Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection

Dokyun Kim, Byeol Yi Park, Min Hyuk Choi, Eun Jeong Yoon, Hyukmin Lee, Kwang Jun Lee, Yoon Soo Park, Jong Hee Shin, Young Uh, Kyeong Seob Shin, Jeong Hwan Shin, Young Ah Kim, Seokhoon Jeong

Research output: Contribution to journalArticle

Abstract

Objectives: To investigate the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI) with a focus on antimicrobial resistance and virulence factors. Methods: All KP BSI patients (n = 579) from six general hospitals during a 1 year period were included in this study. The risk factors of hosts and causative KP isolates were assessed to determine associations with the 30 day mortality of KP BSI patients by multivariate Cox hazards modelling. Results: The 30 day mortality rate of KP BSI patients was 16.9% (98/579). Among the host-associated factors, increased SOFA score and leucopenia status exhibited strong associations with increased 30 day mortality. Among the pathogenic factors, carriage of the pks gene cluster (adjusted HR 1.80; 95% CI 1.16-2.79) was a risk factor, especially when accompanied by MDR. In this regard, KP isolates of the wzi50 capsular type (n = 22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n = 15) and mostly exhibited MDR (63.6%, n = 14), resulting in increased 30 day mortality. In contrast, hypermucoviscous KP isolates showed an inverse association with 30 day mortality (adjusted HR 0.55; 95% CI 0.33-0.90). Conclusions: Despite the reported virulence of hypermucoviscous KP strains, they were associated with good prognoses in KP BSI patients. Importantly, carriage of the pks gene cluster, which is responsible for the synthesis of colibactin, was a relevant marker of early mortality.

LanguageEnglish
Pages190-199
Number of pages10
JournalThe Journal of antimicrobial chemotherapy
Volume74
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

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R Factors
Klebsiella pneumoniae
Virulence Factors
Mortality
Infection
Multigene Family
Leukopenia
General Hospitals
Virulence

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Kim, Dokyun ; Park, Byeol Yi ; Choi, Min Hyuk ; Yoon, Eun Jeong ; Lee, Hyukmin ; Lee, Kwang Jun ; Park, Yoon Soo ; Shin, Jong Hee ; Uh, Young ; Shin, Kyeong Seob ; Shin, Jeong Hwan ; Kim, Young Ah ; Jeong, Seokhoon. / Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection. In: The Journal of antimicrobial chemotherapy. 2019 ; Vol. 74, No. 1. pp. 190-199.
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abstract = "Objectives: To investigate the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI) with a focus on antimicrobial resistance and virulence factors. Methods: All KP BSI patients (n = 579) from six general hospitals during a 1 year period were included in this study. The risk factors of hosts and causative KP isolates were assessed to determine associations with the 30 day mortality of KP BSI patients by multivariate Cox hazards modelling. Results: The 30 day mortality rate of KP BSI patients was 16.9{\%} (98/579). Among the host-associated factors, increased SOFA score and leucopenia status exhibited strong associations with increased 30 day mortality. Among the pathogenic factors, carriage of the pks gene cluster (adjusted HR 1.80; 95{\%} CI 1.16-2.79) was a risk factor, especially when accompanied by MDR. In this regard, KP isolates of the wzi50 capsular type (n = 22) frequently harboured pks (63.6{\%}, 14/22) and ybtA (68.2{\%}, n = 15) and mostly exhibited MDR (63.6{\%}, n = 14), resulting in increased 30 day mortality. In contrast, hypermucoviscous KP isolates showed an inverse association with 30 day mortality (adjusted HR 0.55; 95{\%} CI 0.33-0.90). Conclusions: Despite the reported virulence of hypermucoviscous KP strains, they were associated with good prognoses in KP BSI patients. Importantly, carriage of the pks gene cluster, which is responsible for the synthesis of colibactin, was a relevant marker of early mortality.",
author = "Dokyun Kim and Park, {Byeol Yi} and Choi, {Min Hyuk} and Yoon, {Eun Jeong} and Hyukmin Lee and Lee, {Kwang Jun} and Park, {Yoon Soo} and Shin, {Jong Hee} and Young Uh and Shin, {Kyeong Seob} and Shin, {Jeong Hwan} and Kim, {Young Ah} and Seokhoon Jeong",
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Kim, D, Park, BY, Choi, MH, Yoon, EJ, Lee, H, Lee, KJ, Park, YS, Shin, JH, Uh, Y, Shin, KS, Shin, JH, Kim, YA & Jeong, S 2019, 'Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection', The Journal of antimicrobial chemotherapy, vol. 74, no. 1, pp. 190-199. https://doi.org/10.1093/jac/dky397

Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection. / Kim, Dokyun; Park, Byeol Yi; Choi, Min Hyuk; Yoon, Eun Jeong; Lee, Hyukmin; Lee, Kwang Jun; Park, Yoon Soo; Shin, Jong Hee; Uh, Young; Shin, Kyeong Seob; Shin, Jeong Hwan; Kim, Young Ah; Jeong, Seokhoon.

In: The Journal of antimicrobial chemotherapy, Vol. 74, No. 1, 01.01.2019, p. 190-199.

Research output: Contribution to journalArticle

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T1 - Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection

AU - Kim, Dokyun

AU - Park, Byeol Yi

AU - Choi, Min Hyuk

AU - Yoon, Eun Jeong

AU - Lee, Hyukmin

AU - Lee, Kwang Jun

AU - Park, Yoon Soo

AU - Shin, Jong Hee

AU - Uh, Young

AU - Shin, Kyeong Seob

AU - Shin, Jeong Hwan

AU - Kim, Young Ah

AU - Jeong, Seokhoon

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To investigate the risk factors of patients with Klebsiella pneumoniae (KP) bloodstream infection (BSI) with a focus on antimicrobial resistance and virulence factors. Methods: All KP BSI patients (n = 579) from six general hospitals during a 1 year period were included in this study. The risk factors of hosts and causative KP isolates were assessed to determine associations with the 30 day mortality of KP BSI patients by multivariate Cox hazards modelling. Results: The 30 day mortality rate of KP BSI patients was 16.9% (98/579). Among the host-associated factors, increased SOFA score and leucopenia status exhibited strong associations with increased 30 day mortality. Among the pathogenic factors, carriage of the pks gene cluster (adjusted HR 1.80; 95% CI 1.16-2.79) was a risk factor, especially when accompanied by MDR. In this regard, KP isolates of the wzi50 capsular type (n = 22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n = 15) and mostly exhibited MDR (63.6%, n = 14), resulting in increased 30 day mortality. In contrast, hypermucoviscous KP isolates showed an inverse association with 30 day mortality (adjusted HR 0.55; 95% CI 0.33-0.90). Conclusions: Despite the reported virulence of hypermucoviscous KP strains, they were associated with good prognoses in KP BSI patients. Importantly, carriage of the pks gene cluster, which is responsible for the synthesis of colibactin, was a relevant marker of early mortality.

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