Dataset Information

Clinical and Genomic Characterization of a Cohort of Patients With Klebsiella pneumoniae Bloodstream Infection.

ABSTRACT:

Background

The clinical and microbial factors associated with Klebsiella pneumoniae bloodstream infections (BSIs) are not well characterized. Prior studies have focused on highly resistant or hypervirulent isolates, limiting our understanding of K. pneumoniae strains that commonly cause BSI. We performed a record review and whole-genome sequencing to investigate the clinical characteristics, bacterial diversity, determinants of antimicrobial resistance, and risk factors for in-hospital death in a cohort of patients with K. pneumoniae BSI.

Methods

We identified 562 patients at Massachusetts General Hospital with K. pneumoniae BSIs between 2016 and 2022. We collected data on comorbid conditions, infection source, clinical outcomes, and antibiotic resistance and performed whole-genome sequencing on 108 sequential BSI isolates from 2021 to 2022.

Results

Intra-abdominal infection was the most common source of infection accounting for 34% of all BSIs. A respiratory tract source accounted for 6% of BSIs but was associated with a higher in-hospital mortality rate (adjusted odds ratio, 5.4 [95% confidence interval, 2.2-12.8]; P < .001 for comparison with other sources). Resistance to the first antibiotic prescribed was also associated with a higher risk of death (adjusted odds ratio, 5.2 [95% confidence interval, 2.2-12.4]; P < .001). BSI isolates were genetically diverse, and no clusters of epidemiologically and genetically linked cases were observed. Virulence factors associated with invasiveness were observed at a low prevalence, although an unexpected association between O-antigen type and the source of infection was found.

Conclusions

These observations demonstrate the versatility of K. pneumoniae as an opportunistic pathogen and highlight the need for new approaches for surveillance and the rapid identification of patients with invasive antimicrobial-resistant K. pneumoniae infection.

SUBMITTER: Roach DJ

PROVIDER: S-EPMC10810715 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Clinical and Genomic Characterization of a Cohort of Patients With Klebsiella pneumoniae Bloodstream Infection.

Roach David J DJ Sridhar Sushmita S Oliver Elizabeth E Rao Sowmya R SR Slater Damien M DM Hwang Wontae W Hutt Vater Kian K Dinesh Anupama A Qadri Firdausi F Chisti Mohammod J MJ Pierce Virginia M VM Turbett Sarah E SE Bhattacharyya Roby P RP Worby Colin J CJ Earl Ashlee M AM LaRocque Regina C RC Harris Jason B JB

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 20240101 1

<h4>Background</h4>The clinical and microbial factors associated with Klebsiella pneumoniae bloodstream infections (BSIs) are not well characterized. Prior studies have focused on highly resistant or hypervirulent isolates, limiting our understanding of K. pneumoniae strains that commonly cause BSI. We performed a record review and whole-genome sequencing to investigate the clinical characteristics, bacterial diversity, determinants of antimicrobial resistance, and risk factors for in-hospital d ...[more]

PMID: 37633257

Similar Datasets

Project description:BackgroundKlebsiella pneumoniae bloodstream infection (KP BSI) is a severe clinical condition characterized by high mortality rates. Despite the clinical significance, accurate predictors of mortality in KP BSI have yet to be fully identified.MethodsA retrospective analysis was conducted on the clinical data of 90 cases of KP BSI. The clinical data was extracted from electronic medical records. Antimicrobial susceptibility testing, string testing, and whole-genome sequencing (WGS) were performed on all isolates. Additionally, relevant bioinformatics analyses, such as phylogenetic analysis and assessment of resistance and virulence genes, were carried out. Logistic regression modeling was employed to evaluate the risk factors associated with 28-day mortality in patients with KP BSI, considering both host characteristics and the characteristics of the causative Klebsiella pneumoniae (KP) isolates.ResultsAmong the 90 patients included in this study, the 28-day mortality rate for those with KP BSI was 30.00% (27/90). Multivariate analysis revealed several host-related factors associated with an increased risk of 28-day mortality. These factors included an elevated qSOFA score (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.21-7.31, p = 0.017), presence of septic shock (OR 8.21, 95% CI 1.63-41.93, p = 0.008), and nosocomial infection (OR 7.72, 95% CI 1.71-34.74, p = 0.002). Regarding bacterial factors, the presence of the virulence genes rfbA/B/D (OR 8.53, 95% CI 1.41-51.57, p = 0.020) was identified as an independent risk factor, particularly for nosocomial infection patients. However, hypermucoviscosity phenotype, ST type, serotype, and resistance genes were not associated with an increased risk of 28-day mortality.ConclusionThe carriage of virulence genes rfbA/B/D, which is responsible for the synthesis of O-antigen, was associated with poor prognosis of KP BSI. It may facilitate the clinical management of patients with bloodstream infection (BSI) caused by hypervirulent KP strains, especially those with rfbA/B/D genes.Clinical trial numberNot applicable.

Project description:Bloodstream infection (BSI) caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious and urgent threat for hospitalized patients. This study aims to describe the clinical and molecular characteristics of CRKP causing BSI in a tertiary-care hospital in Beijing, China. A total of 146 CRKP strains and 39 carbapenem-susceptible K. pneumoniae (CSKP) strains collected in the hospital from 2017 to 2020 were sent for whole-genome sequencing. Univariate and multivariate analyses were used to evaluate risk factors for in-hospital mortality of CRKP-BSI cases. Thirty (20.5%) of 146 CRKP-BSI patients and three (7.7%) of 39 CSKP-BSI patients died at discharge (χ2 = 3.471, P = 0.062). Multivariate logistic regression analysis indicated that age and use of urinary catheters were independent risk factors for the death of CRKP-BSI. The 146 CRKP isolates belonged to 9 sequence types (STs) and 11 serotypes, while the 39 CSKP isolates belonged to 23 STs and 27 serotypes. The mechanism of carbapenem resistance for all the CRKP strains was the acquisition of carbapenemase, mainly KPC-2 (n = 127). There were 2 predominant serotypes for ST11 CRKP, namely, KL47 (n = 82) and KL64 (n = 42). Some virulent genes, including rmpA2, iucABCD and iutA, and repB gene, which was involved in plasmid replication, were detected in all ST11-KL64 strains. Evolutionary transmission analysis suggested that ST11 CRKP strains might have evolved from KL47 into KL64 and were accompanied by multiple outbreak events. This study poses an urgent need for enhancing infection control measures in the hospital, especially in the intensive care unit where the patients are at high-risk for acquiring CRKP-BSI. IMPORTANCE CRKP-BSI is demonstrated to cause high mortality. In this study, we demonstrated that ST11 CRKP strains might carry many virulent genes. Meanwhile, outbreak events occurred several times in the strains collected. Carbapenemase acquisition (mainly KPC-2 carbapenemase) was responsible for carbapenem resistance of all the 146 CRKP strains. As 2 predominant strains, all ST11-KL64 strains, but not ST11-KL47 strains, carried rmpA2, iucABCD, iutA, as well as a plasmid replication initiator (repB). Our study suggested that the occurrence of region-specific recombination events manifested by the acquisition of some virulence genes might contribute to serotype switching from ST11-KL47 to ST11-KL64. The accumulation of virulent genes in epidemic resistant strains poses a great challenge for the prevention and treatment of BSI caused by K. pneumoniae in high-risk patients.

Dataset Information

Clinical and Genomic Characterization of a Cohort of Patients With Klebsiella pneumoniae Bloodstream Infection.

Background

Methods

Results

Conclusions

Publications

Clinical and Genomic Characterization of a Cohort of Patients With Klebsiella pneumoniae Bloodstream Infection.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets