Skip to main content
Top
Published in: BMC Infectious Diseases 1/2015

Open Access 01-12-2015 | Research article

Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China

Authors: Ting-ting Qu, Jian-cang Zhou, Yan Jiang, Ke-ren Shi, Bin Li, Ping Shen, Ze-qing Wei, Yun-song Yu

Published in: BMC Infectious Diseases | Issue 1/2015

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference Lin YT, Wang FD, Wu PF, Fung CP. Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics. BMC Infect Dis. 2013;13:56.CrossRefPubMedPubMedCentral Lin YT, Wang FD, Wu PF, Fung CP. Klebsiella pneumoniae liver abscess in diabetic patients: association of glycemic control with the clinical characteristics. BMC Infect Dis. 2013;13:56.CrossRefPubMedPubMedCentral
2.
go back to reference Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881–7.CrossRefPubMed Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis. 2012;12(11):881–7.CrossRefPubMed
3.
go back to reference Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45(3):284–93.CrossRefPubMed Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45(3):284–93.CrossRefPubMed
4.
go back to reference Lin YC, Lu MC, Tang HL, Liu HC, Chen CH, Liu KS, et al. Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections: comparative virulence analysis with hypermucoviscosity-negative strain. BMC Microbiol. 2011;11:50.CrossRefPubMedPubMedCentral Lin YC, Lu MC, Tang HL, Liu HC, Chen CH, Liu KS, et al. Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections: comparative virulence analysis with hypermucoviscosity-negative strain. BMC Microbiol. 2011;11:50.CrossRefPubMedPubMedCentral
5.
6.
go back to reference Yeh KM, Chang FY, Fung CP, Lin JC, Siu LK. magA is not a specific virulence gene for Klebsiella pneumoniae strains causing liver abscess but is part of the capsular polysaccharide gene cluster of K. pneumoniae serotype K1. J Med Microbiol. 2006;55(Pt 6):803–4.CrossRefPubMed Yeh KM, Chang FY, Fung CP, Lin JC, Siu LK. magA is not a specific virulence gene for Klebsiella pneumoniae strains causing liver abscess but is part of the capsular polysaccharide gene cluster of K. pneumoniae serotype K1. J Med Microbiol. 2006;55(Pt 6):803–4.CrossRefPubMed
7.
go back to reference Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL. The function of wzy_K1 (magA), the serotype K1 polymerase gene in Klebsiella pneumoniae cps gene cluster. J Infect Dis. 2010;201(8):1268–9.CrossRefPubMed Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL. The function of wzy_K1 (magA), the serotype K1 polymerase gene in Klebsiella pneumoniae cps gene cluster. J Infect Dis. 2010;201(8):1268–9.CrossRefPubMed
8.
go back to reference Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 2006;42(10):1351–8.CrossRefPubMed Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 2006;42(10):1351–8.CrossRefPubMed
9.
go back to reference Yeh KM, Lin JC, Yin FY, Fung CP, Hung HC, Siu LK, et al. Revisiting the importance of virulence determinant magA and its surrounding genes in Klebsiella pneumoniae causing pyogenic liver abscesses: exact role in serotype K1 capsule formation. J Infect Dis. 2010;201(8):1259–67.CrossRefPubMed Yeh KM, Lin JC, Yin FY, Fung CP, Hung HC, Siu LK, et al. Revisiting the importance of virulence determinant magA and its surrounding genes in Klebsiella pneumoniae causing pyogenic liver abscesses: exact role in serotype K1 capsule formation. J Infect Dis. 2010;201(8):1259–67.CrossRefPubMed
10.
go back to reference Struve C, Bojer M, Nielsen EM, Hansen DS, Krogfelt KA. Investigation of the putative virulence gene magA in a worldwide collection of 495 Klebsiella isolates: magA is restricted to the gene cluster of Klebsiella pneumoniae capsule serotype K1. J Med Microbiol. 2005;54(Pt 11):1111–3.CrossRefPubMed Struve C, Bojer M, Nielsen EM, Hansen DS, Krogfelt KA. Investigation of the putative virulence gene magA in a worldwide collection of 495 Klebsiella isolates: magA is restricted to the gene cluster of Klebsiella pneumoniae capsule serotype K1. J Med Microbiol. 2005;54(Pt 11):1111–3.CrossRefPubMed
11.
go back to reference Tang HL, Chiang MK, Liou WJ, Chen YT, Peng HL, Chiou CS, et al. Correlation between Klebsiella pneumoniae carrying pLVPK-derived loci and abscess formation. Eur J Clin Microbiol Infect Dis. 2010;29(6):689–98.CrossRefPubMed Tang HL, Chiang MK, Liou WJ, Chen YT, Peng HL, Chiou CS, et al. Correlation between Klebsiella pneumoniae carrying pLVPK-derived loci and abscess formation. Eur J Clin Microbiol Infect Dis. 2010;29(6):689–98.CrossRefPubMed
12.
go back to reference Chuang YC, Lee MF, Tan CK, Ko WC, Wang FD, Yu WL. Can the rmpA gene predict metastatic meningitis among patients with primary Klebsiella pneumoniae liver abscess? J Infection. 2013;67(2):166–8.CrossRef Chuang YC, Lee MF, Tan CK, Ko WC, Wang FD, Yu WL. Can the rmpA gene predict metastatic meningitis among patients with primary Klebsiella pneumoniae liver abscess? J Infection. 2013;67(2):166–8.CrossRef
13.
go back to reference Merlet A, Cazanave C, Dutronc H, de Barbeyrac B, Brisse S, Dupon M. Primary liver abscess due to CC23-K1 virulent clone of Klebsiella pneumoniae in France. Clin Microbiol Infect. 2012;18(9):E338–339.CrossRefPubMed Merlet A, Cazanave C, Dutronc H, de Barbeyrac B, Brisse S, Dupon M. Primary liver abscess due to CC23-K1 virulent clone of Klebsiella pneumoniae in France. Clin Microbiol Infect. 2012;18(9):E338–339.CrossRefPubMed
14.
go back to reference Lin JC, Koh TH, Lee N, Fung CP, Chang FY, Tsai YK, et al. Genotypes and virulence in serotype K2 Klebsiella pneumoniae from liver abscess and non-infectious carriers in Hong Kong, Singapore and Taiwan. Gut Pathogens. 2014;6:21.CrossRefPubMedPubMedCentral Lin JC, Koh TH, Lee N, Fung CP, Chang FY, Tsai YK, et al. Genotypes and virulence in serotype K2 Klebsiella pneumoniae from liver abscess and non-infectious carriers in Hong Kong, Singapore and Taiwan. Gut Pathogens. 2014;6:21.CrossRefPubMedPubMedCentral
15.
go back to reference 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(11):818–24.CrossRef 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(11):818–24.CrossRef
16.
go back to reference Li W, Sun G, Yu Y, Li N, Chen M, Jin R, et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis. 2013;58(2):225–32.CrossRefPubMed Li W, Sun G, Yu Y, Li N, Chen M, Jin R, et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis. 2013;58(2):225–32.CrossRefPubMed
17.
go back to reference Yeh KM, Kurup A, Siu LK, Koh YL, Fung CP, Lin JC, et al. Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan. J Clin Microbiol. 2007;45(2):466–71.CrossRefPubMed Yeh KM, Kurup A, Siu LK, Koh YL, Fung CP, Lin JC, et al. Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan. J Clin Microbiol. 2007;45(2):466–71.CrossRefPubMed
18.
go back to reference Yang J, Ye L, Guo L, Zhao Q, Chen R, Luo Y, et al. A nosocomial outbreak of KPC-2-producing Klebsiella pneumoniae in a Chinese hospital: dissemination of ST11 and emergence of ST37, ST392 and ST395. Clin Microbiol Infect. 2013;19(11):E509–515.CrossRefPubMed Yang J, Ye L, Guo L, Zhao Q, Chen R, Luo Y, et al. A nosocomial outbreak of KPC-2-producing Klebsiella pneumoniae in a Chinese hospital: dissemination of ST11 and emergence of ST37, ST392 and ST395. Clin Microbiol Infect. 2013;19(11):E509–515.CrossRefPubMed
19.
go back to reference Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33(9):2233–9.PubMedPubMedCentral Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33(9):2233–9.PubMedPubMedCentral
20.
go back to reference Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, et al. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infection. 2007;54(6):578–83.CrossRef Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, et al. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infection. 2007;54(6):578–83.CrossRef
21.
go back to reference Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39(11):1654–9.CrossRefPubMed Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis. 2004;39(11):1654–9.CrossRefPubMed
22.
go back to reference Moore R, O'Shea D, Geoghegan T, Mallon PW, Sheehan G. Community-acquired Klebsiella pneumoniae liver abscess: an emerging infection in Ireland and Europe. Infection. 2013;41(3):681–6.CrossRefPubMed Moore R, O'Shea D, Geoghegan T, Mallon PW, Sheehan G. Community-acquired Klebsiella pneumoniae liver abscess: an emerging infection in Ireland and Europe. Infection. 2013;41(3):681–6.CrossRefPubMed
23.
go back to reference Shen DX, Wang J, Li DD. Klebsiella pneumoniae liver abscesses. Lancet Infect Dis. 2013;13(5):390–1.CrossRefPubMed Shen DX, Wang J, Li DD. Klebsiella pneumoniae liver abscesses. Lancet Infect Dis. 2013;13(5):390–1.CrossRefPubMed
24.
go back to reference Liao CH, Huang YT, Chang CY, Hsu HS, Hsueh PR. Capsular serotypes and multilocus sequence types of bacteremic Klebsiella pneumoniae isolates associated with different types of infections. Eur J Clin Microbiol Infect Dis. 2014;33(3):365–9.CrossRefPubMed Liao CH, Huang YT, Chang CY, Hsu HS, Hsueh PR. Capsular serotypes and multilocus sequence types of bacteremic Klebsiella pneumoniae isolates associated with different types of infections. Eur J Clin Microbiol Infect Dis. 2014;33(3):365–9.CrossRefPubMed
25.
go back to reference Chung DR, Lee H, Park MH, Jung SI, Chang HH, Kim YS, et al. Fecal carriage of serotype K1 Klebsiella pneumoniae ST23 strains closely related to liver abscess isolates in Koreans living in Korea. Eur J Clin Microbiol Infect Dis. 2012;31(4):481–6.CrossRefPubMed Chung DR, Lee H, Park MH, Jung SI, Chang HH, Kim YS, et al. Fecal carriage of serotype K1 Klebsiella pneumoniae ST23 strains closely related to liver abscess isolates in Koreans living in Korea. Eur J Clin Microbiol Infect Dis. 2012;31(4):481–6.CrossRefPubMed
26.
go back to reference Siu LK, Fung CP, Chang FY, Lee N, Yeh KM, Koh TH, et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan. J Clin Microbiol. 2011;49(11):3761–5.CrossRefPubMedPubMedCentral Siu LK, Fung CP, Chang FY, Lee N, Yeh KM, Koh TH, et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan. J Clin Microbiol. 2011;49(11):3761–5.CrossRefPubMedPubMedCentral
27.
go back to reference Fung CP, Lin YT, Lin JC, Chen TL, Yeh KM, Chang FY, et al. Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess. Emerg Infect Dis. 2012;18(8):1322–5.CrossRefPubMedPubMedCentral Fung CP, Lin YT, Lin JC, Chen TL, Yeh KM, Chang FY, et al. Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess. Emerg Infect Dis. 2012;18(8):1322–5.CrossRefPubMedPubMedCentral
28.
go back to reference Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis. 2006;193(5):645–54.CrossRefPubMed Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis. 2006;193(5):645–54.CrossRefPubMed
29.
go back to reference Fung CP, Chang FY, Lee SC, Hu BS, Kuo BI, Liu CY, et al. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut. 2002;50(3):420–4.CrossRefPubMedPubMedCentral Fung CP, Chang FY, Lee SC, Hu BS, Kuo BI, Liu CY, et al. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut. 2002;50(3):420–4.CrossRefPubMedPubMedCentral
30.
go back to reference Hsu CR, Lin TL, Chen YC, Chou HC, Wang JT. The role of Klebsiella pneumoniae rmpA in capsular polysaccharide synthesis and virulence revisited. Microbiology. 2011;157(Pt 12):3446–57.CrossRefPubMed Hsu CR, Lin TL, Chen YC, Chou HC, Wang JT. The role of Klebsiella pneumoniae rmpA in capsular polysaccharide synthesis and virulence revisited. Microbiology. 2011;157(Pt 12):3446–57.CrossRefPubMed
Metadata
Title
Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China
Authors
Ting-ting Qu
Jian-cang Zhou
Yan Jiang
Ke-ren Shi
Bin Li
Ping Shen
Ze-qing Wei
Yun-song Yu
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-015-0899-7

Other articles of this Issue 1/2015

BMC Infectious Diseases 1/2015 Go to the issue