Pyogenic liver abscess due to hypervirulent Klebsiella pneumoniae in a 14-year-old boy

Sato, Satoshi; Aoyama, Tomohiro; Uejima, Yoji; Furuichi, Mihoko; Suganuma, Eisuke; Takano, Tadamasa; Ikeda, Mahoko; Mizoguchi, Miyuki; Okugawa, Shu; Moriya, Kyoji; Niimi, Hideki; Kitajima, Isao; Kawashima, Hiroshi; Kawano, Yutaka

doi:10.1016/j.jiac.2018.07.006

Cited by 12 publications

(5 citation statements)

References 15 publications

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“…Although the causative strain was susceptible to meropenem and amikacin, no sign of improvement was observed during antimicrobial treatment. When compared with the previously reported PLA cases, 20,21 the clinical findings and unfavorable outcome of this case suggest the strong hypervirulent phenotype of the causative hvKp strain. The results of the microbiological study correlated well with the clinical presentations, and both the degree of serum resistance and the lethality rate of the causative strain KPN_19‐106 (ST380/K2) were higher than that of NTUH‐K2044.…”

Section: Discussionsupporting

confidence: 52%

A fatal case of liver abscess caused by hypervirulent Klebsiella pneumoniae in a diabetic adolescent: A clinical and laboratory study

Qian

et al. 2021

Pediatric Investigation

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Importance Hypervirulent variants of Klebsiella pneumoniae (hvKp) are capable of causing life‐threatening pyogenic liver abscesses (PLAs), but hvKp caused PLAs was seldom reported in pediatric populations. Hence, there is an urgent need to raise our awareness of this phenomenon in pediatric populations. Objective This study aimed to report the clinical characteristics of hvKp that caused fatal PLA complicated by bacteremia in an adolescent and further identify the microbiological and genomic features of the causative strain. Methods A 14‐year‐old boy with diabetes mellitus was admitted to our hospital with a diagnosis of PLA complicated by bacteremia. A hypermucoviscous hvKp strain, KPN_19‐106, was isolated from the drainage fluid present within the liver abscess cavity and blood. The hypermucoviscosity phenotype of the causative strain was determined by string test. Its virulence was measured using serum resistance assay and Galleria mellonella larvae‐killing assay. Antimicrobial susceptibility was determined by broth microdilution method. Genetic information was obtained by whole‐genome sequencing and bioinformatics analysis. Results KPN_19‐106 belonged to sequence type 380 and serotype K2 and exhibited stronger serum resistance and higher in vivo lethality than the well‐characterized hvKp NTUH‐K2044 strain. Although KPN_19‐106 is susceptible to most antibiotics, no sign of improvement was observed during treatment with such drugs. Whole‐genome sequencing revealed that the isolate had integrated multiple mobile genetic elements related to virulence. Interpretation Antibiotic‐susceptible hvKp can cause fatal PLA complicated by bacteremia in adolescents, with no improvement during antimicrobial therapy. The causative strain in this case had integrated multiple virulence genes and thus exhibited higher virulence both in vitro and in vivo when compared with NTUH‐K2044.

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Section: Discussionsupporting

confidence: 52%

A fatal case of liver abscess caused by hypervirulent Klebsiella pneumoniae in a diabetic adolescent: A clinical and laboratory study

Qian

et al. 2021

Pediatric Investigation

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“…Hsu et al reported that fever and abdominal pain were present in most pyogenic liver abscess patients, with about one-third of patients presenting with right upper abdominal pain and cough. 13 However, our patient had no obvious abdominal pain and her symptoms were not typical. Liver abscesses caused by hvKP have the characteristics of acute onset, rapid progress, and a high mortality rate.…”

Section: Discussionmentioning

confidence: 55%

A case report of pyogenic liver abscess caused by hypervirulent Klebsiella pneumoniae diagnosed by metagenomic next-generation sequencing

Xie

Zhu

2021

J Int Med Res

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A 56-year-old woman with a history of diabetes mellitus presented with high fever but no abdominal pain. An abdominal computed tomography scan showed a large liver abscess. Hypervirulent, string test-positive, rmpA/ ampA2-, and iutA-positive Klebsiella pneumoniae was rapidly identified from drainage fluid of the liver abscess using metagenomic next-generation sequencing (mNGS). After intravenous antibiotic therapy and drainage of the abscess, the patient’s condition resolved. This case report highlights the value of mNGS in rapidly and accurately identifying a pathogenic microorganism, which helps reduce the incidence of antimicrobial resistance and enables the targeted use of antibiotics.

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“…There are various mechanisms used by K. pneumoniae to evade the action of antibiotics. One of the mechanisms of antibiotic resistance is the possession of antibiotic genes called efflux pumps, which modify membrane porosity, the production of inactive enzymes and the alteration of the target location [12]. Bacteria carrying ARDs release their genes into surface waters.…”

Section: Introductionmentioning

confidence: 99%

Molecular Characterization of Antibiotic Resistance Determinants in Klebsiella pneumoniae Isolates Recovered from Hospital Effluents in the Eastern Cape Province, South Africa

Okafor

Nwodo

2023

Antibiotics

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Klebsiella pneumoniae (K. pneumoniae) is an opportunistic bacteria responsible for many nosocomial and community-acquired infections. The emergence and spread of antibiotic resistances have resulted in widespread epidemics and endemic dissemination of multidrug-resistant pathogens. A total of 145 K. pneumoniae isolates were recovered from hospital wastewater effluents and subjected to antibiogram profiling. Furthermore, the antibiotic resistance determinants were assessed among phenotypic resistant isolates using polymerase chain reaction (PCR). The isolates showed a wide range of antibiotic resistance against 21 selected antibiotics under 11 classes, with the most susceptible shown against imipenem (94.5%) and the most resistant shown against ampicillin (86.2%). The isolates also showed susceptibility to piperacillin/tazobactam (89.0%), ertapenem (87.6%), norfloxacin (86.2%), cefoxitin (86.2%), meropenem (76.6%), doripenem (76.6%), gentamicin (76.6%), chloramphenicol (73.1%), nitrofurantoin (71.7%), ciprofloxacin (79.3%), amikacin (60.7%), and amoxicillin/clavulanic acid (70.4%). Conversely, resistance was also recorded against tetracycline (69%), doxycycline (56.6%), cefuroxime (46.2%), cefotaxime (48.3%), ceftazidime (41.4%). Out of the 32 resistance genes tested, 28 were confirmed, with [tetA (58.8%), tetD (47.89%), tetM (25.2%), tetB (5.9%)], [sul1 (68.4%), sul1I (66.6%)], and [aadA (62.3%), strA (26%), aac(3)-IIa(aacC2)a (14.4%)] genes having the highest occurrence. Strong significant associations exist among the resistance determinants screened. About 82.7% of the K. pneumoniae isolates were multidrug-resistant (MDR) with a multiple antibiotics resistance index (MARI) range of 0.24 to 1.0. A dual presence of the resistant genes among K. pneumoniae was also observed to occur more frequently than multiple presences. This study reveals a worrisome presence of multidrug-resistant K. pneumoniae isolates and resistance genes in hospital waste effluent, resulting in higher public health risks using untreated surface water for human consumption. As a result, adequate water treatment and monitoring initiatives designed to monitor antimicrobial resistance patterns in the aquatic ecosystem are required.

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Pyogenic liver abscess due to hypervirulent Klebsiella pneumoniae in a 14-year-old boy

Cited by 12 publications

References 15 publications

A fatal case of liver abscess caused by hypervirulent Klebsiella pneumoniae in a diabetic adolescent: A clinical and laboratory study

A fatal case of liver abscess caused by hypervirulent Klebsiella pneumoniae in a diabetic adolescent: A clinical and laboratory study

A case report of pyogenic liver abscess caused by hypervirulent Klebsiella pneumoniae diagnosed by metagenomic next-generation sequencing

Molecular Characterization of Antibiotic Resistance Determinants in Klebsiella pneumoniae Isolates Recovered from Hospital Effluents in the Eastern Cape Province, South Africa

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