Molecular epidemiology of Klebsiella pneumoniae bacteremic strains allows for a better understanding of preventive and therapeutic strategies. Clinical and microbiological characteristics of 348 K. pneumoniae bacteremia cases (2007–2009) were retrospectively characterized by multilocus sequence typing and extended-spectrum beta-lactamases (ESBL) production. Overall, 223 (64.08%) cases were nosocomial (NA), 58 (16.67%) healthcare associated, and 67 (19.25%) community acquired. The main infection origins were urinary tract (16.6%, 50.0%, and 43.3%), biliary tract (10.8%, 24.2%, and 31.3%), and catheter-related infection (39.9%, 5.2%, and 0%). The 30-day mortality rate was around 20%. The rates of resistance were around 45% the highest being among NA cases, and ESBL production was detected in 7.2% of cases. A total of 161 different sequence types were grouped into 13 clonal sets by e-burst analysis. No relationship could be established between clonal sets and the origin of infection or the healthcare-related settings. The high genetic variability among the isolates suggests their intrapatient endogenous origin.
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References
1.
HusseinK., Raz-PasteurA., FinkelsteinR., NeubergerA., Shachor-MeyouhasY., OrenI., and KassisI.. 2013. Impact of carbapenem resistance on the outcome of patients' hospital-acquired bacteraemia caused by Klebsiella pneumoniae. J. Hosp. Infect., 83:307–313.
2.
PeraltaG., LameloM., Alvarez-GarcíaP., VelascoM., DelgadoA., HorcajadaJ.P., MonteroM., RoizM.P., FariñasM.C., AlonsoJ., MartínezL.M., Gutiérrez-MacíasA., AlavaJ.A., RodríguezA., FleitesA., NavarroV., SirventE., and CapdevilaJ.A.. 2012. Impact of empirical treatment in extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. bacteremia. A multicentric cohort study. BMC Infect. Dis., 12:245.
3.
MeatherallB.L., GregsonD., RossT., PitoutJ.D.D., and LauplandK.B.. 2009. Incidence, risk factors, and outcomes of Klebsiella pneumoniae bacteremia. Am. J. Med., 122:866–873.
4.
MarraA.R., WeyS.B., CasteloA., GalesA.C., CalR.G.R., FilhoJ.R.D.C., EdmondM.B., and PereiraC.A.P.. 2006. Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum beta-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence. BMC Infect. Dis., 6:24.
5.
YangC.-C., LiS.-H., ChuangF.-R., ChenC.-H., LeeC.-H., ChenJ.-B., WuC.-H., and LeeC.-T.. 2012. Discrepancy between effects of carbapenems and flomoxef in treating nosocomial hemodialysis access-related bacteremia secondary to extended spectrum beta-lactamase producing Klebsiella pneumoniae in patients on maintenance hemodialysis. BMC Infect. Dis., 12:206.
6.
ItoR., ShindoY., KobayashiD., AndoM., JinW., WachinoJ.I., YamadaK., KimuraK., YagiT., HasegawaY., and ArakawaY.. 2015. Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia. J. Clin. Microbiol., 53:879–886.
7.
LeeJ., KangC.-I., JooE.-J., HaY.E., KangS.-J., ParkS.Y., ChungD.R., PeckK.R., KoK.S., LeeN.Y., and SongJ.-H.. 2011. Epidemiology and clinical features of community-onset bacteremia caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae. Microb. Drug Resist., 17:267–273.
8.
PienB.C., SundaramP., RaoofN., CostaS.F., MirrettS., WoodsC.W., RellerL.B., and WeinsteinM.P.. 2010. The clinical and prognostic importance of positive blood cultures in adults. Am. J. Med., 123:819–828.
9.
TsayR.-W., SiuL.K., FungC.-P., and ChangF.-Y.. 2002. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection. Arch. Intern. Med., 162:1021.
10.
MarschallJ., FraserV.J., DohertyJ., and WarrenD.K.. 2009. Between community and hospital: healthcare-associated gram-negative bacteremia among hospitalized patients. Infect. Control Hosp. Epidemiol., 30:1050–1056.
11.
NeidellM.J., CohenB., FuruyaY., HillJ., JeonC.Y., GliedS., and LarsonE.L.. 2012. Costs of healthcare-and community-associated infections with antimicrobial-resistant versus antimicrobial-susceptible organisms. Clin. Infect. Dis., 55:807–815.
12.
RosenthalV.D., MakiD.G., MehtaY., LeblebiciogluH., MemishZ.A., Al-MousaH.H., BalkhyH., HuB., Alvarez-MorenoC., MedeirosE.A., ApisarnthanarakA., RakaL., CuellarL.E., AhmedA., Navoa-NgJ.A., El-KholyA.A., KanjS.S., Bat-ErdeneI., DuszynskaW., Van TruongN., PazminoL.N., See-LumL.C., Fernández-HidalgoR., Di-SilvestreG., ZandF., HlinkovaS., BelskiyV., Al-RahmaH., Luque-TorresM.T., BayraktarN., MitrevZ., GurskisV., FisherD., Abu-KhaderI.B., BerechidK., Rodríguez-SánchezA., HorhatF.G., Requejo-PinoO., HadjievaN., Ben-JaballahN., García-MayorcaE., Kushner-DávalosL., PasicS., Pedrozo-OrtizL.E., ApostolopoulouE., MejíaN., Gamar-ElanbyaM.O., JayatillekeK., De Lourdes-DueñasM., and Aguirre-AvalosG.. 2014. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am. J. Infect. Control, 42:942–956.
13.
FriedmanN.D., KayeK.S., StoutJ.E., McgarryS.A., TrivetteS.L., BriggsJ.P., LammW., ClarkC., MacfarquharJ., WaltonA.L., RellerL.B., and SextonD.J.. 2002. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann. Fam. Med., 137:791–798.
14.
CLSI. 2015. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fifth Informational Supplement M100-S25Clinical and Laboratory Standards Institute (CLSI). Wayne, PA.
15.
TenoverF.C., ArbeitR.D., GoeringR V., MickelsenP.A., MurrayB.E., PersingD.H., and SwaminathanB.. 1995. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J. Clin. Microbiol., 33:2233–2239.
16.
Ribeiro-GonçalvesB., FranciscoA.P., VazC., RamirezM., and CarriçoJ.A.. 2016. PHYLOViZ Online: web-based tool for visualization, phylogenetic inference, analysis and sharing of minimum spanning trees. Nucleic Acids Res., 44:W246–W251.
17.
MaatallahM., VadingM., KabirM.H., BakhroufA., KalinM., NauclérP., BrisseS., and GiskeC.G.. 2014. Klebsiella variicola is a frequent cause of bloodstream infection in the Stockholm area, and associated with higher mortality compared to K. pneumoniae. PLoS One, 9:e113539.
18.
FangH., AtakerF., HedinG., and DornbuschK.. 2008. Molecular epidemiology of extended-spectrum β-lactamases among Escherichia coli isolates collected in a Swedish hospital and its associated health care facilities from 2001 to 2006. J. Clin. Microbiol., 46:707–712.
19.
CoqueT.M., OliverA., Pérez-DíazJ.C., BaqueroF., and CantónR.. 2002. Genes encoding TEM-4, SHV-2, and CTX-M-10 extended-spectrum β-lactamases are carried by multiple Klebsiella pneumoniae clones in a single hospital (Madrid, 1989 to 2000). Antimicrob. Agents Chemother., 46:500–510.
20.
HujerK.M., HujerA.M., HultenE.A., BajaksouzianS., AdamsJ.M., DonskeyC.J., EckerD.J., MassireC., EshooM.W., SampathR., ThomsonJ.M., RatherP.N., CraftD.W., FishbainJ.T., EwellA.J., JacobsM.R., PatersonD.L., and BonomoR.A.. 2006. Analysis of antibiotic resistance genes in multidrug-resistant Acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrob. Agents Chemother., 50:4114–4123.
21.
BushK., and JacobyG.A.. 2010. Updated functional classification of beta-lactamases. Antimicrob. Agents Chemother., 54:969–976.
22.
CuberoM., CalatayudL., TubauF., AyatsJ., PeñaC., MartínR., LiñaresJ., DomínguezM.Á., and ArdanuyC.. 2013. Clonal spread of Klebsiella pneumoniae producing OXA-1 betalactamase in a Spanish hospital. Int. Microbiol., 16:227–233.
23.
BodroM., SabéN., TubauF., LladóL., BaliellasC., RocaJ., CruzadoJ.M., CarratalàJ., SabeN., TubauF., LladoL., BaliellasC., RocaJ., CruzadoJ.M., and CarratalaJ.. 2013. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation, 96:843–849.
24.
HaddyR.I., LeeM.III, SangalS.P., WalbroehlG.S., HambrickC.S., and SartiG.M.. 1989. Klebsiella pneumoniae bacteremia in the community hospital. J. Fam. Pract., 28:686–690.
25.
KoupetoriM., RetsasT., AntonakosN., VlachogiannisG., PerdiosI., NathanailC., MakaritsisK., PapadopoulosA., SinapidisD., Giamarellos-BourboulisE.J., PneumatikosI., GogosC., ArmaganidisA., and ParamythiotouE.. 2014. Bloodstream infections and sepsis in Greece: over-time change of epidemiology and impact of de-escalation on final outcome. BMC Infect. Dis., 14:272.
26.
TsengC.P., WuH.S., WuT.H., LinY.T., and FungC.P.. 2013. Clinical characteristics and outcome of patients with community-onset Klebsiella pneumoniae bacteremia requiring intensive care. J. Microbiol. Immunol. Infect., 46:217–223.
27.
DecréD., VerdetC., EmirianA., Le GourrierecT., PetitJ.C., OffenstadtG., MauryE., BrisseS., and ArletG.. 2011. Emerging severe and fatal infections due to Klebsiella pneumoniae in two university hospitals in France. J. Clin. Microbiol., 49:3012–3014.
28.
IsendahlJ., ManjubaC., RodriguesA., XuW., Henriques-NormarkB., GiskeC.G., and NauclérP.. 2014. Prevalence of community-acquired bacteraemia in Guinea-Bissau: an observational study. BMC Infect. Dis., 14:3859.
29.
KoW.C., PatersonD.L., SagnimeniA.J., HansenD.S., Von GottbergA., MohapatraS., CasellasJ.M., GoossensH., MulazimogluL., TrenholmeG., KlugmanK.P., McCormackJ.G., and YuV.L.. 2002. Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg. Infect. Dis., 8:160–166.
30.
MelotB., ColotJ., and GuerrierG.. 2015. Bacteremic community-acquired infections due to Klebsiella pneumoniae: clinical and microbiological presentation in New Caledonia, 2008–2013. Int. J. Infect. Dis., 41:29–31.
31.
MarínM., GudiolC., Garcia-VidalC., ArdanuyC., and CarratalàJ.. 2014. Bloodstream infections in patients with solid tumors: epidemiology, antibiotic therapy, and outcomes in 528 episodes in a single cancer center. Medicine (Baltimore), 93:143–149.
32.
HongsuwanM., SrisamangP., KanoksilM., LuangasanatipN., JatapaiA., DayN.P., PeacockS.J., CooperB.S., and LimmathurotsakulD.. 2014. Increasing incidence of hospital-acquired and healthcare-associated bacteremia in northeast Thailand: a multicenter surveillance study. PLoS One, 9:e109324.
33.
WolfeC.M., CohenB., and LarsonE.. 2014. Prevalence and risk factors for antibiotic-resistant community-associated bloodstream infections. J. Infect. Public Health, 7:224–232.
34.
Chetcuti ZammitS., AzzopardiN., and SantJ.. 2014. Mortality risk score for Klebsiella pneumoniae bacteraemia. Eur. J. Intern. Med., 25:571–576.
35.
CalboE., and GarauJ.. 2015. The changing epidemiology of hospital outbreaks due to ESBL-producing Klebsiella pneumoniae: the CTX-M-15 type consolidation. Future Microbiol., 10:1063–1075.
36.
WebsterD.P., YoungB.C., MortonR., CollyerD., BatchelorB., TurtonJ.F., MaharjanS., LivermoreD.M., BejonP., CooksonB.D., and BowlerI.C.J.W.. 2011. Impact of a clonal outbreak of extended-spectrum β-lactamase-producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK. J. Antimicrob. Chemother., 66:2126–2135.
37.
TalanD.A., KrishnadasanA., AbrahamianF.M., StammW.E., and Moran; Group for the EmergeIDNETSG.J.. 2008. Prevalence and risk factor analysis of trimethoprim-sulfamethoxazole- and fluoroquinolone-resistant Escherichia coli infection among emergency department patients with pyelonephritis. Clin. Infect. Dis., 47:1150.
38.
Rodríguez-MartínezJ.M., VelascoC., GarcíaI., CanoM.E., Martínez-MartínezL., and PascualA.. 2007. Characterisation of integrons containing the plasmid-mediated quinolone resistance gene qnrA1 in Klebsiella pneumoniae. Int. J. Antimicrob. Agents, 29:705–709.
39.
Ruiz-GarbajosaP., CuriaoT., TatoM., GijónD., PintadoV., ValverdeA., BaqueroF., MorosiniM.I., CoqueT.M., and CantónR.. 2013. Multiclonal dispersal of KPC genes following the emergence of non-ST258 KPC-producing Klebsiella pneumoniae clones in Madrid, Spain. J. Antimicrob. Chemother., 68:2487–2492.
40.
JinY., ShaoC., LiJ., FanH., BaiY., and WangY.. 2015. Outbreak of multidrug resistant NDM-1-producing Klebsiella pneumoniae from a neonatal unit in Shandong Province, China. PLoS One, 10:e0119571.
41.
Bialek-DavenetS., CriscuoloA., AilloudF., PassetV., JonesL., Delannoy-VieillardA.S., GarinB., Le HelloS., ArletG., Nicolas-ChanoineM.H., DecréD., and BrisseS.. 2014. Genomic definition of hypervirulent and multidrug-resistant Klebsiella pneumoniae clonal groups. Emerg. Infect. Dis., 20:1812–1820.
42.
BrisseS., FevreC., PassetV., Issenhuth-JeanjeanS., TournebizeR., DiancourtL., and GrimontP.. 2009. Virulent clones of Klebsiella pneumoniae: identification and evolutionary scenario based on genomic and phenotypic characterization. PLoS One, 4:e4982.
43.
CuberoM., GrauI., TubauF., PallarésR., DominguezM.A., LiñaresJ., and ArdanuyC.. 2016. Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007–2013). Clin. Microbiol. Infect., 22:154–160.
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