Abstract

BackgroundKlebsiella pneumoniae displaying the hypermucoviscosity (HV) phenotype are considered more virulent than HV-negative strains. Nevertheless, the emergence of tissue-abscesses-associated HV-negative isolates motivated us to re-evaluate the role of HV-phenotype.ResultsInstead of genetically manipulating the HV-phenotype of K. pneumoniae, we selected two clinically isolated K1 strains, 1112 (HV-positive) and 1084 (HV-negative), to avoid possible interference from defects in the capsule. These well-encapsulated strains with similar genetic backgrounds were used for comparative analysis of bacterial virulence in a pneumoniae or a liver abscess model generated in either naïve or diabetic mice. In the pneumonia model, the HV-positive strain 1112 proliferated to higher loads in the lungs and blood of naïve mice, but was less prone to disseminate into the blood of diabetic mice compared to the HV-negative strain 1084. In the liver abscess model, 1084 was as potent as 1112 in inducing liver abscesses in both the naïve and diabetic mice. The 1084-infected diabetic mice were more inclined to develop bacteremia and had a higher mortality rate than those infected by 1112. A mini-Tn5 mutant of 1112, isolated due to its loss of HV-phenotype, was avirulent to mice.ConclusionThese results indicate that the HV-phenotype is required for the virulence of the clinically isolated HV-positive strain 1112. The superior ability of the HV-negative stain 1084 over 1112 to cause bacteremia in diabetic mice suggests that factors other than the HV phenotype were required for the systemic dissemination of K. pneumoniae in an immunocompromised setting.

Highlights

  • Klebsiella pneumoniae displaying the hypermucoviscosity (HV) phenotype are considered more virulent than HV-negative strains

  • The incidence of strains displaying the HV phenotype in the K. pneumoniae abscess isolates was 51% (48/94), which was significantly lower than that reported by Yu et al (29/34, 85%) [15] and Fang et al (50/53, 98%) [14]

  • Emergence of HV-negative K. pneumoniae related to tissue abscesses To determine the clinical impact of the HV characteristics, 473 non-repetitive isolates were collected from consecutive patients exhibiting K. pneumoniae-related infections under treatment at a referral medical center in central Taiwan, during April 2002-June 2003

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Summary

Introduction

Klebsiella pneumoniae displaying the hypermucoviscosity (HV) phenotype are considered more virulent than HV-negative strains. The emergence of tissue-abscesses-associated HV-negative isolates motivated us to re-evaluate the role of HV-phenotype. As a common pathogen responsible for a wide range of clinical illnesses, K. pneumoniae has long been the principal cause of pneumonia [1], emerging as the major pathogen associated with pyogenic liver abscesses over the past decade [2]. K. pneumoniae has been implicated in 7-12% of hospital-acquired pneumoniae in ICUs in the United States [3,4], accounting for 15, 32, and 34%. Diabetes mellitus (DM), the most common endocrine disease, is a predisposing factor for infections of. Several factors predispose diabetic patients to infection, including genetic susceptibility, altered cellular and humoral immune defense mechanisms, poor blood supply, nerve damage, and alterations in metabolism [12]

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