Abstract
BackgroundEndogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome. Most HVKP strains display a wild-type susceptibility profile to antibiotics. However, reports of antimicrobial-resistant HVKP have increased over time, which poses a serious therapeutic dilemma.Case presentationA 25-year-old man with a liver abscess and poorly controlled diabetes mellitus was admitted for endophthalmitis due to K. pneumoniae. The isolate displayed hypermucoviscosity as determined by a positive string test and exhibited resistance to ceftazidime, piperacillin-tazobactam and amikacin. Whole genome sequencing (WGS) analysis demonstrated the isolate to be a K1-serotype strain and belong to a novel single locus variant of ST23, ST2922. In addition to the virulence genes linked to HVKP, rmpA, magA, iucABCDiutA (aerobactin), ybtAPSTUX (yersiniabactin) and iroBDN (salmochelin), it was found to harbor extended-spectrum β-lactamase (ESBL) gene (blaCTX-M-14), AmpC β-lactamase gene (blaDHA), and 16S rRNA methylase gene (armA).ConclusionsThis is the first known case of endogenous endophthalmitis caused by a multidrug-resistant HVKP strain ever reported in China. Early diagnosis and treatment with intravenous and intravitreal injection of carbapenem were essential for a favorable visual outcome.
Highlights
Endogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome
A distinct variant of K. pneumoniae characterized by a hypermucoviscous phenotype has been recognized as an important pathogen responsible for endogenous endophthalmitis in some regions of Asian, especially in Taiwan [22] and Korea [23]
To the best of our knowledge, this is the first report of endophthalmitis caused by K1-serotype HVKP coharboring AmpC β-lactamase and Extended-spectrum β-lactamase (ESBL) genes
Summary
Endogenous endophthalmitis caused by hypervirulent Klebsiella pneumoniae (HVKP) is an emerging infectious disease commonly with a devastating visual outcome. * Correspondence: fuyiqi@zju.edu.cn 4Department of Respiratory Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Full list of author information is available at the end of the article string test. The genomic analysis of hypervirulent K. pneumoniae (HVKP) most frequently indicates capsular serotypes K1 and K2, as well as the presence of several important virulence factors including rmpA (regulator of mucoid phenotype A), magA (mucoviscosity-associated gene A) and siderophores-encoding genes [4].
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