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European Journal of Clinical Microbiology & Infectious Diseases

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01-04-2018 | Original Article

Risk factors and clinical outcomes of hypervirulent Klebsiella pneumoniae induced bloodstream infections

Authors: Jiayang Li, Jianan Ren, Weiping Wang, Gefei Wang, Guosheng Gu, Xiuwen Wu, Ying Wang, Mei Huang, Jieshou Li

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 4/2018

Abstract

The prevalence of hypervirulent Klebsiella pneumoniae (hvKP) is high in China, but clinical characteristics and outcomes of hvKP induced bloodstream infections (BSIs) are not clear. The purpose of the present study was to determine the risk factors and clinical outcomes of hvKP-BSIs in populations admitted in a teaching hospital of Nanjing, China. The genetic characteristics and antibiotic resistance patterns of the hvKP strains were further analyzed. A retrospective study was conducted in 143 patients with K. pneumoniae BSIs at Jinling Hospital in China from September 2015 to December 2016. A positive polymerase chain reaction (PCR) amplification of the plasmid-borne rmpA (p-rmpA) and aerobactin (iucA) was identified as hvKP. Overall, 24.5% (35/143) of K. pneumoniae isolates were hvKP. Multivariate analysis implicated diabetes mellitus (OR = 3.356) and community-acquired BSIs (OR = 4.898) as independent risk factors for hvKP-BSIs. The 30-day mortality rate of the hvKP-BSIs group was 37.1% (13/35) compared with 40.7% (44/108) in the cKP-BSIs control group (P = 0.706). The KPC-producing isolates (OR = 2.851), underlying disease with gastrointestinal fistula (OR = 3.054), APACHE II score ≥ 15 (OR = 6.694) and Pitt bacteremia score ≥ 2 (OR = 6.232) at infection onset were independent predictors for 30-day mortality of K. pneumoniae bacteremia patients. A high percentage (57.1%, 20/35) of KPC-producing isolates was observed among hvKP strains and ST11 was dominant in hvKP strains (17/35, 48.6%). KPC-producing hvKP is emerging, indicating the importance of epidemiologic surveillance and clinical awareness of this pathogen.

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Title: Risk factors and clinical outcomes of hypervirulent Klebsiella pneumoniae induced bloodstream infections
Authors: Jiayang Li
Jianan Ren
Weiping Wang
Gefei Wang
Guosheng Gu
Xiuwen Wu
Ying Wang
Mei Huang
Jieshou Li
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 4/2018
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-017-3160-z

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