Serotyping of  Klebsiella pneumoniae  and Its Relation with Capsule-Associated Virulence Genes, Antimicrobial Resistance Pattern, and Clinical Infections: A Descriptive Study in Medical Practice

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Abstract

Objective

Klebsiella pneumoniae, one of the clinical superbugs, causes diverse infections because of its variable capsular antigens. This study focused on K. pneumoniae and aimed to assess any correlation between capsular serotype, capsule-associated virulence genes, and evaluate its resistance to conventional antibiotics in order to gain insight into any regional differences.

Materials and Methods

A total of 61 K. pneumoniae collected from various clinical specimens were confirmed genotypically. Clinical and demographic data for all patients were reviewed. All isolates were subjected to antimicrobial susceptibility tests. Capsular serotyping and capsule-associated virulence genes were studied using the molecular method.

Results

All typeable isolates were typed into K5, K20, and K54 serotypes, and among them, K54 was observed to be predominant. The most common capsule-associated virulence genes comprised uge (93.4%), ycfM (91.8%), and wabG (88.5%), while wcaG (29.5%) and rmpA (21.3%) were noted at much lower prevalence rates. The gene wcaG was significantly associated with K54 positive isolates ( p = 0.001), while rmpA was associated with K20 positive isolates ( p = 0.01).

Conclusion

Serotype K54 had a high frequency in isolates collected from patients with pulmonary diseases, while serotype K20 was associated with burn patients. Carbapenems and levofloxacin were the best therapeutic options for the treatment of infections with serotypes K20 and K54.

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Hypervirulent (hypermucoviscous) Klebsiella pneumoniae

Alyssa S. Shon, Rajinder Bajwa, Thomas Russo (2013)

A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged. First described in the Asian Pacific Rim, it now increasingly recognized in Western countries. Defining clinical features are the ability to cause serious, life-threatening community-acquired infection in younger healthy hosts, including liver abscess, pneumonia, meningitis and endophthalmitis and the ability to metastatically spread, an unusual feature for enteric Gram-negative bacilli in the non-immunocompromised. Despite infecting a healthier population, significant morbidity and mortality occurs. Although epidemiologic features are still being defined, colonization, particularly intestinal colonization, appears to be a critical step leading to infection. However the route of entry remains unclear. The majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition. The traits that enhance its virulence when compared with “classical” K. pneumoniae are the ability to more efficiently acquire iron and perhaps an increase in capsule production, which confers the hypermucoviscous phenotype. An objective diagnostic test suitable for routine use in the clinical microbiology laboratory is needed. If/when these strains become increasingly resistant to antimicrobials, we will be faced with a frightening clinical scenario.

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Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess.

Chi-Tai Fang, Shau-Yan Lai, Wen-Ching Yi … (2007)

Since 1986, researchers have noted a syndrome of Klebsiella pneumoniae pyogenic liver abscess that is complicated by endophthalmitis or central nervous system infections. There are limited data regarding the role of bacterial genotype in the pathogenesis of this syndrome. We conducted a retrospective cohort study involving 177 cases of K. pneumoniae pyogenic liver abscess treated during 1997-2005 at a tertiary university hospital in Taiwan. We performed bacterial cps genotyping by polymerase chain reaction detection of serotype-specific alleles at wzy and wzx loci and used an in vitro serum assay to evaluate the virulence of bacterial strains. Septic ocular or central nervous system complications developed in 23 patients (13%). Logistic regression analysis showed that genotype K1 was the only significant risk factor (adjusted odds ratio, 4.8; 95% confidence interval, 1.5-15.7, P=.009). The serum resistance assay indicated that, on average, K1 strains (n=100) were significantly more virulent than were strains of K2 (n=36), K20/K5/K54 (n=21), or other genotypes (n=20) (P<.001 for each comparison). In addition to the serotype-specific cps region, the genomic background of K1 strains also differed significantly from that of non-K1 strains (20-kb kfu/PTS region, 97/100 vs. 13/77; P<.001). Of the 19 cases in which genotype K1 strains caused complications, 8 patients (42%) did not have identifiable underlying medical diseases. K. pneumoniae genotype K1 is an emerging pathogen capable of causing catastrophic septic ocular or central nervous system complications from pyogenic liver abscess independent of underlying diseases in the host.

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Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae

Liangfei Xu, Xiaoxi Sun, Xiaoling Ma (2017)

Purpose Carbapenem resistant K. pneumoniae (CRKP) has aroused widespread attention owing to its very limited therapeutic options, and this strain has increased rapidly in recent years. Although it is accepted that drug resistance is associated with increased mortality in general, but some other studies found no such relationship. To estimate mortality of patients infected with CRKP in general and analyze factors for mortality of this infection, thus, we conducted this systematic review and meta-analysis. Methods A systematic literature review of relevant studies published until December 2015 was conducted. We selected and assessed articles reporting mortality of patients infected with CRKP. Results Pooled mortality was 42.14% among 2462 patients infected with CRKP versus 21.16% in those infected with carbapenem-susceptible K. pneumoniae (CSKP). The mortality of patients with bloodstream infection (BSI) or urinary tract infection was 54.30 and 13.52%, respectively, and 48.9 and 43.13% in patients admitted to the intensive care unit (ICU) or who underwent solid organ transplantation (SOT). Mortality was 47.66% in patients infected with K. pneumoniae carbapenemase-producing K. pneumoniae and 46.71% in those infected with VIM-producing K. pneumoniae. Geographically, mortality reported in studies from North America, South America, Europe, and Asia was 33.24, 46.71, 50.06, and 44.82%, respectively. Conclusions Our study suggests that patients infected with CRKP have higher mortality than those infected with CSKP, especially in association with BSI, ICU admission, or SOT. We also considered that patients’ survival has a close relationship with their physical condition. Our results imply that attention should be paid to CRKP infection, and that strict infection control measures and new antibiotics are required to protect against CRKP infection.

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Author and article information

Journal

Journal ID (nlm-ta): Infect Drug Resist

Journal ID (iso-abbrev): Infect Drug Resist

Journal ID (publisher-id): IDR

Journal ID (pmc): idr

Title: Infection and Drug Resistance

Publisher: Dove

ISSN (Electronic): 1178-6973

Publication date (Electronic): 24 June 2020

Publication date Collection: 2020

Volume: 13

Pages: 1971-1980

Affiliations

[1 ]Immunology Research Center, Tabriz University of Medical Sciences , Tabriz, Iran

[2 ]Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical, Sciences , Tabriz, Iran

[3 ]Sina Hospital, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, Iran

[4 ]Drug Applied Research Center, Tabriz University of Medical Sciences , Tabriz, Iran

[5 ]Department of Infectious Disease, School of Medicine, Shahroud University of Medical Science , Shahroud, Iran

Author notes

Correspondence: Elghar Soltani Immunology Research Center and Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences , Tabriz, IranTel +989366295410Fax +984133808693 Email elghar_soltani@yahoo.com

Author information

Alka Hasani http://orcid.org/0000-0001-6648-0893

Elghar Soltani http://orcid.org/0000-0002-6516-4378

Mohammad Ahangarzadeh Rezaee http://orcid.org/0000-0003-2172-0587

Mahin Ahangar Oskouee http://orcid.org/0000-0002-9682-8835

Pourya Gholizadeh http://orcid.org/0000-0002-1451-3996

Article

Publisher ID: 243984

DOI: 10.2147/IDR.S243984

PMC ID: 7321687

PubMed ID: 32606843

SO-VID: e6f91e09-1717-44ae-8275-608f998a6143

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 28 December 2019

Date accepted : 11 June 2020

Page count

Figures: 1, Tables: 5, References: 41, Pages: 10

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Serotyping of Klebsiella pneumoniae and Its Relation with Capsule-Associated Virulence Genes, Antimicrobial Resistance Pattern, and Clinical Infections: A Descriptive Study in Medical Practice

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Hypervirulent (hypermucoviscous) Klebsiella pneumoniae

Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess.

Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae

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