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. 2014 Sep;58(9):5379-85.
doi: 10.1128/AAC.02523-14. Epub 2014 Jun 30.

Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China

Ying Mei Liu  1 , Bin Bin Li  2 , Yu Yu Zhang  3 , Wu Zhang  2 , Hong Shen  2 , Hui Li  2 , Bin Cao  4
Affiliations

Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China

Ying Mei Liu et al. Antimicrob Agents Chemother. 2014 Sep.

Abstract

Recently, the newly emerged hypervirulent Klebsiella pneumoniae strain (hvKP) has caused great concern globally, but the clinical features and molecular characteristics of bacteremia caused by hvKP are rarely reported in mainland China. Seventy patients with K. pneumoniae bacteremia were investigated to study the clinical features of hvKP infection from 2008 till 2012 in Beijing Chao-Yang Hospital. The molecular characteristics of the hvKP strains were also studied using PCR, multilocus sequence typing, and pulsed-field gel electrophoresis (PFGE) methods. hvKP was identified in 31.4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). Patients with hvKP infection tended to have no underlying diseases compared to those with classic K. pneumoniae (cKP). More hvKP-positive patients (95.5%) had community-acquired infection than did cKP-infected patients (35.4%) (P<0.001). The 30-day mortality rate was lower in hvKP-infected patients than in cKP-infected patients (4.5% compared to 16.7%). Resistance to tested antimicrobials was significantly greater in cKP- than in hvKP-infected patients. Two extended-spectrum-beta-lactamase (ESBL)-producing hvKP strains were found. Seven novel sequence types (STs) and 4 new alleles of K. pneumoniae were revealed. A strong correlation was found between two STs (ST23, ST1265) and the K1 serotype. The hvKP isolates (n=22) had 14 different PFGE patterns, and among them 10 K1 isolates shared similar PFGE patterns. The emerging hvKP strain was prevalent in patients with severe community-acquired infections in healthy individuals in China. Identification of ESBL-producing hvKP strains in hvKP-infected patients will facilitate clinical management of hvKP infection.

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Figures

FIG 1
FIG 1
Graphic summary of molecular characteristic of 70 K. pneumoniae isolates.
FIG 2
FIG 2
Comparative eBURST analyses. The population snapshot shows the clonal assignment of the STs presented in this study compared to that of the STs in the entire K. pneumonia MLST isolate database. Each black dot represents one ST in the database. The blue dots indicate individual founders, while yellow spots are subfounders. The pink circle highlights the matching ST type in this study with the database. The different clonal complexes are shown in red.
FIG 3
FIG 3
Gel image of PFGE result. Genomic DNA was digested using XbaI enzyme and subjected to pulsed-field gel electrophoresis.
See this image and copyright information in PMC

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