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Clin Infect Dis. Increasing occurrence of antimicrobial resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China
[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]
Increasing occurrence of antimicrobial resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China
Wei Li 1,∧, Guizhen Sun 2,∧, Yanhua Yu 2,∧, Ning Li 3, Ming Chen 2, Ronghua Jin 3, Yanmei Jiao 1, and Hao Wu 1,*
Author Affiliations: <SUP>1</SUP>Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China <SUP>2</SUP>Department of Clinical laboratory, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China <SUP>3</SUP>Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
*Corresponding author: Hao Wu: wuhao90000@gmail.com, Tel.: 086-010-83997162, Fax: 086-010-83997164, Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
∧ These authors contributed to this manuscript equally
Abstract
Background.
New hypervirulent variants of K. pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 K. pneumoniae culture-positive patients 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 classical 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 (OR 16.92, 95%CI[4.842?59.145]), capsule antigen K1 (3.355[1.153?9.768]) and K2 (9.280[0.987?87.250]), alcoholic hepatitis (7.435[1.397?39.572]), liver abscess (9.068[1.747?47.061]), metastatic infection (2.752[1.100?6.886]), community-acquired infection (10.432[3.623?30.033]), sputum isolation (0.312[0.095?1.021]), HIV infection (<0.001[N/A]). Multivariate analysis implicated rmpA (17.398[4.224-71.668]) and community-acquired infection (6.844[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 (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 (ESBL). 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.
Received June 6, 2013. Accepted September 27, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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Increasing occurrence of antimicrobial resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China
Wei Li 1,∧, Guizhen Sun 2,∧, Yanhua Yu 2,∧, Ning Li 3, Ming Chen 2, Ronghua Jin 3, Yanmei Jiao 1, and Hao Wu 1,*
Author Affiliations: <SUP>1</SUP>Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China <SUP>2</SUP>Department of Clinical laboratory, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China <SUP>3</SUP>Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
*Corresponding author: Hao Wu: wuhao90000@gmail.com, Tel.: 086-010-83997162, Fax: 086-010-83997164, Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
∧ These authors contributed to this manuscript equally
Abstract
Background.
New hypervirulent variants of K. pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 K. pneumoniae culture-positive patients 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 classical 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 (OR 16.92, 95%CI[4.842?59.145]), capsule antigen K1 (3.355[1.153?9.768]) and K2 (9.280[0.987?87.250]), alcoholic hepatitis (7.435[1.397?39.572]), liver abscess (9.068[1.747?47.061]), metastatic infection (2.752[1.100?6.886]), community-acquired infection (10.432[3.623?30.033]), sputum isolation (0.312[0.095?1.021]), HIV infection (<0.001[N/A]). Multivariate analysis implicated rmpA (17.398[4.224-71.668]) and community-acquired infection (6.844[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 (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 (ESBL). 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.
Received June 6, 2013. Accepted September 27, 2013.
? The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
For Permissions, please e-mail: journals.permissions@oup.com.
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