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, Seok Hoon Jeong

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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 languageEnglish
Pages (from-to)190-199
Number of pages10
JournalJournal of Antimicrobial Chemotherapy
Volume74
Issue number1
DOIs
Publication statusPublished - 2019 Jan 1

All Science Journal Classification (ASJC) codes

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

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    Kim, D., Park, B. Y., Choi, M. H., Yoon, E. J., Lee, H., Lee, K. J., Park, Y. S., Shin, J. H., Uh, Y., Shin, K. S., Shin, J. H., Kim, Y. A., & Jeong, S. H. (2019). Antimicrobial resistance and virulence factors of Klebsiella pneumoniae affecting 30 day mortality in patients with bloodstream infection. Journal of Antimicrobial Chemotherapy, 74(1), 190-199. https://doi.org/10.1093/jac/dky397