Author:
Zhang Yawei,Zhao Chunjiang,Wang Qi,Wang Xiaojuan,Chen Hongbin,Li Henan,Zhang Feifei,Li Shuguang,Wang Ruobing,Wang Hui
Abstract
ABSTRACTHypervirulentKlebsiella pneumoniae(hvKP) is traditionally defined by hypermucoviscosity, but data based on genetic background are limited. Antimicrobial-resistant hvKP has been increasingly reported but has not yet been systematically studied.K. pneumoniaeisolates from bloodstream infections, hospital-acquired pneumonia, and intra-abdominal infections were collected from 10 cities in China during February to July 2013. Clinical data were collected from medical records. AllK. pneumoniaeisolates were investigated by antimicrobial susceptibility testing, string test, extended-spectrum β-lactamase (ESBL) gene detection, capsular serotypes, virulence gene profiles, and multilocus sequence typing. hvKP was defined by aerobactin detection. Of 230K. pneumoniaeisolates, 37.8% were hvKP. The prevalence of hvKP varied among different cities, with the highest rate in Wuhan (73.9%) and the lowest in Zhejiang (8.3%). Hypermucoviscosity and the presence of K1, K2, K20, andrmpAgenes were strongly associated with hvKP (P< 0.001). A significantly higher incidence of liver abscess (P= 0.026), sepsis (P= 0.038), and invasive infections (P= 0.043) was caused by hvKP. Cancer (odds ratio [OR], 2.285) and diabetes mellitus (OR, 2.256) appeared to be independent variables associated with hvKP infections by multivariate analysis. Importantly, 12.6% of hvKP isolates produced ESBLs, and most of them carriedblaCTX-Mgenes. Patients with neutropenia (37.5% versus 5.6%;P= 0.020), history of systemic steroid therapy (37.5% versus 5.6%;P= 0.020), and combination therapy (62.5% versus 16.7%;P= 0.009) were more likely to be infected with ESBL-producing hvKP. The prevalence of hvKP is high in China and has a varied geographic distribution. ESBL-producing hvKP is emerging, suggesting an urgent need to enhance clinical awareness, especially for immunocompromised patients receiving combination therapy.
Funder
National Natural Science Foundation of China
Publisher
American Society for Microbiology
Subject
Infectious Diseases,Pharmacology (medical),Pharmacology