Primary liver abscess due to CC23-K1 virulent clone of Klebsiella pneumoniae in France

Since the mid-1980s, Klebsiella pneumoniae hypermucoviscous isolates have emerged in Taiwan and other Asian countries. We reported the first autochthonous European liver abscess due to an ST57 isolate, which belongs to virulent clonal complex CC23-KI. This case highlights the emergence in France and Europe of hypermucoviscous virulent K. pneumoniae isolates.     

Genetic analysis of ESBL-producing Klebsiella pneumoniae isolated from UTI patients in Indonesia

IntroductionExtended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a serious concern for nosocomial infection and the emergence rate in Indonesia is higher than that in developed countries. The purpose of this study was to investigate the genetic characteristics of ESBL-producing K. pneumoniae isolated from UTI patients in Indonesia.Materials and methodsWe collected K. pneumoniae resistant to ceftazidime or cefotaxime isolated from UTI patients in Dr. Soetomo's Academic Hospital in Surabaya, Indonesia in 2015. Ninety-four strains were identified as ESBL-producing bacteria by confirmation tests. The isolates were investigated by antimicrobial susceptibility testing with 20 drugs and ESBL gene detection, plasmid replicon typing and virulence genes as hypermucoviscous (HMV) strains were tested by the string test.ResultsHigh rates of resistance to ciprofloxacin (86.2%), tetracycline (80.9%) and nalidixic acid (78.7%) were observed. CTX-M-15 was the most common ESBL gene (89.4%), 33 of which also carried SHV-type ESBL. IncF was the most prevalent plasmid replicon typing (47.6%). Sixteen (17.0%) strains were judged as HMV, all of which had rmpA and more than half of which had fimH, uge, and wab. IncL/M was the most common replicon plasmid in the HMV strains, and the difference in the positive rate was statistically significant (p = 0.0024).ConclusionThis study showed the high prevalence of multiple-drug resistant and predominately CTX-M-15-positive ESBL-producing K. pneumoniae in Indonesia. There was a correlation between IncL/M and the HMV phenotype in this study. As such hypervirulent strains continue to emerge, studying their dissemination with resistance determinants is an urgent priority.     

高毒力肺炎克雷伯菌研究进展

肺炎克雷伯菌（KP）为常见的医院获得性和社区获得性感染病原菌,近年来肺炎克雷伯菌所致的肝脓肿患者例数逐渐增加,且多伴随肝外感染,故得到了广泛关注。这种引起肝脓肿的肺炎克雷伯菌具有较高毒力以及高黏液特性,易导致健康个体感染,因此将其定义为高毒力肺炎克雷伯菌（hvKP）。高毒力肺炎克雷伯菌感染的临床特点、对抗菌药物的敏感性以及分子生物学特性,均不同于传统的肺炎克雷伯菌（cKP）,故对高毒力肺炎克雷伯菌的毒力基因进行研究有助于明确该细菌的致病机制,有助于尽早诊断和治疗该细菌导致的感染,有效改善高毒力肺炎克雷伯菌感染者的预后。     

高毒力肺炎克雷伯杆菌的临床特征和高毒力机制

高毒力肺炎克雷伯杆菌是近年发现的具有高侵袭性、高毒力的肺炎克雷伯杆菌,能感染年轻人群导致化脓性肝脓肿、社区获得性肺炎、眼内炎以及其他部位血行播散性感染并可遗留严重后遗症,其中高黏表型和摄铁系统与其高毒力的特性密切相关,文章对近几年的高毒力肺炎克雷伯杆菌的临床特征及高毒力致病机制做总结,希望对以后的临床诊治和研究有帮助.     

Mucoviscous characteristics of Klebsiella pneumoniae strains: A factor of clinical severity?

IntroductionHypermucoviscous Klebsiella pneumoniae (KP) strains are responsible for complicated bacteremia with multiple septic sites (liver, central nervous system, muscles). We aimed to compare the clinical severity of patients presenting with KP bacteremia based on the hypermucoviscous or non-hypermucoviscous characteristic of the strains.MethodsObservational retrospective study successively including all patients with KP bacteremia from May 2013 to March 2015 at the tertiary medical center of New Caledonia. The hypermucoviscous characteristic was defined by the string test results and molecular analysis to determine the capsular serotype.ResultsA total of 55 bacteremic patients were included in the study; 27% of isolated strains were hypermucoviscous. Hypermucoviscous strains accounted for two-thirds of community-acquired infections (72.5% vs. 33.4%, p = 0.01). The rate of intensive care hospitalization was high (hypermucoviscous 46.7%; standard 52.5%) without any difference between the two groups. No significant difference was observed in case fatality (hypermucoviscous 46.7% vs. standard 15%, p = 0.07) but patients with hypermucoviscous strains had longer hospital stays (73.5 days versus 50.7 days, p = 0.04) and longer persistence of positive blood cultures despite an appropriate treatment (OR 1.41, 95% CI: 1.0–1.96, p = 0.045).ConclusionHypermucoviscous KP bacteremia account for most community-acquired Klebsiella infections in New Caledonia and are associated with longer hospital stay and persistence of positive blood cultures despite the implementation of an appropriate treatment.     

Population-based surveillance for hypermucoviscosity Klebsiella pneumoniae causing community-acquired bacteremia in Calgary,Alberta

The characteristics of hypermucoviscosity isolates among Klebsiella pneumoniae causing community-acquired bacteremia were investigated. The hypermucoviscous phenotype was present in 8.2% of K pneumoniae isolates, and was associated with rmpA and the K2 serotype; liver abscesses were the most common clinical presentation. The present analysis represents the first population-based surveillance study of hypermucoviscosity among K pneumoniae causing bacteremia.     

血液分离肺炎克雷伯菌毒力基因与耐药性研究

目的 比较分析血液分离的高黏液性和非高黏液性肺炎克雷伯菌的毒力基因、抗菌药物耐药性和临床特征。方法 收集本院2015 年1 月-2016 年12 月血液标本分离的肺炎克雷伯菌144 株；采用VITEK-2 Compact 全自动微生物鉴定仪进行鉴 定；黏液丝试验检测高黏液表型；PCR 检测分离株主要荚膜型和毒力基因；KB 纸片扩散法对抗菌药物进行敏感性测定；SPSS 17.0 软件对数据进行分析。结果 收集的144 株肺炎克雷伯菌中，高黏液性菌株共31 株(21.53%)，以K1、K2 型多见，rmpA、 icuA、iroN、ybtS 和allS 基因在高黏液性菌株中的比例均显著高于非黏液性菌株(P<0.01)；高黏液性菌株对测定抗菌药物的耐药 性除氨苄西林外均低于非黏液性菌株，尤其是对头孢菌素类、亚胺培南和环丙沙星，具有显著性差异(P<0.05)；与非黏液性菌 株相比，高黏液性菌株血流感染更容易引起肝脓肿(P<0.05)，而两类细菌在致死率方面无明显统计学差异(P>0.05)。结论 血流 感染分离的高黏液性肺炎克雷伯菌较非黏液性肺炎克雷伯菌，含有更多的毒力基因，但药物敏感性较高，高黏液性肺炎克雷伯 菌败血症易发肝脓肿，临床应加强监控。