Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan: Occurrence of hypervirulent infections in health care

Sohei Harada, Kotaro Aoki, Shungo Yamamoto, Yoshikazu Ishii, Noritaka Sekiya, Hanako Kurai, Keiichi Furukawa, Asako Doi, Kentaro Tochitani, Kenji Kubo, Yukihiro Yamaguchi, Masashi Narita, Shinya Kamiyama, Jun Suzuki, Takahiko Fukuchi, Yoshiaki Gu, Keiji Okinaka, Soichi Shiiki, Kayoko Hayakawa, Natsuo TachikawaKei Kasahara, Tadahiro Nakamura, Kyoko Yokota, Masanari Komatsu, Misaki Takamiya, Kazuhiro Tateda, Yohei Doi

Research output: Contribution to journalArticle

Abstract

Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health careassociated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

Original languageEnglish
Article numbere01206-19
JournalJournal of clinical microbiology
Volume57
Issue number11
DOIs
Publication statusPublished - 01-01-2019

Fingerprint

Klebsiella pneumoniae
Japan
Delivery of Health Care
Klebsiella Infections
Infection
Odds Ratio
Confidence Intervals
Klebsiella
Cross Infection
Genome
Community-Acquired Infections
Liver Abscess
Medical Records
Virulence
Pneumonia
Diabetes Mellitus
Clone Cells
Cross-Sectional Studies

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)

Cite this

Harada, Sohei ; Aoki, Kotaro ; Yamamoto, Shungo ; Ishii, Yoshikazu ; Sekiya, Noritaka ; Kurai, Hanako ; Furukawa, Keiichi ; Doi, Asako ; Tochitani, Kentaro ; Kubo, Kenji ; Yamaguchi, Yukihiro ; Narita, Masashi ; Kamiyama, Shinya ; Suzuki, Jun ; Fukuchi, Takahiko ; Gu, Yoshiaki ; Okinaka, Keiji ; Shiiki, Soichi ; Hayakawa, Kayoko ; Tachikawa, Natsuo ; Kasahara, Kei ; Nakamura, Tadahiro ; Yokota, Kyoko ; Komatsu, Masanari ; Takamiya, Misaki ; Tateda, Kazuhiro ; Doi, Yohei. / Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan : Occurrence of hypervirulent infections in health care. In: Journal of clinical microbiology. 2019 ; Vol. 57, No. 11.
@article{f60fff12798c465cab46153cf1d326a7,
title = "Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan: Occurrence of hypervirulent infections in health care",
abstract = "Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6{\%}) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1{\%}) and 14 (10{\%}) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95{\%} confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95{\%} CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95{\%} CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95{\%} CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health careassociated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.",
author = "Sohei Harada and Kotaro Aoki and Shungo Yamamoto and Yoshikazu Ishii and Noritaka Sekiya and Hanako Kurai and Keiichi Furukawa and Asako Doi and Kentaro Tochitani and Kenji Kubo and Yukihiro Yamaguchi and Masashi Narita and Shinya Kamiyama and Jun Suzuki and Takahiko Fukuchi and Yoshiaki Gu and Keiji Okinaka and Soichi Shiiki and Kayoko Hayakawa and Natsuo Tachikawa and Kei Kasahara and Tadahiro Nakamura and Kyoko Yokota and Masanari Komatsu and Misaki Takamiya and Kazuhiro Tateda and Yohei Doi",
year = "2019",
month = "1",
day = "1",
doi = "10.1128/JCM.01206-19",
language = "English",
volume = "57",
journal = "Journal of Clinical Microbiology",
issn = "0095-1137",
publisher = "American Society for Microbiology",
number = "11",

}

Harada, S, Aoki, K, Yamamoto, S, Ishii, Y, Sekiya, N, Kurai, H, Furukawa, K, Doi, A, Tochitani, K, Kubo, K, Yamaguchi, Y, Narita, M, Kamiyama, S, Suzuki, J, Fukuchi, T, Gu, Y, Okinaka, K, Shiiki, S, Hayakawa, K, Tachikawa, N, Kasahara, K, Nakamura, T, Yokota, K, Komatsu, M, Takamiya, M, Tateda, K & Doi, Y 2019, 'Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan: Occurrence of hypervirulent infections in health care', Journal of clinical microbiology, vol. 57, no. 11, e01206-19. https://doi.org/10.1128/JCM.01206-19

Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan : Occurrence of hypervirulent infections in health care. / Harada, Sohei; Aoki, Kotaro; Yamamoto, Shungo; Ishii, Yoshikazu; Sekiya, Noritaka; Kurai, Hanako; Furukawa, Keiichi; Doi, Asako; Tochitani, Kentaro; Kubo, Kenji; Yamaguchi, Yukihiro; Narita, Masashi; Kamiyama, Shinya; Suzuki, Jun; Fukuchi, Takahiko; Gu, Yoshiaki; Okinaka, Keiji; Shiiki, Soichi; Hayakawa, Kayoko; Tachikawa, Natsuo; Kasahara, Kei; Nakamura, Tadahiro; Yokota, Kyoko; Komatsu, Masanari; Takamiya, Misaki; Tateda, Kazuhiro; Doi, Yohei.

In: Journal of clinical microbiology, Vol. 57, No. 11, e01206-19, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical and molecular characteristics of klebsiella pneumoniae isolates causing bloodstream infections in Japan

T2 - Occurrence of hypervirulent infections in health care

AU - Harada, Sohei

AU - Aoki, Kotaro

AU - Yamamoto, Shungo

AU - Ishii, Yoshikazu

AU - Sekiya, Noritaka

AU - Kurai, Hanako

AU - Furukawa, Keiichi

AU - Doi, Asako

AU - Tochitani, Kentaro

AU - Kubo, Kenji

AU - Yamaguchi, Yukihiro

AU - Narita, Masashi

AU - Kamiyama, Shinya

AU - Suzuki, Jun

AU - Fukuchi, Takahiko

AU - Gu, Yoshiaki

AU - Okinaka, Keiji

AU - Shiiki, Soichi

AU - Hayakawa, Kayoko

AU - Tachikawa, Natsuo

AU - Kasahara, Kei

AU - Nakamura, Tadahiro

AU - Yokota, Kyoko

AU - Komatsu, Masanari

AU - Takamiya, Misaki

AU - Tateda, Kazuhiro

AU - Doi, Yohei

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health careassociated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

AB - Although hypervirulent Klebsiella pneumoniae (hvKp) has been associated with severe community-acquired infections that occur among relatively healthy individuals, information about hvKp infections in health care settings remains limited. Here, we systematically analyzed the clinical and molecular characteristics of K. pneumoniae isolates causing bloodstream infections in a cross-sectional study. Clinical characteristics of K. pneumoniae bloodstream infections from hospitals across Japan were analyzed by a review of the medical records. Whole-genome sequencing of the causative isolates was performed. Bacterial species were confirmed and hvKp were identified using whole-genome sequencing data. Clinical characteristics of hvKp infections were compared with those of non-hvKp infections by bivariate analyses. Of 140 cases of K. pneumoniae bloodstream infections, 26 cases (18.6%) were caused by various clones of hvKp defined by the carriage of cardinal virulence genes. Molecular identification revealed that 24 (17.1%) and 14 (10%) cases were caused by Klebsiella variicola and Klebsiella quasipneumoniae, respectively. Patients with hvKp infections had higher proportions of diabetes mellitus (risk ratio [RR], 1.75; 95% confidence interval [CI], 1.05 to 2.94), and their infections had significantly higher propensity to involve pneumonia (RR, 5.85; 95% CI, 1.39 to 24.6), liver abscess (RR, 5.85; 95% CI, 1.39 to 24.6), and disseminated infections (RR, 6.58; 95% CI, 1.16 to 37.4) than infections by other isolates. More than one-half of hvKp infections were health care associated or hospital acquired, and a probable event of health careassociated transmission of hvKp was documented. hvKp isolates, which are significantly associated with severe and disseminated infections, are frequently involved in health care-associated and hospital-acquired infections in Japan.

UR - http://www.scopus.com/inward/record.url?scp=85074117671&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85074117671&partnerID=8YFLogxK

U2 - 10.1128/JCM.01206-19

DO - 10.1128/JCM.01206-19

M3 - Article

C2 - 31434721

AN - SCOPUS:85074117671

VL - 57

JO - Journal of Clinical Microbiology

JF - Journal of Clinical Microbiology

SN - 0095-1137

IS - 11

M1 - e01206-19

ER -