Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Lin, Yong-Chun; Cao, Xi; Mo, Yun-Chao; Xie, Cai-Peng; YongFang, Zhang; Li, Na; Chen, Hualing

doi:10.1016/j.idcr.2021.e01276

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…Severe hvKP infections with pyogenic liver abscesses in healthy adults have been reported previously [10,31,37,41]. Moreover, liver abscess is a significant risk factor for hvKP infecitons [42], and abscess has been identified as an independent predictor for associated with hvKP-BSIs [43].…”

Section: Discussionmentioning

confidence: 85%

“…Patients with KP pyogenic liver abscesses with sepsis have higher rates of septic shock and acute respiratory distress syndrome [ 40 ]. Severe hvKP infections with pyogenic liver abscesses in healthy adults have been reported previously [ 10 , 31 , 37 , 41 ]. Moreover, liver abscess is a significant risk factor for hvKP infecitons [ 42 ], and abscess has been identified as an independent predictor for associated with hvKP -BSIs [ 43 ].…”

Section: Discussionmentioning

confidence: 93%

“…Diabetes mellitus is considered a significant risk factor for acquiring hvKP infections [26][27][28][29], which primarily affects male individuals aged 55-60 years [30]. Diabetes is an independent risk factor for KP pyogenic liver abscess [31], as poor glycaemic control might impair neutrophil phagocytosis and promote pathogen growth in tissues, while metabolic disturbances might negatively affect the liver [32,33]. Moreover, diabetes, which is more likely to progress hvKP infections, especially hvKP-bloodstream infections (BSIs) [26,28], is an independent risk factor for hvKP-BSIs [12].…”

Section: Discussionmentioning

confidence: 99%

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Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

Huang,

Chen,

et al. 2023

BMC Infect Dis

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Background Hypervirulent Klebsiella pneumoniae (hvKP) is emerging globally and can cause various, severe infections in healthy individuals. However, the clinical manifestations of hvKP infections are nonspecific, and there is no gold standard for differentiating hvKP strains. Our objective was to develop prognostic models for estimating severity of disease and predicting 30-day all-cause mortality in patients with hvKP infections. Methods We enrolled 116 patients diagnosed with hvKP infections and obtained their demographic and clinical data. Taking septic shock and acute respiratory distress syndrome (ARDS) as the primary outcomes for disease severity and 30-day all-cause mortality as the primary outcome for clinical prognosis, we explored the influencing factors and constructed prognostic models. Results The results showed that increased Acute Physiologic and Chronic Health Evaluation (APACHE) II score [odds ratio (OR) = 1.146; 95% confidence interval (CI), 1.059–1.240], decreased albumin (ALB) level (OR = 0.867; 95% CI, 0.758–0.990), diabetes (OR = 9.591; 95% CI, 1.766–52.075) and high procalcitonin (PCT) level (OR = 1.051; 95%CI, 1.005–1.099) were independent risk factors for septic shock. And increased APACHE II score (OR = 1.254; 95% CI, 1.110–1.147), community-acquired pneumonia (CAP) (OR = 11.880; 95% CI, 2.524–55.923), and extrahepatic lesion involved (OR = 14.718; 95% CI, 1.005–215.502) were independent risk factors for ARDS. Prognostic models were constructed for disease severity with these independent risk factors, and the models were significantly correlated with continuous renal replacement therapy (CRRT) duration, vasopressor duration, mechanical ventilator duration and length of ICU stay. The 30-day all-cause mortality rate in our study was 28.4%. Younger age [hazard ratio (HR) = 0.947; 95% CI, 0.923–0.973)], increased APACHE II score (HR = 1.157; 95% CI, 1.110–1.207), and decreased ALB level (HR = 0.924; 95% CI, 0.869–0.983) were the independent risk factors for 30-day all-cause mortality. A prediction model for 30-day mortality was constructed, which had a good validation effect. Conclusions We developed validated models containing routine clinical parameters for estimating disease severity and predicting 30-day mortality in patients with hvKP infections and confirmed their calibration. The models may assist clinicians in assessing disease severity and estimating the 30-day mortality early.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

Huang,

Chen,

et al. 2023

BMC Infect Dis

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“…pneumonia, bacteremia, and urinary tract infections, but metastatic dissemination is relatively uncommon 2,3 . Notably, cKp exhibits a wide diversity of K capsular types and a high propensity to develop resistance to commonly used antibiotics, such as cephalosporins, carbapenems, and colistin.…”

mentioning

confidence: 99%

Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam

Nguyen,

et al. 2024

Nat Commun

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Hypervirulent Klebsiella pneumoniae (hvKp) is a significant cause of severe invasive infections in Vietnam, yet data on its epidemiology, population structure and dynamics are scarce. We screened hvKp isolates from patients with bloodstream infections (BSIs) at a tertiary infectious diseases hospital in Vietnam and healthy individuals, followed by whole genome sequencing and plasmid analysis. Among 700 BSI-causing Kp strains, 100 (14.3%) were hvKp. Thirteen hvKp isolates were identified from 350 rectal swabs of healthy adults; none from 500 rectal swabs of healthy children. The hvKp isolates were genetically diverse, encompassing 17 sequence types (STs), predominantly ST23, ST86 and ST65. Among the 113 hvKp isolates, 14 (12.6%) carried at least one antimicrobial resistance (AMR) gene, largely mediated by IncFII, IncR, and IncA/C plasmids. Notably, the acquisition of AMR conjugative plasmids facilitated horizontal transfer of the non-conjugative virulence plasmid between K. pneumoniae strains. Phylogenetic analysis demonstrated hvKp isolates from BSIs and human carriage clustered together, suggesting a significant role of intestinal carriage in hvKp transmission. Enhanced surveillance is crucial to understand the factors driving intestinal carriage and hvKp transmission dynamics for informing preventive measures. Furthermore, we advocate the clinical use of our molecular assay for diagnosing hvKp infections to guide effective management.

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Successful treatment of acute respiratory distress syndrome caused by hypervirulent Klebsiella pneumoniae with extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review

Peng

et al. 2022

Front. Med.

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Hypervirulent Klebsiella pneumoniae (hvKP) causes invasive infections and leads to high morbidity and mortality rates. Here, we report the case of a Chinese man with diabetes mellitus who developed acute respiratory distress syndrome and septic shock due to hvKP belonging to the K1 strain. The patient was treated with venovenous extracorporeal membrane oxygenation and continuous renal replacement therapy, in combination with antibiotics and recovered well. Clinicians should be aware of fatal infections caused by hvKP and investigate the best treatment options for patients at various stages of infection.

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Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Cited by 5 publications

References 18 publications

Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

Prognostic models for estimating severity of disease and predicting 30-day mortality of Hypervirulent Klebsiella pneumoniae infections: a bicentric retrospective study

Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam

Successful treatment of acute respiratory distress syndrome caused by hypervirulent Klebsiella pneumoniae with extracorporeal membrane oxygenation and continuous renal replacement therapy: A case report and literature review

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