The increased recurrence rate of liver abscess caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae

Wang, Hairui; Ren, Yongcheng; Chang, Zhihui; Liu, Zhaoyu

doi:10.1007/s10096-020-03848-1

Cited by 15 publications

(18 citation statements)

References 33 publications

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“…In the past two decades, Klebsiella pneumoniae has been identified as the predominant pathogen of PLA in Asia [ 3 ]. Klebsiella pneumoniae -caused liver abscess (KPLA) was first reported in the 1980s in Taiwan [ 4 ], and the incidence of Klebsiella pneumoniae causing PLA was from 30% in the 1980s to over 80% in the 1990s among all causal pathogens [ 5 ]. KPLA is associated with several risk factors, such as diabetes, biliary tract disease and history of malignancy.…”

Section: Introductionmentioning

confidence: 99%

Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

Peng

Qin

et al. 2021

BMC Infect Dis

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Background Klebsiella pneumoniae is a primary pathogen of pyogenic liver abscess (PLA). However, little data are available on combination with sepsis. In this study, we aimed to evaluate the clinical characteristics and prognostic differences of PLA patients with sepsis. Methods This retrospective cohort study was conducted to investigate 135 patients with confirmed Klebsiella pneumoniae-caused liver abscesses (KPLA) from a tertiary teaching hospital, from 2013 to 2019. The patients were divided into two groups, KPLA with sepsis and KPLA without sepsis. The demographic characteristics, clinical features as well as laboratory and microbiologic findings were analyzed. Results A total of 135 patients with KPLA were analyzed. The mean age of patients was 60.9 ± 12.7 years, and the percentage of men was 59.3%. Among them, 37/135 (27.4%) of patients had sepsis and the mortality rate was 1.5%. The most common symptom was fever (91.1%). KPLA patients with sepsis had a significantly higher proportion of frailty, diarrhea, fatty liver, chronic renal insufficiency, and hepatic dysfunction compared to KPLA patients without sepsis (p < 0.05). Antibiotic therapy and percutaneous drainage were most frequently therapeutic strategy. Furthermore, the incidences of sepsis shock and acute respiratory distress syndrome were higher in the sepsis group compared to the non-sepsis group. As for metastatic infections, the lung was the most common site. In addition, KPLA patients with sepsis showed respiratory symptoms in 11 patients, endophthalmitis in 4 patients, and meningitis in 1 patient. Conclusion Our findings emphasize that KPLA patients combined with or without sepsis have different clinical features, but KPLA patients with sepsis have higher rates of complications and metastatic infections. Taken together, further surveillance and control of septic spread is essential for KPLA patients.

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Section: Introductionmentioning

confidence: 99%

Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

Peng

Qin

et al. 2021

BMC Infect Dis

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“…Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis [28]. It found that K. pneumoniae was the main pathogen that caused the bacterial liver abscess, compared with E. coli [29][30][31]. In a retrospective study, a total of 102 nonrepetitive strains of bacteria from 178 patients were isolated, including Klebsiella pneumoniae (82 strains, 80.3%), Escherichia coli (8 strains), Pseudomonas aeruginosa (2 strains), Acinetobacter baumannii (1 strain), and Gram-positive cocci (9 strains).…”

Section: Discussionmentioning

confidence: 99%

Pyogenic Liver Abscesses Patients With Diabetes Mellitus Induced by Klebsiella Pneumoniae Are More Prone to Organ Dysfunction

Zeng

Shao

et al. 2021

Preprint

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Background Diabetes mellitus (DM) has become a common risk factor for pyogenic liver abscess (PLA) patients, Klebsiella pneumoniae is a primary pathogen of PLA (KPLA). The purpose of this study was to evaluate the clinical and microbiological characteristics in PLA patients with or without DM induced by Klebsiella pneumoniae or not.Methods The clinical data of the total 557 PLA patients were collected in Zhongshan Hospital from January 2015 to December 2020. The liver abscess were confirmed using abdominal ultrasound (US)，computerized tomography (CT), and/or magnetic resonance imaging (MRI). The 557 patients were divided into two groups, PLA with DM and PLA without DM. In the group of PLA with DM, the patients were further separated into KPLA with DM and non-KPLA with DM.Results The total of 557 patients with PLA were analyzed, 225 (40.40%) patients comorbided DM. Among PLA patients with DM, there is a higher proportion of patients with hypertension (42.22%) and fatty liver diseases (38.67%), the most common clinical manifestation is frail and fatigue (18.22%), and more likely to progress to sepsis and metastatic infections such as periorbital infection. The PLA patients with DM have higher inflammatory markers (WBC, N%, CRP, ESR and PCT). There was significant difference between the group of PLA with DM and PLA without DM in the percentage of neutrophils, liver enzymes, albumin, glucose metabolism (blood glucose, glycated hemoglobin and glycated albumin), lipid metabolism (triglycerides, low density lipoprotein, high density lipoprotein), blood sodium and chlorine, blood urea nitrogen and higher heart markers ( proBNP and CK-MB). In KPLA patients with DM compared with non-KPLA with DM, inflammatory markers (WBC, N%, CRP, ESR and PCT), liver function index (TB, CB, ALT, AST, ALP and r-GT) and cardiac markers (cTnT and proBNP) are more higher. The level of albumin, serum sodium and ferritin are more lower between the KPLA patients with DM and non-KPLA with DM. Detection of liver abscess by high-throughput sequencing is more sensitive and accurate. There was no in-hospital mortality.Conclusions The study found that in the PLA patients with diabetic DM, Klebsiella pneumoniae infection is the most common, which is more prone to organ dysfunction and electrolyte disorder. High-throughput sequencing can help early diagnosis and accurate treatment of PLA patients.

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“…Of the iuc+ isolates, (42). These invasive infections are associated with significant mortality and morbidity; patients with PLA take longer to recover and 9-18% have recurrent PLA (43,44). In addition, one study showed that 10/14 patients with endogenous endophthalmitis progressed to blindness (45).…”

Section: Discussionmentioning

confidence: 99%

“…The invasive nature of hvKP strains allow them to cause unusual infections such as PLA, endogenous endophthalmitis, necrotizing fasciitis, and meningitis associated with clinical implications distinct from those of the more common cKP strains (33). For example, 9-18% of PLA patients have a recurrence of their infection (74,75), suggesting that prolonged treatment courses may be necessary. In one study, 10 of 14 patients with endogenous endophthalmitis progressed to blindness (76), underscoring that these infections are medical emergencies.…”

Section: Discussionmentioning

confidence: 99%

Genomic surveillance for multidrug-resistant or hypervirulentKlebsiella pneumoniaeamong bloodstream isolates at a United States academic medical center

Kochan¹,

Khalatyan²,

Cheung³

et al. 2020

Preprint

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Klebsiella pneumoniae is a major threat to human health worldwide. “Classical” K. pneumoniae (cKp) strains commonly cause multidrug-resistant (MDR) infections in debilitated patients residing in hospitals and long-term care facilities. In contrast, hypervirulent K. pneumoniae (hvKp) strains may cause invasive, community-acquired infections in otherwise healthy individuals. These highly virulent strains were first identified in Taiwan in 1986 and have since disseminated across the globe. The prevalence of hvKp has been well described in Southeast Asia, but is not well understood in the United States. In this work, 141 consecutive K. pneumoniae blood stream isolates were collected at Northwestern Memorial Hospital from 2015-2017. To screen this collection for hvKp, isolates were tested for the hypermucoviscous phenotype and the presence of aerobactin and salmochelin biosynthesis genes, biomarkers that have been used to distinguish hvKp from cKp. These biomarkers were identified in 12 (8.5%), 6 (4.3%), and 5 (3.5%) isolates, respectively. Whole genome sequencing was performed on the six isolates that contained aerobactin biosynthesis genes and demonstrated that these genes were contained on large plasmids. Five isolates contained plasmids nearly identical to previously described hvKp virulence plasmids while one was similar to a plasmid from a swine isolate of K. pneumoniae. These findings indicate that several non-clonal hvKp-like strains are present in the U.S.

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The increased recurrence rate of liver abscess caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae

Cited by 15 publications

References 33 publications

Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

Clinical features and development of Sepsis in Klebsiella pneumoniae infected liver abscess patients: a retrospective analysis of 135 cases

Pyogenic Liver Abscesses Patients With Diabetes Mellitus Induced by Klebsiella Pneumoniae Are More Prone to Organ Dysfunction

Genomic surveillance for multidrug-resistant or hypervirulentKlebsiella pneumoniaeamong bloodstream isolates at a United States academic medical center

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