Abstract
Introduction: Recent reports indicate the emergence of community-acquired pneumonia associated with K64-Klebsiella pneumoniae. Here, we identify the capsular types and sequence type of invasive and commensal K. pneumoniae isolates from Vietnam. Methods: We included 93 K. pneumoniae isolates from patients hospitalized at the National Hospital for Tropical Diseases, Hanoi between 2007 and 2011; and 110 commensal isolates from throat swabs from healthy volunteers living in rural and urban Hanoi in 2012. We determined sequence types (STs) by multi-locus sequence typing (MLST) and capsule typing for seven K types by PCR. Antibiotic susceptibility testing was performed using disk diffusion. Results: The most common detected capsule types were K1 (39/203, 19.2%, mainly ST23) and K2 (31/203, 15.3%, multiple STs: ST65, ST86, ST380). We found significantly more K2 isolates among invasive in comparison to commensal isolates (22.6% vs 9%, p = 0.01) but no significant difference was observed between invasive and commensal K1 isolates (14.5% vs 24.7%, p = 0.075). K64 with varying sequence types were predominantly seen among invasive K. pneumoniae (8 vs. 3) and were isolated from sepsis and meningitis patients. Among K64 isolates, one was carbapenem-resistant with ST799. Conclusion: Our study confirms that capsule type K64 K. pneumoniae is associated with community-acquired invasive infections in Vietnam. Research is needed to unravel the mechanisms of virulence of capsule type K64 in both community and hospital settings.
Highlights
Recent reports indicate the emergence of communityacquired pneumonia associated with K64-Klebsiella pneumoniae
In addition to the emergence of carbapenem-resistant K. pneumoniae worldwide, previous studies have shown that infections caused by hypervirulent carbapenem susceptible K. pneumoniae can be considered a threat to public health.[12]
Our study showed that besides capsule type K2, capsule type K64 was overrepresented among invasive strains (5.4% vs 1.8%, Chi-square, p < 0.001), consistent with previous studies.[3,13]
Summary
Recent reports indicate the emergence of communityacquired pneumonia associated with K64-Klebsiella pneumoniae. In low and middle-income countries in Asia, like Vietnam, Klebsiella pneumoniae is an important cause of severe communityacquired infections, including pneumonia, liver abscesses and sepsis.[1] Multidrug-resistance in K. pneumoniae, especially among hospital acquired infections, is an emerging problem associated with high morbidity and mortality.[2] A genomic analysis of diversity and population structure of 288 human and animal K. pneumoniae isolates from six countries, spanning four continents, has shown that K64 mostly found in Vietnam (n = 3) and Singapore (n = 1), was among the important capsule types associated with community acquired pneumonia.[3] In addition to cases and outbreaks reported on severe K. pneumoniae infections by K64 with the convergence of carbapenem-resistant phenotypes,[4] in one case report, K64-ST1764 K. pneumoniae was found to be a cause of pyogenic liver abscess and endogenous endophthalmitis. We found K64-K. pneumoniae to be more common among invasive isolates as compared to commensal isolates isolated from Vietnamese individuals
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