levels in affected patients but that certain infections do not require siderophore-dependent growth. For example, bacteremia from K. pneumoniae is likely caused by seeding from other, more permissive sites (19), such as the urinary tract. The second possibility is that Ent ϩ isolates cause opportunistic infections under conditions of Lcn2 deficiency.…”

Section: Discussionmentioning

confidence: 99%

Klebsiella pneumoniae Yersiniabactin Promotes Respiratory Tract Infection through Evasion of Lipocalin 2

et al. 2011

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Klebsiella pneumoniae is a pathogen of increasing concern because of multidrug resistance, especially due to K. pneumoniae carbapenemases (KPCs). K. pneumoniae must acquire iron to replicate, and it utilizes ironscavenging siderophores, such as enterobactin (Ent). The innate immune protein lipocalin 2 (Lcn2) is able to specifically bind Ent and disrupt iron acquisition. To determine whether K. pneumoniae must produce Lcn2-resistant siderophores to cause disease, we examined siderophore production by clinical isolates (n ‫؍‬ 129) from respiratory, urine, blood, and stool samples and by defined siderophore mutants through genotyping and liquid chromatography-mass spectrometry. Three categories of K. pneumoniae isolates were identified: enterobactin positive (Ent ؉ ) (81%), enterobactin and yersiniabactin positive (Ent ؉ Ybt ؉ ) (17%), and enterobactin and salmochelin (glycosylated Ent) positive (Ent ؉ gly-Ent ؉ ) with or without Ybt (2%). Ent ؉ Ybt ؉ strains were significantly overrepresented among respiratory tract isolates (P ‫؍‬ 0.0068) and ␤-lactam-resistant isolates (P ‫؍‬ 0.0019), including the epidemic KPC-producing clone multilocus sequence type 258 (ST258). In ex vivo growth assays, gly-Ent but not Ybt allowed evasion of Lcn2 in human serum, whereas siderophores were dispensable for growth in human urine. In a murine pneumonia model, an Ent ؉ strain was an opportunistic pathogen that was completely inhibited by Lcn2 but caused severe, disseminated disease in Lcn2 ؊/؊ mice. In contrast, an Ent ؉ Ybt ؉ strain was a frank respiratory pathogen, causing pneumonia despite Lcn2. However, Lcn2 retained partial protection against disseminated disease. In summary, Ybt is a virulence factor that is prevalent among KPC-producing K. pneumoniae isolates and promotes respiratory tract infections through evasion of Lcn2.

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“…have been typed by various techniques, including bacteriocin typing," biotyping,12 ser~typing,'~*'~ bacteriophage typing,15-17 antibioticsusceptibility testing,l' protein profiling," multilocus enzyme analysis,'. 2o and several molecular techniques.8* 1 8 , 2 1 , 2 2 Each typing method has drawbacks and recent reviews have detailed their Because of the limitations of employing a single approach to typing, some investigators have used two or more typing methods for improved discrimination between isolates. '8* 26-28 Although the current trend is toward the use of mark.32 Isolates of K. pneumoniae from human, veterinary and environmental sources were obtained over a 5-year period through submission to one of us (R. P. R.) for epidemiological serotyping.…”

Section: Introductionmentioning

confidence: 99%

The use of bacteriophages to differentiate serologically cross-reactive isolates of Klebsiella pneumoniae

Pieroni

Rennie

Ziola

et al. 1994

Journal of Medical Microbiology

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Summary. In serological typing of Klebsiella pneumoniae strains from human, equine and environmental sources, the capsular identity of many isolates could not be determined because of serological cross-reactivity. A panel of 91 bacteriophages able to lyse each of the 77 capsular serotypes of K . pneumoniae was isolated and tested for the ability to distinguish between strains in a collection of 17 clinical isolates of K. pneumoniae which exhibited crossreactivity with two or more capsular type sera. Most isolates could be assigned a capsular type by performing a simple streak test with bacteriophage, although some required the application of an efficiency of plating analysis to discern capsular type. Bacteriophage typing was found to be an effective, inexpensive and clinically practical adjunct to serotyping in distinguishing serologically cross-reactive K. pneumoniae isolates, irrespective of their origin.

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Klebsiella Bacteremia: An Analysis of 100 Episodes

Cited by 89 publications

References 34 publications

Prevalence and antibiotic susceptibility pattern of ESBL producing Klebsiellae isolated from clinical specimens in a Nigerian tertiary hospital

Prevalence and antibiotic susceptibility pattern of ESBL producing Klebsiellae isolated from clinical specimens in a Nigerian tertiary hospital

Klebsiella pneumoniae Yersiniabactin Promotes Respiratory Tract Infection through Evasion of Lipocalin 2

The use of bacteriophages to differentiate serologically cross-reactive isolates of Klebsiella pneumoniae

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