701
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Chiang TT, Yang YS, Yeh KM, Chiu SK, Wang NC, Lin TY, Huang LY, Chang FY, Siu LK, Lin JC, Chen JH. Quantification and comparison of virulence and characteristics of different variants of carbapenemase-producing Klebsiella pneumoniae clinical isolates from Taiwan and the United States. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 49:83-90. [PMID: 26514941 DOI: 10.1016/j.jmii.2015.08.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/08/2015] [Accepted: 08/31/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE The emergence of Klebsiella pneumoniae carbapenemase (KPC)-producing strains is a challenge for clinicians. The characteristics and virulence of variants of KPC-producing K. pneumoniae isolates were evaluated. METHODS Five clinical isolates-three KPC subtypes from Taiwan (KPC2-TW, KPC3-TW, and KPC17-TW) and two clinical strains from the United States (US; KPC2-US, KPC3-US)-were included. Virulent traits and capsular serotypes were analyzed by Polymerase Chain Reaction (PCR). Serum killing, neutrophil phagocytosis, and mice lethargy studies were performed to evaluate virulence. RESULTS Multilocus sequence typing (MLST) demonstrated that KPC2-TW and KPC17-TW belonged to sequence type (ST)11, and KPC2-US, KPC3-US, and KPC3-TW to ST258. KPC3-TW expressed capsular serotype K1, whereas the others were non-K1/K2/K5 isolates. MLST analysis indicated that ST11 strains were serum resistant, whereas ST258 isolates were serum sensitive. ST11 isolates exhibited significantly higher 15-minute phagocytic rates than ST258 isolates (70.28 ± 16.68% vs. 34.88 ± 10.52%, p < 0.001). The capsular serotype K1 strain was more resistant to neutrophil phagocytosis than non-K1/K2/K5 isolates (27.1 ± 10.23% vs. 54.46 ± 20.94%, p = 0.050). All KPC-producing strain variants from Taiwan and the US demonstrated less virulence in a mouse lethality study, where the LD50 ranged from approximately 10(6) colony-forming units (CFU) to >10(7) CFU. Immunological responses were not significantly correlated with KPC subtype; however, responses were associated with MLST and capsular serotype. CONCLUSION Production of KPC itself was not associated with increased virulence despite different variants of KPC. The ST11 KPC-producing strain was resistant to serum killing, whereas capsular ss K1 was associated with resistance to neutrophil phagocytosis.
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Affiliation(s)
- Tsung-Ta Chiang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Ming Yeh
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sun-Kang Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ning-Chi Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Te-Yu Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Li-Yueh Huang
- Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - L K Siu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Division of Clinical Research, National Health Research Institutes, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Jiun-Han Chen
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
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702
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Flores-Kim J, Darwin AJ. Regulation of bacterial virulence gene expression by cell envelope stress responses. Virulence 2015; 5:835-51. [PMID: 25603429 DOI: 10.4161/21505594.2014.965580] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The bacterial cytoplasm lies within a multilayered envelope that must be protected from internal and external hazards. This protection is provided by cell envelope stress responses (ESRs), which detect threats and reprogram gene expression to ensure survival. Pathogens frequently need these ESRs to survive inside the host, where their envelopes face dangerous environmental changes and attack from antimicrobial molecules. In addition, some virulence genes have become integrated into ESR regulons. This might be because these genes can protect the cell envelope from damage by host molecules, or it might help ESRs to reduce stress by moderating the assembly of virulence factors within the envelope. Alternatively, it could simply be a mechanism to coordinate the induction of virulence gene expression with entry into the host. Here, we briefly describe some of the bacterial ESRs, followed by examples where they control virulence gene expression in both Gram-negative and Gram-positive pathogens.
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Key Words
- BFP, bundle-forming pilus
- CAMP, cationic antimicrobial peptide
- CF, cystic fibrosis
- ECF, extracytoplasmic function
- EPEC, enteropathogenic E. coli
- ESR, envelope stress response
- HMV, hypermucoviscosity
- IM, inner membrane
- LPS, lipopolysaccharide
- LTA, lipoteichoic acids
- OM, outer membrane
- OMP, outer membrane protein
- PG, phosphatidylglycerol
- T(2/3/4)SS, type II/III/IV secretion system
- UPEC, uropathogenic E. coli
- WTA, wall teichoic acids
- antimicrobial peptide
- bacterial pathogens
- cell envelope
- gene regulation
- peptidoglycan
- phospholipid
- stress response
- teichoic acid
- virulence gene
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Affiliation(s)
- Josué Flores-Kim
- a Department of Microbiology ; New York University School of Medicine ; New York , NY USA
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703
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704
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Zhang Y, Zeng J, Liu W, Zhao F, Hu Z, Zhao C, Wang Q, Wang X, Chen H, Li H, Zhang F, Li S, Cao B, Wang H. Emergence of a hypervirulent carbapenem-resistant Klebsiella pneumoniae isolate from clinical infections in China. J Infect 2015; 71:553-60. [PMID: 26304687 DOI: 10.1016/j.jinf.2015.07.010] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Hypervirulent Klebsiella pneumoniae (hvKP) infections occur worldwide, but carbapenem-resistant hvKP strain has rarely been observed. METHODS A retrospective study was conducted in 28 cases of carbapenem-resistant K. pneumoniae (CRKP) infections from 9 cities in China. Clinical data were collected from medical records. All the isolates were characterized by antimicrobial susceptibility testing, string test, multilocus sequence typing, and capsular genotyping. All the hypermucoviscous CRKP strains were analyzed by virulence gene profiles, serum killing assay, and mouse lethality assay. RESULTS Of 28 CRKP isolates, five were positive for string test. Importantly, one of the hypermucoviscous strains isolated from blood sample was identified as hvKP. The hypervirulent CRKP strain showed highly resistant to carbapenems (MIC > 32 μg/mL), decreased expression of ompK35/36, and ESBLs production. Significantly increased resistance to serum killing and mice mortality were found in the hypervirulent CRKP strain compared to the other CRKPs. Capsular polysaccharide synthesis genotyping revealed that the hypervirulent strain belongs to K2 serotype, while others belong to K-nontypable serotype. The K2 hypervirulent CRKP strain carried rmpA, aerobactin, entB, and mrkD genes. CONCLUSIONS The newly emerged hypervirulent carbapenem-resistant K. pneumoniae might cause a serious threat to public health, suggesting an urgent need to enhance clinical awareness and epidemiologic surveillance.
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Affiliation(s)
- Yawei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Ji Zeng
- Department of Clinical Laboratory, Union Hospital of Huazhong University of Science and Technology, Wuhan, China
| | - Wenen Liu
- Department of Clinical Laboratory, Xiangya Hospital of Central South University, Changsha, China
| | - Feng Zhao
- Department of Clinical Laboratory, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
| | - Zhidong Hu
- Department of Clinical Laboratory, General Hospital of Tianjin Medical University, Tianjin, China
| | - Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Qi Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Xiaojuan Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Henan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Shuguang Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
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705
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Loss of hypermucoviscosity and increased fitness cost in colistin-resistant Klebsiella pneumoniae sequence type 23 strains. Antimicrob Agents Chemother 2015; 59:6763-73. [PMID: 26282408 DOI: 10.1128/aac.00952-15] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/08/2015] [Indexed: 12/31/2022] Open
Abstract
In this study, we investigated the effects of colistin resistance on virulence and fitness in hypermucoviscous (HV) Klebsiella pneumoniae sequence type 23 (ST23) strains. Colistin-resistant mutants were developed from three colistin-susceptible HV K. pneumoniae ST23 strains. The lipid A structures of strains were analyzed by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry. Changes in HV were investigated using the string test, and extracellular polysaccharide production was quantified. The expression levels of the phoQ, pmrD, pmrB, pbgP, magA, and p-rmpA2 genes, serum resistance, and biofilm-forming activity were determined. The fitness of colistin-resistant mutants compared to that of the parental strains was examined by determining the competitive index (CI). The colistin-resistant mutants exhibited reduced HV, which was accompanied by decreased formation of capsular polysaccharides (CPS) and reduced expression of genes (magA and p-rmpA2). While there was enhanced expression of pmrD and pbgP in all colistin-resistant derivatives, there were differences in the expression levels of phoQ and pmrB between strains. MALDI-TOF analysis detected the addition of aminoarabinose or palmitate to the lipid A moiety of lipopolysaccharide in the colistin-resistant derivatives. In addition, survival rates in the presence of normal human serum were decreased in the mutant strains, and CI values (0.01 to 0.19) indicated significant fitness defects in the colistin-resistant derivatives compared to the respective parental strains. In hypervirulent HV K. pneumoniae strains, the acquisition of colistin resistance was accompanied by reduced CPS production, impaired virulence, and a significant fitness cost.
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706
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Persichino J, Kim D, Lee H, Sutjita M. Eight cases of invasive Klebsiella pneumoniae infection from a public teaching medical institution in the USA. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jon Persichino
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Daniel Kim
- Department of Internal Medicine, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Hayley Lee
- Office of Research, Riverside County Regional Medical Center, Moreno Valley, CA, USA
| | - Made Sutjita
- Infectious Disease Section, Riverside County Regional Medical Center, Moreno Valley, CA, USA
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707
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Davis GS, Waits K, Nordstrom L, Weaver B, Aziz M, Gauld L, Grande H, Bigler R, Horwinski J, Porter S, Stegger M, Johnson JR, Liu CM, Price LB. Intermingled Klebsiella pneumoniae Populations Between Retail Meats and Human Urinary Tract Infections. Clin Infect Dis 2015. [PMID: 26206847 PMCID: PMC4551003 DOI: 10.1093/cid/civ428] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a common colonizer of the gastrointestinal tract of humans, companion animals, and livestock. To better understand potential contributions of foodborne K. pneumoniae to human clinical infections, we compared K. pneumoniae isolates from retail meat products and human clinical specimens to assess their similarity based on antibiotic resistance, genetic relatedness, and virulence. METHODS Klebsiella pneumoniae was isolated from retail meats from Flagstaff grocery stores in 2012 and from urine and blood specimens from Flagstaff Medical Center in 2011-2012. Isolates underwent antibiotic susceptibility testing and whole-genome sequencing. Genetic relatedness of the isolates was assessed using multilocus sequence typing and phylogenetic analyses. Extraintestinal virulence of several closely related meat-source and urine isolates was assessed using a murine sepsis model. RESULTS Meat-source isolates were significantly more likely to be multidrug resistant and resistant to tetracycline and gentamicin than clinical isolates. Four sequence types occurred among both meat-source and clinical isolates. Phylogenetic analyses confirmed close relationships among meat-source and clinical isolates. Isolates from both sources showed similar virulence in the mouse sepsis model. CONCLUSIONS Meat-source K. pneumoniae isolates were more likely than clinical isolates to be antibiotic resistant, which could reflect selective pressures from antibiotic use in food-animal production. The close genetic relatedness of meat-source and clinical isolates, coupled with similarities in virulence, suggest that the barriers to transmission between these 2 sources are low. Taken together, our results suggest that retail meat is a potential vehicle for transmitting virulent, antibiotic-resistant K. pneumoniae from food animals to humans.
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Affiliation(s)
- Gregg S Davis
- George Washington University Milken Institute School of Public Health, Washington D.C
| | - Kara Waits
- Translational Genomics Research Institute
| | | | | | - Maliha Aziz
- George Washington University Milken Institute School of Public Health, Washington D.C. Translational Genomics Research Institute
| | | | | | | | | | | | - Marc Stegger
- Translational Genomics Research Institute Statens Serum Institut, Copenhagen, Denmark
| | - James R Johnson
- VA Healthcare System Minneapolis, Minnesota Department of Medicine, University of Minnesota, Minneapolis
| | - Cindy M Liu
- Translational Genomics Research Institute Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lance B Price
- George Washington University Milken Institute School of Public Health, Washington D.C. Translational Genomics Research Institute
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708
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Abstract
UNLABELLED Highly invasive, community-acquired Klebsiella pneumoniae infections have recently emerged, resulting in pyogenic liver abscesses. These infections are caused by hypervirulent K. pneumoniae (hvKP) isolates primarily of capsule serotype K1 or K2. Hypervirulent K1 isolates belong to clonal complex 23 (CC23), indicating that this clonal lineage has a specific genetic background conferring hypervirulence. Here, we apply whole-genome sequencing to a collection of K. pneumoniae isolates to characterize the phylogenetic background of hvKP isolates with an emphasis on CC23. Most of the hvKP isolates belonged to CC23 and grouped into a distinct monophyletic clade, revealing that CC23 is a unique clonal lineage, clearly distinct from nonhypervirulent strains. Separate phylogenetic analyses of the CC23 isolates indicated that the CC23 lineage evolved recently by clonal expansion from a single common ancestor. Limited grouping according to geographical origin was observed, suggesting that CC23 has spread globally through multiple international transmissions. Conversely, hypervirulent K2 strains clustered in genetically unrelated groups. Strikingly, homologues of a large virulence plasmid were detected in all hvKP clonal lineages, indicating a key role in K. pneumoniae hypervirulence. The plasmid encodes two siderophores, aerobactin and salmochelin, and RmpA (regulator of the mucoid phenotype); all these factors were found to be restricted to hvKP isolates. Genomic comparisons revealed additional factors specifically associated with CC23. These included a distinct variant of a genomic island encoding yersiniabactin, colibactin, and microcin E492. Furthermore, additional novel genomic regions unique to CC23 were revealed which may also be involved in the increased virulence of this important clonal lineage. IMPORTANCE During the last 3 decades, hypervirulent Klebsiella pneumoniae (hvKP) isolates have emerged, causing severe community-acquired infections primarily in the form of pyogenic liver abscesses. This syndrome has so far primarily been found in Southeast Asia, but increasing numbers of cases are being reported worldwide, indicating that the syndrome is turning into a globally emerging disease. We applied whole-genome sequencing to a collection of K. pneumoniae clinical isolates to reveal the phylogenetic background of hvKP and to identify genetic factors associated with the increased virulence. The hvKP isolates primarily belonged to clonal complex 23 (CC23), and this clonal lineage was revealed to be clearly distinct from nonhypervirulent strains. A specific virulence plasmid was found to be associated with hypervirulence, and novel genetic determinants uniquely associated with CC23 were identified. Our findings extend the understanding of the genetic background of the emergence of hvKP clones.
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709
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Zhang Y, Sun J, Mi C, Li W, Zhao S, Wang Q, Shi D, Liu L, Ding B, Chang YF, Guo H, Guo X, Li Q, Zhu Y. First report of two rapid-onset fatal infections caused by a newly emerging hypervirulent K. Pneumonia ST86 strain of serotype K2 in China. Front Microbiol 2015; 6:721. [PMID: 26257712 PMCID: PMC4508851 DOI: 10.3389/fmicb.2015.00721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/01/2015] [Indexed: 11/13/2022] Open
Abstract
Here, we present the first report of one suspected dead case and two confirmed rapid-onset fatal infections caused by a newly emerging hypervirulent Klebsiella pneumoniae ST86 strain of serotype K2. The three cases occurred in a surgery ward during 2013 in Shanghai, China. A combination of multilocus sequence typing, pulsed-field gel electrophoresis, phenotypic and PCR tests for detecting virulence factors (VFs) was used to identify the isolates as K2 ST86 strains with common VFs, including Aerobactin and rmpA. Furthermore, the two K2 ST86 strains additionally harbored a distinct VF kfu (responsible for iron uptake system), which commonly existed in invasive K1 strains only. Thus, the unusual presence of both K1 and K2 VFs in the lethal ST86 strain might further enhance its hypervirulence and cause rapid onset of a life-threatening infection. Nevertheless, despite the administration of a combined antibiotic treatment, these three patients all died within 24 h of acute onset, thereby highlighting that the importance of early diagnosis to determine whether the ST86 strains harbor key K2 VF and unusual K1 kfu and whether patients should receive a timely and targeted antibiotic therapy to prevent ST86 induced fatal pneumonia. Finally, even though these patients are clinically improved, keeping on with oral antibiotic treatment for additional 2–3 weeks will be also vital for successfully preventing hvKP reinfection or relapse.
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Affiliation(s)
- Yibo Zhang
- Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Jingyong Sun
- Department of Microbiology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine Shanghai, China
| | - Chenrong Mi
- Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Wenhui Li
- Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Shengyuan Zhao
- Department of Microbiology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine Shanghai, China
| | - Qun Wang
- Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Dake Shi
- Department of Hospital Infection Control, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Luo Liu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Bingyu Ding
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Yung-Fu Chang
- Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University Ithaca, NY, USA
| | - Hongxiong Guo
- Department of STD and AIDS Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention Nanjing, China
| | - XiaoKui Guo
- Department of Immunology and Microbiology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Qingtian Li
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine Shanghai, China
| | - Yongzhang Zhu
- Department of Immunology and Microbiology, Institutes of Medical Sciences, Shanghai Jiao Tong University School of Medicine Shanghai, China
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710
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Li B, Zhao Y, Liu C, Chen Z, Zhou D. Molecular pathogenesis of Klebsiella pneumoniae. Future Microbiol 2015; 9:1071-81. [PMID: 25340836 DOI: 10.2217/fmb.14.48] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Typical Klebsiella pneumoniae is an opportunistic pathogen, which mostly affects those with weakened immune systems and tends to cause nosocomial infections. A subset of hypervirulent K. pneumoniae serotypes with elevated production of capsule polysaccharide can affect previously healthy persons and cause life-threatening community-acquired infections, such as pyogenic liver abscess, meningitis, necrotizing fasciitis, endophthalmitis and severe pneumonia. K. pneumoniae utilizes a variety of virulence factors, especially capsule polysaccharide, lipopolysaccharide, fimbriae, outer membrane proteins and determinants for iron acquisition and nitrogen source utilization, for survival and immune evasion during infection. This article aims to present the state-of-the-art understanding of the molecular pathogenesis of K. pneumoniae.
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Affiliation(s)
- Bei Li
- Department of Dermatology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China
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711
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Bialek-Davenet S, Criscuolo A, Ailloud F, Passet V, Jones L, Delannoy-Vieillard AS, Garin B, Le Hello S, Arlet G, Nicolas-Chanoine MH, Decré D, Brisse S. Genomic definition of hypervirulent and multidrug-resistant Klebsiella pneumoniae clonal groups. Emerg Infect Dis 2015; 20:1812-20. [PMID: 25341126 PMCID: PMC4214299 DOI: 10.3201/eid2011.140206] [Citation(s) in RCA: 325] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Multidrug-resistant and highly virulent Klebsiella pneumoniae isolates are emerging, but the clonal groups (CGs) corresponding to these high-risk strains have remained imprecisely defined. We aimed to identify K. pneumoniae CGs on the basis of genome-wide sequence variation and to provide a simple bioinformatics tool to extract virulence and resistance gene data from genomic data. We sequenced 48 K. pneumoniae isolates, mostly of serotypes K1 and K2, and compared the genomes with 119 publicly available genomes. A total of 694 highly conserved genes were included in a core-genome multilocus sequence typing scheme, and cluster analysis of the data enabled precise definition of globally distributed hypervirulent and multidrug-resistant CGs. In addition, we created a freely accessible database, BIGSdb-Kp, to enable rapid extraction of medically and epidemiologically relevant information from genomic sequences of K. pneumoniae. Although drug-resistant and virulent K. pneumoniae populations were largely nonoverlapping, isolates with combined virulence and resistance features were detected.
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712
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Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health. Proc Natl Acad Sci U S A 2015; 112:E3574-81. [PMID: 26100894 DOI: 10.1073/pnas.1501049112] [Citation(s) in RCA: 762] [Impact Index Per Article: 84.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Klebsiella pneumoniae is now recognized as an urgent threat to human health because of the emergence of multidrug-resistant strains associated with hospital outbreaks and hypervirulent strains associated with severe community-acquired infections. K. pneumoniae is ubiquitous in the environment and can colonize and infect both plants and animals. However, little is known about the population structure of K. pneumoniae, so it is difficult to recognize or understand the emergence of clinically important clones within this highly genetically diverse species. Here we present a detailed genomic framework for K. pneumoniae based on whole-genome sequencing of more than 300 human and animal isolates spanning four continents. Our data provide genome-wide support for the splitting of K. pneumoniae into three distinct species, KpI (K. pneumoniae), KpII (K. quasipneumoniae), and KpIII (K. variicola). Further, for K. pneumoniae (KpI), the entity most frequently associated with human infection, we show the existence of >150 deeply branching lineages including numerous multidrug-resistant or hypervirulent clones. We show K. pneumoniae has a large accessory genome approaching 30,000 protein-coding genes, including a number of virulence functions that are significantly associated with invasive community-acquired disease in humans. In our dataset, antimicrobial resistance genes were common among human carriage isolates and hospital-acquired infections, which generally lacked the genes associated with invasive disease. The convergence of virulence and resistance genes potentially could lead to the emergence of untreatable invasive K. pneumoniae infections; our data provide the whole-genome framework against which to track the emergence of such threats.
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713
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Septic arthritis in immunocompetent and immunosuppressed hosts. Best Pract Res Clin Rheumatol 2015; 29:275-89. [PMID: 26362744 DOI: 10.1016/j.berh.2015.05.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/08/2015] [Indexed: 12/12/2022]
Abstract
Septic arthritis has long been considered an orthopedic emergency. Historically, Neisseria gonorrhoeae and Staphylococcus aureus have been the most common causes of septic arthritis worldwide but in the modern era of biological therapy and extensive use of prosthetic joint replacements, the spectrum of microbiological causes of septic arthritis has widened considerably. There are also new approaches to diagnosis but therapy remains a challenge, with a need for careful consideration of a combined medical and surgical approach in most cases.
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714
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Aerobactin, but not yersiniabactin, salmochelin, or enterobactin, enables the growth/survival of hypervirulent (hypermucoviscous) Klebsiella pneumoniae ex vivo and in vivo. Infect Immun 2015; 83:3325-33. [PMID: 26056379 DOI: 10.1128/iai.00430-15] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022] Open
Abstract
The siderophore aerobactin is the dominant siderophore produced by hypervirulent Klebsiella pneumoniae (hvKP) and was previously shown to be a major virulence factor in systemic infection. However, strains of hvKP commonly produce the additional siderophores yersiniabactin, salmochelin, and enterobactin. The roles of these siderophores in hvKP infection have not been optimally defined. To that end, site-specific gene disruptions were created in hvKP1 (wild type), resulting in the generation of hvKP1ΔiucA (aerobactin deficient), hvKP1ΔiroB (salmochelin deficient), hvKP1ΔentB (enterobactin and salmochelin deficient), hvKP1Δirp2 (yersiniabactin deficient), and hvKP1ΔentBΔirp2 (enterobactin, salmochelin, and yersiniabactin deficient). The growth/survival of these constructs was compared to that of their wild-type parent hvKP1 ex vivo in human ascites fluid, human serum, and human urine and in vivo in mouse systemic infection and pulmonary challenge models. Interestingly, in contrast to aerobactin, the inability to produce enterobactin, salmochelin, or yersiniabactin individually or in combination did not decrease the ex vivo growth/survival in human ascites or serum or decrease virulence in the in vivo infection models. Surprisingly, none of the siderophores increased growth in human urine. In human ascites fluid supplemented with exogenous siderophores, siderophores increased the growth of hvKP1ΔiucA, with the relative activity being enterobactin > aerobactin > yersiniabactin > salmochelin, suggesting that the contribution of aerobactin to virulence is dependent on both innate biologic activity and quantity produced. Taken together, these data confirm and extend a role for aerobactin as a critical virulence factor for hvKP. Since it appears that aerobactin production is a defining trait of hvKP strains, this factor is a potential antivirulence target.
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715
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Transfer of CMY-2 Cephalosporinase from Escherichia coli to Virulent Klebsiella pneumoniae Causing a Recurrent Liver Abscess. Antimicrob Agents Chemother 2015; 59:5000-2. [PMID: 25987637 DOI: 10.1128/aac.00492-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 05/09/2015] [Indexed: 11/20/2022] Open
Abstract
A CMY-2-producing capsular type K2 Klebsiella pneumoniae strain (TVGHKP93) with multidrug resistance was isolated from a recurrent liver abscess in a patient who also carried a CMY-2-producing Escherichia coli strain (TVGHEC01) in the stool. TVGHKP93 retained its high virulence compared with that of the isogenic strain (TVGHKP60) with wild-type resistance from the first liver abscess. Our conjugation experiment showed the successful transfer of the blaCMY-2-carrying plasmid from TVGHEC01 into TVGHKP60. The transconjugant showed both high virulence and the multidrug-resistant phenotype, as did TVGHKP93.
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716
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Draft Genome Sequence of the First Hypermucoviscous Klebsiella variicola Clinical Isolate. GENOME ANNOUNCEMENTS 2015; 3:3/2/e01352-14. [PMID: 25858850 PMCID: PMC4392162 DOI: 10.1128/genomea.01352-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
An antibiotic-susceptible and hypermucoviscous clinical isolate of Klebsiella variicola (K. variicola 8917) was obtained from the sputum of an adult patient. This work reports the complete draft genome sequence of K. variicola 8917 with 103 contigs and an annotation that revealed a 5,686,491-bp circular chromosome containing a total of 5,621 coding DNA sequences, 65 tRNA genes, and an average G+C content of 56.98%.
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717
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Kunze G, Staritz M, Köhler M. Contrast-enhanced ultrasound in different stages of pyogenic liver abscess. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:952-959. [PMID: 25701525 DOI: 10.1016/j.ultrasmedbio.2014.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 10/20/2014] [Accepted: 12/02/2014] [Indexed: 06/04/2023]
Abstract
To enable sonographic classification of different stages of pyogenic liver abscesses, sonographic findings in 86 patients with 113 pyogenic liver abscesses were retrospectively analyzed and compared with established pathomorphologic descriptions of the disease. The typical findings in contrast-enhanced ultrasound were sub-segmental hyperemia (93/113, 82%) and necrosis with a hyperemic margin (109/113, 96%) in the arterial phase and a washout of liver tissue surrounding necrosis in the late phase (101/113, 89%). Four different sonomorphologic stages of pyogenic liver abscess were identified. Stage I was defined by focal inflammation without necrosis (n = 2); stage II by focal clusters of micro-abscesses appearing to coalesce (n = 41); and stage III by a single cavity with or without capsule (n = 64). Stage IV was defined as numerous small abscesses scattered all over the liver (n = 6). The results indicate that contrast-enhanced ultrasound is suitable for classifying different stages of pyogenic liver abscesses. Knowledge of the described morphologic patterns influences therapeutic decisions and helps distinguish abscesses from other liver masses.
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Affiliation(s)
- Georg Kunze
- Department for Internal Medicine and Gastroenterology, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany.
| | | | - Michael Köhler
- Department for Internal Medicine and Gastroenterology, Schwarzwald-Baar Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany
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718
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Qu TT, Zhou JC, Jiang Y, Shi KR, Li B, Shen P, Wei ZQ, Yu YS. Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China. BMC Infect Dis 2015; 15:161. [PMID: 25886859 PMCID: PMC4381403 DOI: 10.1186/s12879-015-0899-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 03/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background Klebsiella pneumoniae has been the dominant pathogen for liver abscesses in several Asian countries. Although the prevalence of K. pneumoniae liver abscess (KLA) in mainland China is increasing recently, the clinical and microbiological characteristics of KLA in China have not been elucidated. Methods Clinical and microbiology characteristics of 45 consecutive patients with KLA from a tertiary teaching hospital in China between June 2008 and June 2012 were retrospectively evaluated. Results Vast majority of the strains were susceptible to main antimicrobial agents. Most of K. pneumoniae strains from pyogenic liver abscess patients belonged to K1/K2 serotype (68.9% for K1 serotype and 20% for K2 serotype). All K. pneumoniae strains were rmpA positive, and 68.9% of these strains were magA positive. Overall, 57.8% (26/45) of K. pneumoniae strains belonged to ST23. Twenty-five of 26 ST23 K. pneumoniae isolates (96.2%) from KLA patients were magA-positive and K1 serotype. Only 28.9% (13/45) of KLA isolates exhibited hypermucoviscous phenotype, which is clinically used as the characteristic of hypervirulent K. pneumoniae (hvKP). Liver abscess sizes in patients infected with hvKP were tend to be larger than those in patients infected with cKP. There was no significant association between the microbiological and clinical characteristics including serotypes, magA and rmpA genotypes, and STs with the metastatic infection and prognosis of KLA. Conclusions Neither the serotypes, magA and rmpA genotypes, nor the STs of K. pneumoniae were associated with the metastatic infection and prognosis of KLA. However, further studies with larger sample are needed in the future. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0899-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ting-ting Qu
- State Key Laboratory for Diagnosis and treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, China. .,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang, China.
| | - Jian-cang Zhou
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Ke-ren Shi
- Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Bin Li
- Department of Infectious Diseases, Forth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, Zhejiang, China.
| | - Ping Shen
- State Key Laboratory for Diagnosis and treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, China.
| | - Ze-qing Wei
- State Key Laboratory for Diagnosis and treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, China.
| | - Yun-song Yu
- State Key Laboratory for Diagnosis and treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, China. .,Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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719
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Wei DD, Wan LG, Deng Q, Liu Y. Emergence of KPC-producing Klebsiella pneumoniae hypervirulent clone of capsular serotype K1 that belongs to sequence type 11 in Mainland China. Diagn Microbiol Infect Dis 2015; 85:192-4. [PMID: 27049969 DOI: 10.1016/j.diagmicrobio.2015.03.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
KPC-2 has been rarely reported in hypervirulent Klebsiella pneumoniae strains. Here, we describe a KPC-2-producing K. pneumoniae hypervirulent clone of capsular serotype K1 belonging to sequence type 11. The presence of KPC carbapenemase in hypervirulent clone could mark an evolutionary step toward its establishment as major nosocomial pathogen.
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Affiliation(s)
- Dan-Dan Wei
- Department of Bacteriology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China
| | - La-Gen Wan
- Department of Bacteriology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China
| | - Qiong Deng
- Department of Hospital Infection Control, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China
| | - Yang Liu
- Department of Bacteriology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China.
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720
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Czotter N, Molnar J, Szabó E, Demian E, Kontra L, Baksa I, Szittya G, Kocsis L, Deak T, Bisztray G, Tusnady GE, Burgyan J, Varallyay E. Community-onset Klebsiella pneumoniae pneumonia in Taiwan: clinical features of the disease and associated microbiological characteristics of isolates from pneumonia and nasopharynx. Front Microbiol 2015; 9:122. [PMID: 25741336 PMCID: PMC5808220 DOI: 10.3389/fmicb.2015.00122] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 01/30/2015] [Indexed: 12/31/2022] Open
Abstract
Klebsiella pneumoniae is an important cause of community-onset pneumonia in Asian countries and South Africa. We investigated the clinical characteristics of K. pneumoniae causing community-onset pneumonia, and the associated microbiological features between K. pneumoniae isolates from pneumonia and those from the nasopharynx in Taiwan. This study was conducted at the Taipei Veterans General Hospital during July, 2012 to February, 2014. The clinical characteristics in patients with community-onset K. pneumoniae pneumonia were analyzed. K. pneumoniae isolates from the nasopharynx of adults attending otorhinolaryngology outpatient clinics were collected to compare their microbiological features with those from pneumonia. Capsular genotypes, antimicrobial susceptibility, and multilocus sequence type (MLST) were determined among these strains. Ninety-one patients with community-onset K. pneumoniae pneumonia were enrolled. We found a high mortality (29.7%) among these patients. Capsular types K1, K2, K5, K20, K54, and K57 accounted for ∼70% of the K. pneumoniae isolates causing pneumonia, and ∼70% of all the K. pneumoniae strains isolated from the nasopharynx of patients in outpatient clinics. The MLST profiles further demonstrated the genetic relatedness between most pneumonia isolates and those from the nasopharynx. In conclusion, our results show that community-onset pneumonia caused by K. pneumoniae was associated with high mortality and could have a reservoir in the nasopharynx. To tackle this high-mortality disease, the distribution of capsular types in the nasopharynx might have implications for future vaccine development.
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Affiliation(s)
- Nikoletta Czotter
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Janos Molnar
- Research Center of Natural Sciences, Institute of Enzymology, HAS, Budapest, Hungary
- Department of Biotechnology, Nanophage-therapy Center, Enviroinvest Corporation, Pécs, Hungary
| | - Emese Szabó
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Emese Demian
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Levente Kontra
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Ivett Baksa
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Gyorgy Szittya
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Laszlo Kocsis
- Department of Horticulture, Georgikon Faculty, University of Pannonia, Keszthely, Hungary
| | - Tamas Deak
- Department of Viticulture, Institute of Viticulture and Oenology, Szent-Istvan University, Budapest, Hungary
| | - Gyorgy Bisztray
- Department of Viticulture, Institute of Viticulture and Oenology, Szent-Istvan University, Budapest, Hungary
| | - Gabor E. Tusnady
- Research Center of Natural Sciences, Institute of Enzymology, HAS, Budapest, Hungary
| | - Jozsef Burgyan
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
| | - Eva Varallyay
- National Agricultural Research and Innovation Center, Agricultural Biotechnology Institute, Gödöllo, Hungary
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721
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Association of tellurite resistance with hypervirulent clonal groups of Klebsiella pneumoniae. J Clin Microbiol 2015; 53:1380-2. [PMID: 25631812 DOI: 10.1128/jcm.03053-14] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Tellurite-based selective growth media are used for several bacterial pathogens. We found that, in Klebsiella pneumoniae, tellurite resistance is strongly associated with hypervirulent clonal group 23 (CG23), CG65, and CG86, providing a novel approach for screening environmental or carriage samples. The terW gene was also associated with these groups.
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722
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Cox BL, Schiffer H, Dagget G, Beierschmitt A, Sithole F, Lee E, Revan F, Halliday-Simmonds I, Beeler-Marfisi J, Palmour R, Soto E. Resistance of Klebsiella pneumoniae to the innate immune system of African green monkeys. Vet Microbiol 2015; 176:134-42. [PMID: 25614101 DOI: 10.1016/j.vetmic.2015.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/01/2015] [Accepted: 01/03/2015] [Indexed: 11/28/2022]
Abstract
In recent years, an emergent Klebsiella pneumoniae hypermucoviscosity (HMV) phenotype has been associated with increased invasiveness and pathogenicity in primates. In this project, bacteria recovered from infected African green monkeys (AGM) (Chlorocebus aethiops sabaeus) were screened for HMV phenotype, and were compared to non-HMV isolates in in vitro, serum, and oxidative-mediated killing assays. Complement-mediated killing was assessed utilizing freshly collected serum from healthy AGM. Oxidative-mediated killing was investigated utilizing sodium hypochlorite and hydrogen peroxide. Compared to non-HMV isolates, HMV isolates were more resistant to serum-mediated and oxidative killing (p<0.05). Phagocytosis resistance was evaluated using AGM peripheral blood monocytes (PBMC), and results indicated that non-HMV isolates associated with the AGM PBMC to a greater extent than HMV isolates (p<0.001). Measurement of lactate dehydrogenase release showed that HMV isolates were more cytotoxic to AGM PBMC than non-HMV isolates (p<0.001). Thus, the hypermucoid phenotype appears to be an important virulence factor that promotes evasion of innate immune defenses.
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Affiliation(s)
- Brandi L Cox
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Holly Schiffer
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Gregory Dagget
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Amy Beierschmitt
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis; Behavioural Science Foundation, Estridge Estate, Saint Kitts and Nevis
| | - Fortune Sithole
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Elise Lee
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Floyd Revan
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Iona Halliday-Simmonds
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis
| | - Janet Beeler-Marfisi
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis; Gribbles Veterinary Pathology, Christchurch, New Zealand
| | - Roberta Palmour
- Behavioural Science Foundation, Estridge Estate, Saint Kitts and Nevis
| | - Esteban Soto
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Saint Kitts and Nevis.
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723
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Guo C, Yang X, Wu Y, Yang H, Han Y, Yang R, Hu L, Cui Y, Zhou D. MLST-based inference of genetic diversity and population structure of clinical Klebsiella pneumoniae, China. Sci Rep 2015; 5:7612. [PMID: 25556771 PMCID: PMC5154592 DOI: 10.1038/srep07612] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 12/03/2014] [Indexed: 12/13/2022] Open
Abstract
Multilocus sequence typing was applied to a collection of 327 clinical isolates of Klebsiella pneumoniae from China, which was proven to be a good representative of the global diversity of K. pneumoniae. Three lineages L1 to L3 are presented in the population with limited genetic flow across different lineages. However, extremely high levels of recombination can be observed within lineages to the extent at which the alleles are associated almost randomly. Lineages L2 and L3 most likely represent highly specific subgroups of less-virulent K. pneumoniae with modified metabolic networks, while lineage L1 contains not only hypervirulent clones with massive acquisition of virulent genes but also 'primitive and intermediate forms' during evolution of hypervirulent K. pneumoniae.
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Affiliation(s)
- Chenyi Guo
- Consulting Center of Biomedical Statistics, Beijing 100850, China
| | - Xianwei Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yarong Wu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Huiying Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yanping Han
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Ruifu Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Liangping Hu
- Consulting Center of Biomedical Statistics, Beijing 100850, China
| | - Yujun Cui
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
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724
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Takahashi K, Miura A, Yamaguchi T, Kanematsu M. Novel cord-like structures on MRI in a case of hypervirulent Klebsiella pneumoniae. Intern Med 2015; 54:355-6. [PMID: 25748749 DOI: 10.2169/internalmedicine.54.3485] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Keiji Takahashi
- Department of Internal Medicine, Mino Municipal Hospital, Japan
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725
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Ng D, Frazee B. Necrotizing fasciitis caused by hypermucoviscous Klebsiella pneumoniae in a Filipino female in North America. West J Emerg Med 2014; 16:165-8. [PMID: 25671032 PMCID: PMC4307707 DOI: 10.5811/westjem.2014.11.23599] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 10/07/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022] Open
Abstract
Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America.
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Affiliation(s)
- Daniel Ng
- Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California
| | - Brad Frazee
- Highland Hospital - Alameda Health System, Department of Emergency Medicine, Oakland, California
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726
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Affiliation(s)
- A Kumabe
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan
| | - T Kenzaka
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Japan
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727
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Bialek-Davenet S, Criscuolo A, Ailloud F, Passet V, Nicolas-Chanoine MH, Decré D, Brisse S. Development of a multiplex PCR assay for identification of Klebsiella pneumoniae hypervirulent clones of capsular serotype K2. J Med Microbiol 2014; 63:1608-1614. [DOI: 10.1099/jmm.0.081448-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Hypervirulent Klebsiella pneumoniae isolates of capsular serotype K2 (hvKP-K2) that cause community-acquired invasive infections represent several unrelated clones, which all belong to phylogenetic group KpI. These clones can be recognized using multilocus sequence typing and genomic analyses, but no rapid method currently exists to differentiate them. In this work, a multiplex PCR assay was developed to identify three hvKP-K2 groups: (i) sequence type (ST)86; (ii) ST380 and ST679 (i.e. clonal group 380); and (iii) ST65 and ST375. A specific genetic marker, Kp50233, allowing K. pneumoniae sensu stricto (corresponding to phylogroup KpI) to be distinguished from closely related species, was included in the assay. This PCR assay will be useful in better defining the epidemiology and clinical features of emerging virulent K. pneumoniae clones.
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Affiliation(s)
- Suzanne Bialek-Davenet
- Service de Microbiologie, Hôpital Beaujon, AP-HP, 100 boulevard du Général Leclerc, 92110 Clichy, France
- CNRS, UMR3525, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, 28 rue du Dr Roux, 75724 Paris, France
| | - Alexis Criscuolo
- CNRS, UMR3525, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, 28 rue du Dr Roux, 75724 Paris, France
| | - Florent Ailloud
- CNRS, UMR3525, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, 28 rue du Dr Roux, 75724 Paris, France
| | - Virginie Passet
- CNRS, UMR3525, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, 28 rue du Dr Roux, 75724 Paris, France
| | - Marie-Hélène Nicolas-Chanoine
- INSERM UMR 1149, Université Paris Diderot – Paris 7, Paris, France
- Faculté de Médecine, Université Paris Diderot – Paris 7, Paris, France
- Service de Microbiologie, Hôpital Beaujon, AP-HP, 100 boulevard du Général Leclerc, 92110 Clichy, France
| | - Dominique Decré
- INSERM U1135, Centre d′Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), 75013 Paris, France
- Sorbonne Universités, UPMC Univ Paris 06 CR7, Centre d′Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), 75013
- Laboratoire de Bactériologie, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Sylvain Brisse
- CNRS, UMR3525, Paris, France
- Institut Pasteur, Microbial Evolutionary Genomics, 28 rue du Dr Roux, 75724 Paris, France
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728
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Dulku G, Tibballs J. Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome (CIKPLA) in Western Australia? Australas Med J 2014; 7:436-40. [PMID: 25550714 DOI: 10.4066/amj.2014.2188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Virulent serotypes of Klebsiella pneumoniae are recognised to cause metastatic infections at various sites. Prevalence of this invasive syndrome has been observed worldwide with predominance in Asian series. However, reports in an Australian setting have been limited. We report two cases of fulminating community-acquired invasive Klebsiella pneumoniae liver abscess syndrome occurring in two Caucasian patients, from two different, distant suburbs in Western Australia with no known clinical comorbidities prior to the hospital presentation and no history of recent travel overseas. The interval between both admissions was 18 days, where only one patient survived.
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Affiliation(s)
- Gurjeet Dulku
- Department of Radiology, Interventional Specials, Sir Charles Gairdner Hospital, Western Australia
| | - Jonathan Tibballs
- Department of Radiology, Interventional Specials, Sir Charles Gairdner Hospital, Western Australia
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729
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Maatallah M, Vading M, Kabir MH, Bakhrouf A, Kalin M, Nauclér P, Brisse S, Giske CG. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae. PLoS One 2014; 9:e113539. [PMID: 25426853 PMCID: PMC4245126 DOI: 10.1371/journal.pone.0113539] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 10/27/2014] [Indexed: 01/26/2023] Open
Abstract
Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10–8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.
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Affiliation(s)
- Makaoui Maatallah
- Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia
| | - Malin Vading
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Muhammad Humaun Kabir
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
| | - Amina Bakhrouf
- Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia
| | - Mats Kalin
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Sylvain Brisse
- Institut Pasteur, Microbial Evolutionary Genomics, Paris, France
- CNRS, Paris, France
| | - Christian G. Giske
- Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden
- * E-mail:
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730
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Gao L, Jiang X, Fu S, Gong H. In silico identification of potential virulence genes in 1,3-propanediol producer Klebsiella pneumonia. J Biotechnol 2014; 189:9-14. [DOI: 10.1016/j.jbiotec.2014.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 11/24/2022]
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731
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Multiplex PCR for detection of seven virulence factors and K1/K2 capsular serotypes of Klebsiella pneumoniae. J Clin Microbiol 2014; 52:4377-80. [PMID: 25275000 DOI: 10.1128/jcm.02316-14] [Citation(s) in RCA: 176] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A single multiplex PCR assay targeting seven virulence factors and the wzi gene specific for the K1 and K2 capsular serotypes of Klebsiella pneumoniae was developed and tested on 65 clinical isolates, which included 45 isolates responsible for community-acquired severe human infections. The assay is useful for the surveillance of emerging highly virulent strains.
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732
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On a Boat: A Case in Australia of Endophthalmitis and Pyogenic Liver, Prostatic, and Lung Abscesses in a Previously Well Patient due to Klebsiella pneumoniae. Case Rep Infect Dis 2014; 2014:137248. [PMID: 25309763 PMCID: PMC4182685 DOI: 10.1155/2014/137248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/12/2014] [Accepted: 08/17/2014] [Indexed: 11/17/2022] Open
Abstract
This is a case report about a patient who arrived in our emergency department in Western Australia to the care of the urologists having just gotten off a ship with a bacterial infection that would result in a 44-day stay in hospital and have quite devastating lasting effects for the young male. His story was in fact reflective of an emerging global phenomenon. Once thought to generally be a bacterium of threat only to the elderly and alcoholics, causing pneumonia and urinary tract infections, this case report describes the potentially devastating consequences of what is now becoming recognized as a hypervirulent form of Klebsiella pneumoniae with the potential to spread throughout the system rapidly seeding abscesses and causing significant morbidity in nonimmunocompromised patients. Initially noticed in Asia increasingly case reports are emerging in Western countries suggesting a global spread.
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733
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Podder MP, Rogers L, Daley PK, Keefe GP, Whitney HG, Tahlan K. Klebsiella species associated with bovine mastitis in Newfoundland. PLoS One 2014; 9:e106518. [PMID: 25180510 PMCID: PMC4152263 DOI: 10.1371/journal.pone.0106518] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/05/2014] [Indexed: 02/05/2023] Open
Abstract
Klebsiella spp. is a common cause of bovine mastitis, but information regarding its molecular epidemiology is lacking from many parts of the world. On using mass spectrometry and partial sequencing of the rpoB gene, it was found that over a one year study, K. variicola and Enterobacter cloacae were misidentified as K. pneumoniae in a small number of clinical mastitis (CM) cases from Newfoundland. Results suggest that the currently used standard biochemical/phenotypic tests lack the sensitivity required to accurately discriminate among the three mentioned Gram negative bacteria. In addition, a single strain of K. variicola was associated with CM from one farm in the study as demonstrated by Random Amplified Polymorphic DNA (RAPD) PCR. To the best of our knowledge, K. variicola, which is normally found in the environment, has not been isolated previously from milk obtained from cows with CM. Therefore, it is possible that K. variicola was not detected in milk samples in the past due to the inability of standard tests to discriminate it from other Klebsiella species.
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Affiliation(s)
- Milka P. Podder
- Department of Biology, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Laura Rogers
- Animal Health Division, Newfoundland and Labrador Department of Natural Resources, St. John’s, NL, Canada
| | - Peter K. Daley
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Greg P. Keefe
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, PEI, Canada
| | - Hugh G. Whitney
- Animal Health Division, Newfoundland and Labrador Department of Natural Resources, St. John’s, NL, Canada
- * E-mail: (KT); (HGW)
| | - Kapil Tahlan
- Department of Biology, Memorial University of Newfoundland, St. John’s, NL, Canada
- * E-mail: (KT); (HGW)
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734
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Li J, Liu F, Wang Q, Ge P, Woo PCY, Yan J, Zhao Y, Gao GF, Liu CH, Liu C. Genomic and transcriptomic analysis of NDM-1 Klebsiella pneumoniae in spaceflight reveal mechanisms underlying environmental adaptability. Sci Rep 2014; 4:6216. [PMID: 25163721 PMCID: PMC4147364 DOI: 10.1038/srep06216] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 01/10/2023] Open
Abstract
The emergence and rapid spread of New Delhi Metallo-beta-lactamase-1 (NDM-1)-producing Klebsiella pneumoniae strains has caused a great concern worldwide. To better understand the mechanisms underlying environmental adaptation of those highly drug-resistant K. pneumoniae strains, we took advantage of the China's Shenzhou 10 spacecraft mission to conduct comparative genomic and transcriptomic analysis of a NDM-1 K. pneumoniae strain (ATCC BAA-2146) being cultivated under different conditions. The samples were recovered from semisolid medium placed on the ground (D strain), in simulated space condition (M strain), or in Shenzhou 10 spacecraft (T strain) for analysis. Our data revealed multiple variations underlying pathogen adaptation into different environments in terms of changes in morphology, H2O2 tolerance and biofilm formation ability, genomic stability and regulation of metabolic pathways. Additionally, we found a few non-coding RNAs to be differentially regulated. The results are helpful for better understanding the adaptive mechanisms of drug-resistant bacterial pathogens.
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Affiliation(s)
- Jia Li
- 1] Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China [2] School of medicine, Nankai University, 94 Weijin Road, Nankai District, Tianjin 300071, China
| | - Fei Liu
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Qi Wang
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Pupu Ge
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Patrick C Y Woo
- State Key Laboratory of Emerging Infectious Diseases, Department of Microbiology, The University of Hong Kong, University Pathology Building, Compound Pokfulam Road, Hong Kong, China
| | - Jinghua Yan
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Yanlin Zhao
- National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbei Road, Changping District, Beijing 102206, China
| | - George F Gao
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Cui Hua Liu
- CAS key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, No. 1 West Beichen Road, Chaoyang District, Beijing 100101, China
| | - Changting Liu
- Nanlou Respiratory Diseases Department, Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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735
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Monié M, Drieux L, Nzili B, Dicko M, Goursot C, Greffard S, Decré D, Mézière A. Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman. Clin Interv Aging 2014; 9:1171-4. [PMID: 25071368 PMCID: PMC4111645 DOI: 10.2147/cia.s60812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.
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Affiliation(s)
- Marguerite Monié
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Laurence Drieux
- Assistance Publique-Hôpitaux de Paris, Hôpital Charles-Foix, Bactériologie-Hygiène, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
| | - Bernadette Nzili
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Michèle Dicko
- AP-HP, GHU Henri Mondor, Département de Médecine Interne et Gériatrie, Créteil, France
| | - Catherine Goursot
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
| | - Sandrine Greffard
- AP-HP, GHU Pitié Salpêtrière-Charles Foix, site Pitié Salpêtrière, Service de Médecine Gériatrique, Paris, France
| | - Dominique Decré
- Sorbonne Universités, UPMC Univ Paris 06, CR7, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- INSERM, U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
- AP-HP, Hôpital Saint-Antoine, Bactériologie-Hygiène, Paris, France
| | - Anthony Mézière
- Assistance Publique-Hôpitaux de Paris (AP-HP), GHU Pitié Salpêtrière-Charles Foix, site Charles Foix, Service de Soins de Suite et Réadaptation orthogériatrique et polyvalent, Fondation d’Heur et Chemin Delatour, Ivry s/Seine, Paris, France
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736
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Clinical and molecular characteristics of emerging hypervirulent Klebsiella pneumoniae bloodstream infections in mainland China. Antimicrob Agents Chemother 2014; 58:5379-85. [PMID: 24982067 DOI: 10.1128/aac.02523-14] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recently, the newly emerged hypervirulent Klebsiella pneumoniae strain (hvKP) has caused great concern globally, but the clinical features and molecular characteristics of bacteremia caused by hvKP are rarely reported in mainland China. Seventy patients with K. pneumoniae bacteremia were investigated to study the clinical features of hvKP infection from 2008 till 2012 in Beijing Chao-Yang Hospital. The molecular characteristics of the hvKP strains were also studied using PCR, multilocus sequence typing, and pulsed-field gel electrophoresis (PFGE) methods. hvKP was identified in 31.4% of the patients with K. pneumoniae bacteremia, which displayed 4 serotypes (K1, K2, K20, and K57). Patients with hvKP infection tended to have no underlying diseases compared to those with classic K. pneumoniae (cKP). More hvKP-positive patients (95.5%) had community-acquired infection than did cKP-infected patients (35.4%) (P<0.001). The 30-day mortality rate was lower in hvKP-infected patients than in cKP-infected patients (4.5% compared to 16.7%). Resistance to tested antimicrobials was significantly greater in cKP- than in hvKP-infected patients. Two extended-spectrum-beta-lactamase (ESBL)-producing hvKP strains were found. Seven novel sequence types (STs) and 4 new alleles of K. pneumoniae were revealed. A strong correlation was found between two STs (ST23, ST1265) and the K1 serotype. The hvKP isolates (n=22) had 14 different PFGE patterns, and among them 10 K1 isolates shared similar PFGE patterns. The emerging hvKP strain was prevalent in patients with severe community-acquired infections in healthy individuals in China. Identification of ESBL-producing hvKP strains in hvKP-infected patients will facilitate clinical management of hvKP infection.
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737
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Brisse S, Passet V, Grimont PAD. Description of Klebsiella quasipneumoniae sp. nov., isolated from human infections, with two subspecies, Klebsiella quasipneumoniae subsp. quasipneumoniae subsp. nov. and Klebsiella quasipneumoniae subsp. similipneumoniae subsp. nov., and demonstration that Klebsiella singaporensis is a junior heterotypic synonym of Klebsiella variicola. Int J Syst Evol Microbiol 2014; 64:3146-3152. [PMID: 24958762 DOI: 10.1099/ijs.0.062737-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Strains previously classified as members of Klebsiella pneumoniae phylogroups KpI, KpII-A, KpII-B and KpIII were characterized by 16S rRNA (rrs) gene sequencing, multilocus sequence analysis based on rpoB, fusA, gapA, gyrA and leuS genes, average nucleotide identity and biochemical characteristics. Phylogenetic analysis demonstrated that KpI and KpIII corresponded to K. pneumoniae and Klebsiella variicola, respectively, whereas KpII-A and KpII-B formed two well-demarcated sequence clusters distinct from other members of the genus Klebsiella. Average nucleotide identity between KpII-A and KpII-B was 96.4 %, whereas values lower than 94 % were obtained for both groups when compared with K. pneumoniae and K. variicola. Biochemical properties differentiated KpII-A, KpII-B, K. pneumoniae and K. variicola, with acid production from adonitol and l-sorbose and ability to use 3-phenylproprionate, 5-keto-d-gluconate and tricarballylic acid as sole carbon sources being particularly useful. Based on their genetic and phenotypic characteristics, we propose the names Klebsiella quasipneumoniae subsp. quasipneumoniae subsp. nov. and K. quasipneumoniae subsp. similipneumoniae subsp. nov. for strains of KpII-A and KpII-B, respectively. The type strain of K. quasipneumoniae sp. nov. and of K. quasipneumoniae subsp. quasipneumoniae subsp. nov. is 01A030(T) ( = SB11(T) = CIP 110771(T) = DSM 28211(T)). The type strain of K. quasipneumoniae subsp. similipneumoniae subsp. nov. is 07A044(T) ( = SB30(T) = CIP 110770(T) = DSM 28212(T)). Both strains were isolated from human blood cultures. This work also showed that Klebsiella singaporensis is a junior heterotypic synonym of K. variicola.
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Affiliation(s)
- Sylvain Brisse
- CNRS, UMR 3525, Paris, France.,Institut Pasteur, Microbial Evolutionary Genomics Unit, Paris, France
| | - Virginie Passet
- CNRS, UMR 3525, Paris, France.,Institut Pasteur, Microbial Evolutionary Genomics Unit, Paris, France
| | - Patrick A D Grimont
- Unité Biodiversité des Bactéries Pathogènes Emergentes, Institut Pasteur, Paris, France
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738
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Hyun JI, Kim YJ, Jeon YH, Kim SI, Park YJ, Kang MW, Kim W, Jang JH. A Case of Ventriculitis Associated with Renal Abscess Caused by Serotype K1 Klebsiella pneumoniae. Infect Chemother 2014; 46:120-4. [PMID: 25024876 PMCID: PMC4091369 DOI: 10.3947/ic.2014.46.2.120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/03/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022] Open
Abstract
Recently, serotype K1 Klebsiella pneumoniae has been a major agent of an invasive syndrome characterized by liver abscess and its metastatic infection. Extrahepatic infection and its characteristics in patients with renal abscess caused by K. pneumoniae are poorly understood, and few cases of central nervous system infection have been reported. This is a report of 80-year-old woman with uncontrolled type 2 diabetes mellitus with renal abscess caused by serotype K1 K. pneumoniae, complicated with ventriculitis despite of appropriate use of antibiotics. Physicians need to be aware of possibility of metastatic infection in patients with serotype K1 K. pneumoniae infection, if they develop neurologic symptom and focus of infection is still present.
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Affiliation(s)
- Ji In Hyun
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Youn Jeong Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yoon Hee Jeon
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sang Il Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Joon Park
- Department of Laboratory Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Moon Won Kang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Woohyeon Kim
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ji Hye Jang
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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739
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Luo Y, Wang Y, Ye L, Yang J. Molecular epidemiology and virulence factors of pyogenic liver abscess causing Klebsiella pneumoniae in China. Clin Microbiol Infect 2014; 20:O818-24. [PMID: 24804560 DOI: 10.1111/1469-0691.12664] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 03/12/2014] [Accepted: 05/02/2014] [Indexed: 11/29/2022]
Abstract
The molecular epidemiology and prevalence of virulence factors of isolates from patients with Klebsiella pneumoniae liver abscess (KLA) in mainland China are unknown. Klebsiella pneumoniae isolates were obtained from drainage samples aseptically collected from patients with pyogenic liver abscess (PLA). The genetic similarity of KLA isolates was analyzed by pulsed-field gel electrophoresis. The hypermucoviscosity (HV) phenotype was identified by a positive string test. The K1 and K2 genotypes, the pLVPK-derived genetic loci, aerobactin gene, kfu and alls were detected by PCR amplification. The sequence types (STs) were identified by multilocus sequence typing. Among the 51 non-repetitive KLA isolates, 49 PFGE types have been identified. In total, 19 (37.2%) and 14 (27.4%) of the 51 KLA isolates belonged to clonal complex (CC) 23 and CC65, respectively, while the other 18 isolates (35.3%) were defined as other STs. CC23 consisted of only K1 strains, while CC65 included only K2 strains. All non-K1/K2 strains were classified as STs other than CC23 and CC65. Approximately 70.6% (36/51) of KLA isolates exhibited an HV phenotype. Both K1 and K2 isolates presented significantly higher prevalence of the pLVPK-derived loci than non-K1/K2 isolates. The K1 isolates had a significantly higher prevalence of the kfu and allS genes than K2 and non-K1/K2 isolates, while the K2 isolates exhibited higher repA prevalence than K1 and non-K1/K2 isolates. The majority of KLA isolates belonged to CC23K1 and CC65K2, while other STs with non-K1/K2 capsular types have also been identified. The virulent factors exhibited diverse distribution among the different clones of KLA isolates.
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Affiliation(s)
- Y Luo
- Department of Microbiology, Chinese PLA General Hospital, Beijing, China
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740
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Osman KM, Hassan HM, Orabi A, Abdelhafez AST. Phenotypic, antimicrobial susceptibility profile and virulence factors of Klebsiella pneumoniae isolated from buffalo and cow mastitic milk. Pathog Glob Health 2014; 108:191-9. [PMID: 24915048 DOI: 10.1179/2047773214y.0000000141] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Studies on the prevalence and virulence genes of Klebsiella mastitis pathogens in a buffalo population are undocumented. Also, the association of rmpA kfu, uge, magA, Aerobactin, K1 and K2 virulent factors with K. pneumoniae buffalo, and cow mastitis is unreported. The virulence of K. pneumoniae was evaluated through both phenotypic and molecular assays. In vivo virulence was assessed by the Vero cell cytotoxicity, suckling mouse assay and mice lethality test. Antimicrobial susceptibility was tested by disk diffusion method. The 45 K. pneumoniae isolates from buffalo (n = 10/232) and cow (n = 35/293) milk were isolated (45/525; 8.6%) and screened via PCR for seven virulence genes encoding uridine diphosphate galactose 4 epimerase encoding gene responsible for capsule and smooth lipopolysaccharide synthesis (uge), siderophores (kfu and aerobactin), protectines or invasins (rmpA and magA), and the capsule and hypermucoviscosity (K1 and K2). The most common virulence genes were rmpA, kfu, uge, and magA (77.8% each). Aerobactin and K1 genes were found at medium rates of 66.7% each and K2 (55.6%). The Vero cell cytotoxicity and LD (50) in mice were found in 100% of isolates. A multidrug resistance pattern was observed for 40% of the antimicrobials. The distribution of virulence profiles indicate a role of rmpA, kfu, uge, magA, Aerobactin, and K1 and K2 in pathogenicity of K. pneumoniae in udder infections and invasiveness, and constitutes a threat for vulnerable animals, even more if they are in combination with antibiotic resistance.
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741
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Resistance determinants and mobile genetic elements of an NDM-1-encoding Klebsiella pneumoniae strain. PLoS One 2014; 9:e99209. [PMID: 24905728 PMCID: PMC4048246 DOI: 10.1371/journal.pone.0099209] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/12/2014] [Indexed: 01/12/2023] Open
Abstract
Multidrug-resistant Enterobacteriaceae are emerging as a serious infectious disease challenge. These strains can accumulate many antibiotic resistance genes though horizontal transfer of genetic elements, those for β-lactamases being of particular concern. Some β-lactamases are active on a broad spectrum of β-lactams including the last-resort carbapenems. The gene for the broad-spectrum and carbapenem-active metallo-β-lactamase NDM-1 is rapidly spreading. We present the complete genome of Klebsiella pneumoniae ATCC BAA-2146, the first U.S. isolate found to encode NDM-1, and describe its repertoire of antibiotic-resistance genes and mutations, including genes for eight β-lactamases and 15 additional antibiotic-resistance enzymes. To elucidate the evolution of this rich repertoire, the mobile elements of the genome were characterized, including four plasmids with varying degrees of conservation and mosaicism and eleven chromosomal genomic islands. One island was identified by a novel phylogenomic approach, that further indicated the cps-lps polysaccharide synthesis locus, where operon translocation and fusion was noted. Unique plasmid segments and mosaic junctions were identified. Plasmid-borne blaCTX-M-15 was transposed recently to the chromosome by ISEcp1. None of the eleven full copies of IS26, the most frequent IS element in the genome, had the expected 8-bp direct repeat of the integration target sequence, suggesting that each copy underwent homologous recombination subsequent to its last transposition event. Comparative analysis likewise indicates IS26 as a frequent recombinational junction between plasmid ancestors, and also indicates a resolvase site. In one novel use of high-throughput sequencing, homologously recombinant subpopulations of the bacterial culture were detected. In a second novel use, circular transposition intermediates were detected for the novel insertion sequence ISKpn21 of the ISNCY family, suggesting that it uses the two-step transposition mechanism of IS3. Robust genome-based phylogeny showed that a unified Klebsiella cluster contains Enterobacter aerogenes and Raoultella, suggesting the latter genus should be abandoned.
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742
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Patel PK, Russo TA, Karchmer AW. Hypervirulent Klebsiella pneumoniae. Open Forum Infect Dis 2014; 1:ofu028. [PMID: 25734101 PMCID: PMC4324179 DOI: 10.1093/ofid/ofu028] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 05/05/2014] [Indexed: 11/14/2022] Open
Abstract
Hypervirulent strains of Klebsiella pneumoniae are associated with abscess formation, commonly hepatic, and metastatic spread, even in healthy patients. We describe a case of this clinical syndrome, genotypic and phenotypic features of the isolate, and briefly review epidemiology, clinical manifestations, and pathogenesis of this underappreciated syndrome.
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Affiliation(s)
- Payal K Patel
- Division of Infectious Diseases, Department of Internal Medicine, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston, Massachusetts
| | - Thomas A Russo
- Veterans Administration Western New York Healthcare System, Buffalo, New York ; Departments of Medicine ; Microbiology and Immunology , University at Buffalo-State University of New York , Buffalo, New York
| | - Adolf W Karchmer
- Division of Infectious Diseases, Department of Internal Medicine, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston, Massachusetts
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743
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Expansion and evolution of a virulent, extensively drug-resistant (polymyxin B-resistant), QnrS1-, CTX-M-2-, and KPC-2-producing Klebsiella pneumoniae ST11 international high-risk clone. J Clin Microbiol 2014; 52:2530-5. [PMID: 24808234 DOI: 10.1128/jcm.00088-14] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
In this study, we report the early expansion, evolution, and characterization of a multiresistant Klebsiella pneumoniae clone that was isolated with increasing frequency from inpatients in a tertiary-care university hospital in Brazil. Seven carbapenem- and quinolone-resistant and polymyxin B-susceptible or -resistant K. pneumoniae isolates isolated between December 2012 and February 2013 were investigated. Beta-lactamase- and plasmid-mediated quinolone resistance (PMQR)-encoding genes and the genetic environment were investigated using PCR, sequencing, and restriction fragment length polymorphism (RFLP). Clonal relatedness was established using XbaI-pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and phylogenetic group characterization. Plasmid analyses included PCR-based replicon typing (PBRT) and hybridization of the S1-PFGE product, plasmid MLST, and conjugation experiments. Virulence potential was assessed by PCR by searching for 10 virulence factor-encoding genes (ureA, fimH, kfuBC, uge, wabG, magA, mrkD, allS, rmpA, and cf29a) and by phenotypic tests to analyze the hypermucoviscous phenotype. The genetic context of a multidrug-resistant and extensively drug-resistant K. pneumoniae ST11-KpI clone harboring IncFIIk-Tn4401a-blaKPC-2, qnrS1, and blaCTX-M-2 was found. Moreover, three isolates displayed high resistance to polymyxin B (MICs = 32, 32, and 128 mg/liter) as well as mucous and hypermucoviscous phenotypes. These bacteria also harbored ureA, fimH, uge, wabG, and mrkD, which code for virulence factors associated with binding, biofilm formation, and the ability to colonize and escape from phagocytosis. Our study describes the association of important coresistance and virulence factors in the K. pneumoniae ST11 international high-risk clone, which makes this pathogen successful at infections and points to the quick expansion and evolution of this multiresistant and virulent clone, leading to a pandrug-resistant phenotype and persistent bacteria in a Brazilian hospital.
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744
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Aerobactin mediates virulence and accounts for increased siderophore production under iron-limiting conditions by hypervirulent (hypermucoviscous) Klebsiella pneumoniae. Infect Immun 2014; 82:2356-67. [PMID: 24664504 DOI: 10.1128/iai.01667-13] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Hypervirulent (hypermucoviscous) Klebsiella pneumoniae (hvKP) strains are an emerging variant of "classical" K. pneumoniae (cKP) that cause organ and life-threatening infection in healthy individuals. An understanding of hvKP-specific virulence mechanisms that enabled evolution from cKP is limited. Observations by our group and previously published molecular epidemiologic data led us to hypothesize that hvKP strains produced more siderophores than cKP strains and that this trait enhanced hvKP virulence. Quantitative analysis of 12 hvKP strains in iron-poor minimal medium or human ascites fluid showed a significant and distinguishing 6- to 10-fold increase in siderophore production compared to that for 14 cKP strains. Surprisingly, high-pressure liquid chromatography (HPLC)-mass spectrometry and characterization of the hvKP strains hvKP1, A1142, and A1365 and their isogenic aerobactin-deficient (ΔiucA) derivatives established that aerobactin accounted for the overwhelming majority of increased siderophore production and that this was not due to gene copy number. Further, aerobactin was the primary factor in conditioned medium that enhanced the growth/survival of hvKP1 in human ascites fluid. Importantly the ex vivo growth/survival of hvKP1 ΔiucA was significantly less than that of hvKP1 in human ascites fluid, and the survival of outbred CD1 mice challenged subcutaneously or intraperitoneally with hvKP1 was significantly less than that of mice challenged with hvKP1 ΔiucA. The lowest subcutaneous and intraperitoneal challenge inocula of 3 × 10(2) and 3.2 × 10(1) CFU, respectively, resulted in 100% mortality, demonstrating the virulence of hvKP1 and its ability to cause infection at a low dose. These data strongly support that aerobactin accounts for increased siderophore production in hvKP compared to cKP (a potential defining trait) and is an important virulence factor.
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745
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Li W, Li N, Sun G, Wu H. Reply to Zhang et al. Clin Infect Dis 2014; 58:1494. [PMID: 24610427 DOI: 10.1093/cid/ciu112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wei Li
- Center of Infectious Diseases
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746
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Zhang Y, Ma Y, Ye L, Luo Y, Yang J. Prevalence and Antimicrobial Susceptibility of Hypervirulent Klebsiella pneumoniae Isolates in China. Clin Infect Dis 2014; 58:1493-4. [DOI: 10.1093/cid/ciu110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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747
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Chen Z, Liu M, Cui Y, Wang L, Zhang Y, Qiu J, Yang R, Liu C, Zhou D. A novel PCR-based genotyping scheme for clinical Klebsiella pneumoniae. Future Microbiol 2014; 9:21-32. [DOI: 10.2217/fmb.13.137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Aim: To establish a PCR-based genotyping method for clinical Klebsiella pneumoniae. Materials & methods: The prevalence of six serotype markers, 41 large variably presented gene clusters, and seven additional virulence markers were screened by PCR in 327 clinical K. pneumoniae strains from China. Results: Detection of serotype markers enabled the identification of capsular serotypes K1, K2, K5, K20, K54 and K57. K. pneumoniae isolates of different origins gave distinct profiles of virulence loci, allowing us to gain a full overview of virulence gene distribution of the strains tested. A novel genotyping scheme was established to group clinical K. pneumoniae strains into distinct complexes based on the profiles of large variably presented gene clusters and virulence markers. Conclusion: This PCR-based genotyping method would be useful to not only characterize genetic diversity and virulence gene distribution, but also for genotyping, origin tracing and risk estimation of K. pneumoniae.
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Affiliation(s)
- Zhenhong Chen
- Nanlou Respiratory Diseases Department, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Mengying Liu
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yujun Cui
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
| | - Li Wang
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Yiquan Zhang
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
| | - Jingfu Qiu
- School of Public Health, Chongqing Medical University, Chongqing 400016, China
| | - Ruifu Yang
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
- School of Medicine, Tsinghua University, Bejing 100084, China
| | - Changting Liu
- Nanlou Respiratory Diseases Department, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen & Biosecurity, Beijing Institute of Microbiology & Epidemiology, Beijing 100071, China
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Pyogenic Liver Abscess, Bacteremia, and Meningitis with Hypermucoviscous Klebsiella pneumoniae: An Unusual Case Report in a Human T-Cell Lymphotropic Virus Positive Patient of Caribbean Origin in the United States. Case Rep Infect Dis 2013; 2013:676340. [PMID: 24490092 PMCID: PMC3893836 DOI: 10.1155/2013/676340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Pyogenic liver abscess (PLA) is a potentially fatal disease. Klebsiella pneumoniae (K. pneumoniae) has replaced Escherichia coli (E. coli) as the predominant causative organism for pyogenic liver abscess. Over the years a unique form of community-acquired invasive K. pneumoniae infection of the liver has been well described in Southeast Asia. This has recently been linked to a virulent hypermucoviscous K. pneumoniae phenotype and to a specific genotype, rmpA positive. To our knowledge, we report the first case of PLA with bacteremia and meningitis in a Guyanese patient with the presence of rmpA-positive K. pneumoniae with laboratory evidence in North America.
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749
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Fevre C, Almeida AS, Taront S, Pedron T, Huerre M, Prevost MC, Kieusseian A, Cumano A, Brisse S, Sansonetti PJ, Tournebize R. A novel murine model of rhinoscleroma identifies Mikulicz cells, the disease signature, as IL-10 dependent derivatives of inflammatory monocytes. EMBO Mol Med 2013; 5:516-30. [PMID: 23554169 PMCID: PMC3628109 DOI: 10.1002/emmm.201202023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/31/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022] Open
Abstract
Rhinoscleroma is a human specific chronic disease characterized by the formation of granuloma in the airways, caused by the bacterium Klebsiella pneumoniae subspecies rhinoscleromatis, a species very closely related to K. pneumoniae subspecies pneumoniae. It is characterized by the appearance of specific foamy macrophages called Mikulicz cells. However, very little is known about the pathophysiological processes underlying rhinoscleroma. Herein, we characterized a murine model recapitulating the formation of Mikulicz cells in lungs and identified them as atypical inflammatory monocytes specifically recruited from the bone marrow upon K. rhinoscleromatis infection in a CCR2-independent manner. While K. pneumoniae and K. rhinoscleromatis infections induced a classical inflammatory reaction, K. rhinoscleromatis infection was characterized by a strong production of IL-10 concomitant to the appearance of Mikulicz cells. Strikingly, in the absence of IL-10, very few Mikulicz cells were observed, confirming a crucial role of IL-10 in the establishment of a proper environment leading to the maturation of these atypical monocytes. This is the first characterization of the environment leading to Mikulicz cells maturation and their identification as inflammatory monocytes.
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Affiliation(s)
- Cindy Fevre
- Institut Pasteur, Génotypage des Pathogènes et Santé Publique, Paris Cedex, France
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750
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Li W, Sun G, Yu Y, Li N, Chen M, Jin R, Jiao Y, Wu H. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2013; 58:225-32. [PMID: 24099919 DOI: 10.1093/cid/cit675] [Citation(s) in RCA: 190] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility. METHODS A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates. RESULTS Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842-59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153-9.768]) and K2 (OR, 9.280 [95% CI, 0.987-87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397-39.572]), liver abscess (OR, 9.068 [95% CI, 1.747-47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100-6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623-30.033]), sputum isolation (OR, 0.312 [95% CI, .095-1.021]), and HIV infection (<0.001 [not applicable]). Multivariate analysis implicated rmpA (OR, 17.398 [95% CI, 4.224-71.668]) and community-acquired infection (OR, 6.844 [95% CI, 1.905-24.585]) as independent risk factors. The proportion of hvKP isolates increased from April to December 2010, January to September 2011, and October 2011 to June 2012 (to 25.5%, 26.7%, and 54.5%, respectively). Resistance to 14 of 19 tested antimicrobials was found to be significantly greater in cKP compared to hvKP. Importantly, resistance to all the tested antimicrobials, except carbapenems and amikacin, was observed in a proportion of hvKP strains, 17% (5/29) of which expressed extended-spectrum β-lactamase. Furthermore, antimicrobial resistance in hvKP strains increased over time. CONCLUSIONS HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.
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Affiliation(s)
- Wei Li
- Department of Infectious Diseases
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