Dokyun Kim1, Byeol Yi Park1, Min Hyuk Choi1, Eun-Jeong Yoon1, Hyukmin Lee1, Kwang Jun Lee2, Yoon Soo Park3, Jong Hee Shin4, Young Uh5, Kyeong Seob Shin6, Jeong Hwan Shin7, Young Ah Kim8, Seok Hoon Jeong1. 1. Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea. 2. Division of Antimicrobial Resistance, National Institute of Health, Centers for Disease Control and Prevention, Cheongju, South Korea. 3. Division of Infectious Diseases, Department of Internal Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea. 4. Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, South Korea. 5. Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea. 6. Department of Laboratory Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea. 7. Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, South Korea. 8. Department of Laboratory Medicine, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea.
Abstract
Objectives: To investigate the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI) with a focus on antimicrobial resistance and virulence factors. Methods: All KP BSI patients (n = 579) from six general hospitals during a 1 year period were included in this study. The risk factors of hosts and causative KP isolates were assessed to determine associations with the 30 day mortality of KP BSI patients by multivariate Cox hazards modelling. Results: The 30 day mortality rate of KP BSI patients was 16.9% (98/579). Among the host-associated factors, increased SOFA score and leucopenia status exhibited strong associations with increased 30 day mortality. Among the pathogenic factors, carriage of the pks gene cluster (adjusted HR 1.80; 95% CI 1.16-2.79) was a risk factor, especially when accompanied by MDR. In this regard, KP isolates of the wzi50 capsular type (n = 22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n = 15) and mostly exhibited MDR (63.6%, n = 14), resulting in increased 30 day mortality. In contrast, hypermucoviscous KP isolates showed an inverse association with 30 day mortality (adjusted HR 0.55; 95% CI 0.33-0.90). Conclusions: Despite the reported virulence of hypermucoviscous KP strains, they were associated with good prognoses in KP BSI patients. Importantly, carriage of the pks gene cluster, which is responsible for the synthesis of colibactin, was a relevant marker of early mortality.
Objectives: To investigate the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI) with a focus on antimicrobial resistance and virulence factors. Methods: All KP BSI patients (n = 579) from six general hospitals during a 1 year period were included in this study. The risk factors of hosts and causative KP isolates were assessed to determine associations with the 30 day mortality of KP BSI patients by multivariate Cox hazards modelling. Results: The 30 day mortality rate of KP BSI patients was 16.9% (98/579). Among the host-associated factors, increased SOFA score and leucopenia status exhibited strong associations with increased 30 day mortality. Among the pathogenic factors, carriage of the pks gene cluster (adjusted HR 1.80; 95% CI 1.16-2.79) was a risk factor, especially when accompanied by MDR. In this regard, KP isolates of the wzi50 capsular type (n = 22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n = 15) and mostly exhibited MDR (63.6%, n = 14), resulting in increased 30 day mortality. In contrast, hypermucoviscous KP isolates showed an inverse association with 30 day mortality (adjusted HR 0.55; 95% CI 0.33-0.90). Conclusions: Despite the reported virulence of hypermucoviscous KP strains, they were associated with good prognoses in KP BSI patients. Importantly, carriage of the pks gene cluster, which is responsible for the synthesis of colibactin, was a relevant marker of early mortality.
Authors: Jeong-Hwan Hwang; Mallikarjun Handigund; Joo-Hee Hwang; Yong Gon Cho; Dal Sik Kim; Jaehyeon Lee Journal: Ann Lab Med Date: 2020-06-17 Impact factor: 3.464