Cédric Rafat1,2, Jonathan Messika2,3,4, Guilène Barnaud5, Nicolas Dufour2,6, Fatma Magdoud5, Typhaine Billard-Pomarès3,4,5, Stéphane Gaudry2,7,8, Didier Dreyfuss2,3,4, Catherine Branger3,4,5, Dominique Decré9,10, Jean-Damien Ricard2,3,4. 1. 2Urgences Néphrologiques et Transplantation Rénale, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France. 2. 1Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier Assistance Publique-Hôpitaux de Paris, Colombes, France. 3. 3INSERM, IAME, UMR 1137, F-75018 Paris, France. 4. 4Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018 Paris, France. 5. 5Service de Microbiologie, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France. 6. 6Service de Réanimation médico-chirurgicale, Centre Hospitalier René Dubos, F-95300 Pontoise, France. 7. 7Univ Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France. 8. 8INSERM, ECEVE, U1123, CIC-EC 1425, F-75010 Paris, France. 9. 9Sorbonne Université, Paris 06, INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), Team E13 (Bacteriology), Paris, France. 10. 10AP-HP, Microbiology, St-Antoine Hospital, Paris, France.
Abstract
PURPOSE: Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a leading cause of severe community-acquired pneumonia, liver abscess and disseminated infection in the Far East. Data regarding the incidence, clinical features and microbiological characteristics related to hvKp infections in the Western world are scarce. METHODOLOGY: The incidence, clinical features and microbiological characteristics of hvKp infections were investigated through a 5-year survey conducted in a single French intensive care unit. K. pneumoniae strains were screened for hypermucoviscosity based on a string test. Multilocus sequence typing and multiplex PCR analysis targeting virulence genes were performed on string test-positive strains. RESULTS: Over a 53-month period, a total of 59 infections due to K. pneumoniae were identified including 26 community-onset infections. Twelve hvKp infections were documented, accounting for 46.1 % of community-acquired K. pneumoniae. Community-acquired pneumonia (n=6), aspiration pneumonia (n=4) and liver abscess (n=2) represented initial sites and mode of infection. Compared to non-hvKp infections, patients with hvKp infections displayed higher rates of multi-organ failure (83.3 % vs 35.7 %; P=0.04), but mortality rates were not different (50 % vs 35 %; P=0.71). Strains K1/ST23 (n=5) and K2/ST86 (n=5) predominated. All hvKp strains displayed wild-type susceptibility. CONCLUSION: hvKp represent a potentially underestimated cause of fatal infections in the Western world.
PURPOSE:Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a leading cause of severe community-acquired pneumonia, liver abscess and disseminated infection in the Far East. Data regarding the incidence, clinical features and microbiological characteristics related to hvKp infections in the Western world are scarce. METHODOLOGY: The incidence, clinical features and microbiological characteristics of hvKp infections were investigated through a 5-year survey conducted in a single French intensive care unit. K. pneumoniae strains were screened for hypermucoviscosity based on a string test. Multilocus sequence typing and multiplex PCR analysis targeting virulence genes were performed on string test-positive strains. RESULTS: Over a 53-month period, a total of 59 infections due to K. pneumoniae were identified including 26 community-onset infections. Twelve hvKp infections were documented, accounting for 46.1 % of community-acquired K. pneumoniae. Community-acquired pneumonia (n=6), aspiration pneumonia (n=4) and liver abscess (n=2) represented initial sites and mode of infection. Compared to non-hvKp infections, patients with hvKp infections displayed higher rates of multi-organ failure (83.3 % vs 35.7 %; P=0.04), but mortality rates were not different (50 % vs 35 %; P=0.71). Strains K1/ST23 (n=5) and K2/ST86 (n=5) predominated. All hvKp strains displayed wild-type susceptibility. CONCLUSION: hvKp represent a potentially underestimated cause of fatal infections in the Western world.