Abstract
Klebsiella pneumoniae (KP) resistance to broad-spectrum cephalosporin (BSC) in meningitis is important because of limited therapeutic options. To investigate the antibiotic resistance, virulence and epidemiology of KP in meningitis, we conducted a retrospective study for 33 non-metastatic isolates, including primary meningitis (n = 20) and post-craniotomy meningitis (n = 13) collected from 1999 to 2013. BSC resistance was found in 9 (27.3%) isolates, all from post-craniotomy meningitis, harboring blaSHV-5 (n = 6), blaCMY-2 (n = 2), blaDHA-1 (n = 2), and blaTEM-1B (n = 1). Positive virulence factors were hypermucoviscosity (n = 22), larger bacterial size (n = 24), virulent capsule serotypes (n = 24, K2, 11; K1, 5; K57, 3; K5, 2; K20, 2 and K54, 1), rmpA (n = 23), rmpA2 (n = 20), aerobactin gene (n = 22) and high-grade serum resistance (n = 23, 69.7%). Higher mouse lethality (LD50 < 106) was found in 16 isolates (48.5%). Post-craniotomy isolates were significantly less virulent than primary meningitis isolates, except for similar serum resistance capability. The pulsotype and sequence typing (ST) results were diverse. A minor cluster with pulsotype C and ST23 (n = 5) was identified in primary meningitis isolates. In conclusion, virulence factors and BSC resistance corresponded to about 70% and 30% of KP meningitis isolates respectively. BSC remains appropriate for treating primary meningitis, whereas meropenem is indicated for post-craniotomy meningitis empirically.
Highlights
Klebsiella pneumoniae causes different types of community-acquired and healthcare-associated infections, including pneumonia, bloodstream infection, surgical site infections, liver abscess and meningitis[1,2,3,4]
Post-craniotomy meningitis could be caused by classic” K. pneumoniae (cKP) through disruption of the central nervous system barrier, whereas primary meningitis might commonly be caused by hypervirulent” K. pneumoniae (hvKP)
We aimed to investigate the molecular epidemiology and representative virulence factors in terms of capsule sizes, capsule serotypes, HV phenotype, serum resistance, pathogenic genes, including plasmid-borne rmpA, rmpA2, aerobactin gene and chromosomal rmpA (c-rmpA), kfu and allS, as well as mouse lethality capability for K. pneumoniae strains isolated from cerebrospinal fluid (CSF) among adult patients without liver or distant abscesses
Summary
Klebsiella pneumoniae causes different types of community-acquired and healthcare-associated infections, including pneumonia, bloodstream infection, surgical site infections, liver abscess and meningitis[1,2,3,4]. Distinct from hvKP, less virulent “classic” K. pneumoniae (cKP) that does not exhibit the hypermucoviscosity (HV) phenotype usually causes various infections in hospitals[14]. Post-craniotomy meningitis could be caused by cKP through disruption of the central nervous system barrier, whereas primary meningitis might commonly be caused by hvKP. We aimed to investigate the molecular epidemiology and representative virulence factors in terms of capsule sizes, capsule serotypes, HV phenotype, serum resistance, pathogenic genes, including plasmid-borne rmpA, rmpA2, aerobactin gene and chromosomal rmpA (c-rmpA), kfu (responsible for an iron uptake system) and allS (associated with allantoin metabolism), as well as mouse lethality capability for K. pneumoniae strains isolated from cerebrospinal fluid (CSF) among adult patients without liver or distant abscesses. Antibiotic resistance profiles and virulence factors between non-metastatic K. pneumoniae isolates of primary meningitis and post-craniotomy meningitis were compared
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