Clinical and Bacterial Characteristics of Klebsiella pneumoniae Affecting 30-Day Mortality in Patients With Bloodstream Infection.

Xingbing Wu,Hongcheng Wu,Shimo Shen,Qingyi Shi,Chen Huang

doi:10.3389/fcimb.2021.688989

Abstract

BackgroundThere is a paucity of studies using clinical characteristics and whole-genome sequencing together to fully identify the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI).MethodsWe retrospectively analyzed the clinical and microbiological characteristics of patients with KP BSI. Isolates were processed using Illumina NGS, and relevant bioinformatics analysis was conducted (multi-locus sequence typing, serotype, phylogenetic reconstruction, detection of antibiotic resistance, and virulence genes). A logistic regression model was used to evaluate the risk factors of hosts and causative KP isolates associated with 30-day mortality in patients infected with KP BSI.ResultsOf the 79 eligible patients, the 30-day mortality rate of patients with KP BSI was 30.4%. Multivariate analysis showed that host-associated factors (increased APACHE II score and septic shock) were strongly associated with increased 30-day mortality. For the pathogenic factors, carriage of iutA (OR, 1.46; 95% CI, 1.11–1.81, p = 0.002) or Kvar_1549 (OR, 1.31; 95% CI, 1.02–1.69, p = 0.043) was an independent risk factor, especially when accompanied by a multidrug-resistant phenotype. In addition, ST11-K64 hypervirulent carbapenem-resistant KP co-harbored acquired blaKPC-2 together with iutA (76.5%, 13/17) and Kvar_1549 (100%, 17/17) genes. Comparative genomic analysis showed that they were clustered together based on a phylogenetic tree, and more virulence genes were observed in the group of ST11-K64 strains compared with ST11-non-K64. The patients infected with ST11-K64 strains were associated with relatively high mortality (47.2%, 7/17).ConclusionThe carriage of iutA and Kvar_1549 was seen to be an independent mortality risk factor in patients with KP BSI. The identification of hypervirulent and carbapenem-resistant KP strains associated with high mortality should prompt surveillance.

Highlights

Klebsiella pneumoniae (KP) is one of the most common bacterial pathogens that causes community or nosocomial acquired infections, such as pneumonia, urinary tract and surgical site infections, bloodstream infections (BSIs), and hepatobiliary infections (Paczosa and Mecsas, 2016)
The clinical characteristics of KP BSI between non-survivors and survivors are summarized in Table 1 and Supplementary Table S2
Almost half of the patients resided in the intensive care unit (ICU) within 90 days prior to the onset of BSI

Summary

Introduction

Klebsiella pneumoniae (KP) is one of the most common bacterial pathogens that causes community or nosocomial acquired infections, such as pneumonia, urinary tract and surgical site infections, bloodstream infections (BSIs), and hepatobiliary infections (Paczosa and Mecsas, 2016). The management of infections due to KP has been complicated by the emergence of antimicrobial resistance and hypervirulent K. pneumoniae (HvKp). Carbapenem-resistant HvKp have emerged in clinical settings, most KP of hypervirulent and antimicrobial-resistant populations was largely non-overlapping (Bialek-Davenet et al, 2014; Zhang et al, 2016; Gu et al, 2018). The prevalence of such organisms poses a significant challenge for clinicians worldwide and often leads to the failure of clinical treatment (Lin et al, 2010; Mohammad Ali Tabrizi et al, 2018). There is a paucity of studies using clinical characteristics and wholegenome sequencing together to fully identify the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI)

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