Abstract
BackgroundHypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. The hallmark of HVKp infections are liver abscess formation and metastatic infections. Due to the severe sequelae of these complications, method to identify patients at-risk of HVKp infections should be developed.ResultsA retrospective cohort study of 222 patients with K. pneumoniae bloodstream infections (BSIs) was performed. Patient demographics, clinical manifestations, and bacterial characteristics were investigated. Ten cases of liver abscesses were identified. Characteristics such as community-onset BSIs, hypermucoviscosity phenotype, and capsular serotype K1 were identified as risk factors for HVKp infections. A scoring system was developed based on the risk factors. The area under the receiver operating characteristic curve for the scoring system was 0.90. A score of ≥ 2 points provided sensitivity and specificity of 0.70 and 0.94, respectively.ConclusionsSimple scoring system was developed for the diagnosis of HVKp infections. The system allows early identification of patients with K. pneumoniae BSIs in whom hypervirulent infections should be evaluated. Prospective evaluation is expected.
Highlights
Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections
We determined the definition of HVKp infections as “infections by K. pneumoniae complicated by liver abscess formation” with the assumption that classical K. pneumoniae (CKp)
We analyzed the patient cohort of K. pneumoniae bloodstream infections (BSIs) and identified three factors, community-onset infection, hypermucoviscosity phenotype, and capsular serotype K1, as risk factors for HVKp infections
Summary
Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. Risk factors for HVKp infections in patients with K. pneumoniae bloodstream infections (BSIs) has been studied. Harada et al reported that patients with HVKp infection had higher proportions of diabetes mellitus, and their infections had significantly higher propensity to liver abscess formation among Japanese patients with K. pneumoniae BSIs [12]. In these studies, the definitions of HVKp infections were based on molecular assays, in which the detection of virulence-associated genes, such as rmpA, iroBCDN, iucABCD, and iutA, was a prerequisite for defining them as HVKp
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