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
N1 - Publisher Copyright:
Copyright © 2019 American Society for Microbiology. All Rights Reserved.
PY - 2019
Y1 - 2019
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.
KW - Bloodstream infection
KW - Disseminated infection
KW - Hypervirulent Klebsiella pneumoniae
KW - Whole-genome sequencing
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U2 - 10.1128/JCM.01206-19
DO - 10.1128/JCM.01206-19
M3 - Article
C2 - 31434721
AN - SCOPUS:85074117671
SN - 0095-1137
VL - 57
JO - Journal of clinical microbiology
JF - Journal of clinical microbiology
IS - 11
M1 - e01206-19
ER -
