Abstract
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 (n579) 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 (n22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n15) and mostly exhibited MDR (63.6%, n14), 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 wereassociated 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.
| Original language | English |
|---|---|
| Pages (from-to) | 190-199 |
| Number of pages | 10 |
| Journal | Journal of Antimicrobial Chemotherapy |
| Volume | 74 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2019 Jan 1 |
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All Science Journal Classification (ASJC) codes
- Pharmacology
- Microbiology (medical)
- Pharmacology (medical)
- Infectious Diseases
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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: Journal of Antimicrobial Chemotherapy, Vol. 74, No. 1, 01.01.2019, p. 190-199.Research output: Contribution to journal › Article
TY - JOUR
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 - 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 (n579) 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 (n22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n15) and mostly exhibited MDR (63.6%, n14), 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 wereassociated 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.
AB - 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 (n579) 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 (n22) frequently harboured pks (63.6%, 14/22) and ybtA (68.2%, n15) and mostly exhibited MDR (63.6%, n14), 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 wereassociated 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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U2 - 10.1093/jac/dky397
DO - 10.1093/jac/dky397
M3 - Article
VL - 74
SP - 190
EP - 199
JO - Journal of Antimicrobial Chemotherapy
JF - Journal of Antimicrobial Chemotherapy
SN - 0305-7453
IS - 1
ER -