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Klebsiella oxytoca Complex: Update on Taxonomy, Antimicrobial Resistance, and Virulence. Clin Microbiol Rev 2021; 35:e0000621. [PMID: 34851134 DOI: 10.1128/cmr.00006-21] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Klebsiella oxytoca is actually a complex of nine species-Klebsiella grimontii, Klebsiella huaxiensis, Klebsiella michiganensis, K. oxytoca, Klebsiella pasteurii, Klebsiella spallanzanii, and three unnamed novel species. Phenotypic tests can assign isolates to the complex, but precise species identification requires genome-based analysis. The K. oxytoca complex is a human commensal but also an opportunistic pathogen causing various infections, such as antibiotic-associated hemorrhagic colitis (AAHC), urinary tract infection, and bacteremia, and has caused outbreaks. Production of the cytotoxins tilivalline and tilimycin lead to AAHC, while many virulence factors seen in Klebsiella pneumoniae, such as capsular polysaccharides and fimbriae, have been found in the complex; however, their association with pathogenicity remains unclear. Among the 5,724 K. oxytoca clinical isolates in the SENTRY surveillance system, the rates of nonsusceptibility to carbapenems, ceftriaxone, ciprofloxacin, colistin, and tigecycline were 1.8%, 12.5%, 7.1%, 0.8%, and 0.1%, respectively. Resistance to carbapenems is increasing alarmingly. In addition to the intrinsic blaOXY, many genes encoding β-lactamases with varying spectra of hydrolysis, including extended-spectrum β-lactamases, such as a few CTX-M variants and several TEM and SHV variants, have been found. blaKPC-2 is the most common carbapenemase gene found in the complex and is mainly seen on IncN or IncF plasmids. Due to the ability to acquire antimicrobial resistance and the carriage of multiple virulence genes, the K. oxytoca complex has the potential to become a major threat to human health.
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Karimi A, Fayazi A, Ghorobi J, Pourmoghaddas Z. A Pediatric Case of Antibiotic-Associated Hemorrhagic Colitis Caused by Klebsiella Oxytoca. Int J Prev Med 2019; 10:113. [PMID: 31360360 PMCID: PMC6592131 DOI: 10.4103/ijpvm.ijpvm_330_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/20/2019] [Indexed: 12/02/2022] Open
Abstract
In recent decade the prevalence of antibiotic associated diarrhea was increased because of more antibiotic usage. Colstridum difficile is a microorganism which can cause mild to severe colitis. But the only cause of colitis related to Antibiotics is not colstridum difficle. In this case report we explain a child whit antibiotic associated colitis due to klebsiella oxtyoca.
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Affiliation(s)
- Abdollah Karimi
- Research Institute for Children Health, Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medicine Sciences, Tehran, Iran
| | - Arefeh Fayazi
- Research Institute for Children Health, Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medicine Sciences, Tehran, Iran
| | - Javad Ghorobi
- Department of Surgery, Shahid Beheshti University of Medicine Sciences, Tehran, Iran
| | - Zahra Pourmoghaddas
- Research Institute for Children Health, Pediatric Infections Research Center, Mofid Children Hospital, Shahid Beheshti University of Medicine Sciences, Tehran, Iran.,Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Tse H, Gu Q, Sze KH, Chu IK, Kao RYT, Lee KC, Lam CW, Yang D, Tai SSC, Ke Y, Chan E, Chan WM, Dai J, Leung SP, Leung SY, Yuen KY. A tricyclic pyrrolobenzodiazepine produced by Klebsiella oxytoca is associated with cytotoxicity in antibiotic-associated hemorrhagic colitis. J Biol Chem 2017; 292:19503-19520. [PMID: 28972161 DOI: 10.1074/jbc.m117.791558] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
Cytotoxin-producing Klebsiella oxytoca is the causative agent of antibiotic-associated hemorrhagic colitis (AAHC). Recently, the cytotoxin associated with AAHC was identified as tilivalline, a known pentacyclic pyrrolobenzodiazepine (PBD) metabolite produced by K. oxytoca Although this assertion of tilivalline's role in AAHC is supported by evidence from animal experiments, some key aspects of this finding appear to be incompatible with toxicity mechanisms of known PBD toxins. We therefore hypothesized that K. oxytoca may produce some other uncharacterized cytotoxins. To address this question, we investigated whether tilivalline alone is indeed necessary and sufficient to induce cytotoxicity or whether K. oxytoca also produces other cytotoxins. LC-MS- and NMR-based metabolomic analyses revealed the presence of an abundant tricyclic PBD, provisionally designated kleboxymycin, in the supernatant of toxigenic K. oxytoca strains. Moreover, by generating multiple mutants with gene deletions affecting tilivalline biosynthesis, we show that a tryptophanase-deficient, tilivalline-negative K. oxytoca mutant induced cytotoxicity in vitro similar to tilivalline-positive K. oxytoca strains. Furthermore, synthetic kleboxymycin exhibited greater than 9-fold higher cytotoxicity than tilivalline in TC50 cell culture assays. We also found that the biosynthetic pathways for kleboxymycin and tilivalline appear to overlap, as tilivalline is an indole derivative of kleboxymycin. In summary, our results indicate that tilivalline is not essential for inducing cytotoxicity observed in K. oxytoca-associated AAHC and that kleboxymycin is a tilivalline-related bacterial metabolite with even higher cytotoxicity.
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Affiliation(s)
- Herman Tse
- From the Department of Microbiology.,Research Centre of Infection and Immunity, and.,the State Key Laboratory of Emerging Infectious Diseases, Hong Kong SAR, Hong Kong, China.,the Carol Yu Centre for Infection
| | | | - Kong-Hung Sze
- From the Department of Microbiology.,Research Centre of Infection and Immunity, and.,the State Key Laboratory of Emerging Infectious Diseases, Hong Kong SAR, Hong Kong, China.,the Carol Yu Centre for Infection
| | | | - Richard Y-T Kao
- From the Department of Microbiology.,Research Centre of Infection and Immunity, and.,the State Key Laboratory of Emerging Infectious Diseases, Hong Kong SAR, Hong Kong, China.,the Carol Yu Centre for Infection
| | - Kam-Chung Lee
- From the Department of Microbiology.,Research Centre of Infection and Immunity, and.,the State Key Laboratory of Emerging Infectious Diseases, Hong Kong SAR, Hong Kong, China.,the Carol Yu Centre for Infection
| | | | | | | | | | | | | | - Jun Dai
- From the Department of Microbiology
| | | | | | - Kwok-Yung Yuen
- From the Department of Microbiology, .,Research Centre of Infection and Immunity, and.,the State Key Laboratory of Emerging Infectious Diseases, Hong Kong SAR, Hong Kong, China.,the Carol Yu Centre for Infection
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Stampfer L, Deutschmann A, Dür E, Eitelberger FG, Fürpass T, Gorkiewicz G, Heinz-Erian P, Heller I, Herzog K, Hopfer B, Kerbl R, Klug E, Krause R, Leitner E, Mache C, Müller T, Pansy J, Pocivalnik M, Scheuba E, Schneditz G, Schweintzger G, Sterniczky E, Zechner E, Hauer AC, Högenauer C, Hoffmann KM. Causes of hematochezia and hemorrhagic antibiotic-associated colitis in children and adolescents. Medicine (Baltimore) 2017; 96:e7793. [PMID: 28816966 PMCID: PMC5571703 DOI: 10.1097/md.0000000000007793] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diseases causing hematochezia range from benign to potentially life-threatening. Systematic pediatric data on the causes of hematochezia are scarce. We studied the underlying causes and long-term outcome of hematochezia in children. We further investigated the relevance of antibiotic-associated hemorrhagic colitis in children, especially if caused by Klebsiella oxytoca.Infants, children, and adolescents with hematochezia were recruited prospectively. Patients were grouped according to age (<1 year, 1-5 years, 6-13 years, >14 years). In addition to routine diagnostics, K oxytoca stool culture and toxin analysis was performed. We collected data on history, laboratory findings, microbiological diagnostic, imaging, final diagnosis, and long-term outcome.We included 221 patients (female 46%; age 0-19 years). In 98 (44%), hematochezia was caused by infectious diseases. Endoscopy was performed in 30 patients (13.6%). No patient died due to the underlying cause of hematochezia. The most common diagnoses according to age were food protein-induced proctocolitis in infants, bacterial colitis in young children, and inflammatory bowel disease in children and adolescents. Seventeen (7.7%) had a positive stool culture for K oxytoca. Antibiotic-associated colitis was diagnosed in 12 (5%) patients: 2 caused by K oxytoca and 2 by Clostridium difficile; in the remaining 8 patients, no known pathobiont was identified.Infections were the most common cause of hematochezia in this study. In most patients, invasive diagnostic procedures were not necessary. Antibiotic-associated hemorrhagic colitis caused by K oxytoca was an uncommon diagnosis in our cohort. Antibiotic-associated colitis with hematochezia might be caused by pathobionts other than C difficile or K oxytoca.
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Affiliation(s)
- Laura Stampfer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Andrea Deutschmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Elisabeth Dür
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Franz G. Eitelberger
- Division of General Pediatrics and Adolescent Medicine, Hospital Wels-Grieskirchen, Wels
| | - Theresia Fürpass
- Microbiologic Laboratory, Institute of Pathology, General Hospital Hochsteiermark, Leoben
| | | | | | - Ingrid Heller
- Institute of Microbiology, Medical University Innsbruck, Innsbruck
| | - Kathrin Herzog
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Barbara Hopfer
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Reinhold Kerbl
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Evelyn Klug
- Institute of Pathology, Hospital Oberwart, Oberwart
| | - Robert Krause
- Department of Internal Medicine, Medical University Graz
| | - Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine
| | - Christoph Mache
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | | | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University Graz
| | - Mirjam Pocivalnik
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Eva Scheuba
- Division of General Pediatrics and Adolescent Medicine, Hospital Wels-Grieskirchen, Wels
| | - Georg Schneditz
- Institute of Molecular Biosciences, Karl-Franzens University Graz, Graz
| | - Gerolf Schweintzger
- Division of Pediatrics and Adolescent Medicine, General Hospital Hochsteiermark, Leoben
| | - Edith Sterniczky
- Division of Pediatrics and Adolescent Medicine, Hospital Oberwart, Oberwart
| | - Ellen Zechner
- Institute of Molecular Biosciences, Karl-Franzens University Graz, Graz
| | - Almuthe C. Hauer
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Karl Martin Hoffmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University Graz, Graz
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Yamada M, Yamazawa K, Sekiguchi S, Shinjoh M, Tomita K, Takenouchi T, Takahashi T. A Pediatric Case of Antibiotic-Associated Hemorrhagic Colitis Caused by Klebsiella Oxytoca. Glob Pediatr Health 2014; 1:2333794X14550525. [PMID: 27335905 PMCID: PMC4804693 DOI: 10.1177/2333794x14550525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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