Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jul 31;18(1):358.
doi: 10.1186/s12879-018-3263-x.

Bloodstream infections caused by Klebsiella pneumoniae: prevalence of blaKPC, virulence factors and their impacts on clinical outcome

Min Xu  1 , Yiqi Fu  2 , Haishen Kong  3 , Xiao Chen  3 , Yu Chen  1   3 , Lanjuan Li  3 , Qing Yang  4
Affiliations

Bloodstream infections caused by Klebsiella pneumoniae: prevalence of blaKPC, virulence factors and their impacts on clinical outcome

Min Xu et al. BMC Infect Dis. .

Abstract

Background: Klebsiella pneumoniae bloodstream infections (BSIs) occur with significant prevalence and high mortality worldwide. Antimicrobial resistance and virulence are two main factors participating in the pathogenicity of K. pneumoniae. Here we investigated the prevalence of blaKPC and virulence factors in K. pneumoniae isolated from patients with BSIs and their association with clinical outcome.

Methods: The clinical data of 285 K. pneumoniae BSI cases diagnosed from January 2013 to December 2015 in a Chinese university hospital were retrospectively evaluated. The "string test" was performed to identify hypermucoviscous K. pneumoniae (HMKP). blaKPC, rmpA, magA and serotype-specific genes were detected by PCR amplification. Finally, a Cox proportional hazards model was employed to determine the predictors of 14-day mortality.

Results: Of these isolates, the prevalence of blaKPC and rmpA were 33.3% (95/285) and 31.6% (90/285) respectively. 69 isolates (24.2%, 69/285) were HMKP. rmpA was strongly associated with HM phenotype. The KPC-producing KP and HMKP were almost non-overlapping and only three HMKP isolates harbored blaKPC. K1 (28, 40.6%) and K2 (22, 31.9%) were the most common serotypes in HMKP. 44.9% of HMKP BSIs had origin of biliary tract infection or liver abscess. The 14-day mortality was 100% in blaKPC+/HM+ subgroup (3/3), followed by blaKPC+/HM- (39/92, 42.4%), blaKPC-/HM+ (5/66, 7.6%) and blaKPC-/HM- (7/124, 5.6%). The 14-day cumulative survival was significantly different between blaKPC+ and blaKPC- subgroup (Log-rank p < 0.001) but almost equal between blaKPC-/HM+ and blaKPC-/HM- subgroup (Log-rank p = 0.578) under the condition of comparable illness severity between blaKPC-/HM+ and blaKPC-/HM- subgroup. Independent risk factors for 14-day mortality were Pitt bacteremia score (HR 1.24, CI 95% 1.13-1.36, p < 0.001), Charlson comorbidity index (HR 1.24, CI 95% 1.09-1.41, p = 0.001), septic shock (HR 2.61, CI 95% 1.28-5.35, p = 0.009) and blaKPC (HR 2.20, CI 95% 1.06-4.54, p = 0.034).

Conclusions: Most of HMKP were antibiotic-susceptible and people infected received appropriate antimicrobial therapy, which may explain the favorable outcome of HMKP BSIs. The KPC-producing HMKP BSIs were scarce but life-threatening. blaKPC was valuable in predicting 14-day mortality.

Keywords: Bloodstream infections; Hypermucoviscous; KPC; Klebsiella pneumoniae; Prognosis.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was granted from the Ethics Committees and review board of the First Affiliated Hospital, College of Medicine, Zhejiang University. As this study used secondary data, informed consent was not obtained from patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves about impact of blaKPC (a) and HM phenotype (b) on 14-day survival. HM, hypermucoviscous; BSIs, bloodstream infections
See this image and copyright information in PMC

References

    1. Liu YM, Li BB, Zhang YY, Zhang W, Shen H, Li H, et al. Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China. Antimicrob Agents Chemother. 2014;58:5379–5385. doi: 10.1128/AAC.02523-14. - DOI - PMC - PubMed
    1. da Silva KE, Maciel WG, Sacchi FP, Carvalhaes CG, Rodrigues-Costa F, da Silva AC, et al. Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery. J Med Microbiol. 2016;65:547–553. doi: 10.1099/jmm.0.000254. - DOI - PubMed
    1. Fraenkel-Wandel Y, Raveh-Brawer D, Wiener-Well Y, Yinnon AM, Assous MV. Mortality due to blaKPCKlebsiella pneumoniae bacteraemia. J Antimicrob Chemother. 2016;71:1083–1087. doi: 10.1093/jac/dkv414. - DOI - PubMed
    1. Falcone M, Russo A, Iacovelli A, Restuccia G, Ceccarelli G, Giordano A, et al. Predictors of outcome in ICU patients with septic shock caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Clin Microbiol Infect. 2016;22:444–450. doi: 10.1016/j.cmi.2016.01.016. - DOI - PubMed
    1. Liu Q, Li W, Du X, Li W, Zhong T, Tang Y, et al. Risk and prognostic factors for multidrug-resistant Acinetobacter Baumannii complex bacteremia: a retrospective study in a tertiary Hospital of West China. PLoS One. 2015;10:e0130701. doi: 10.1371/journal.pone.0130701. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources