Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: Association with invasive syndrome in patients with community-acquired bacteraemia

Hsin Chun Lee, Yin Ching Chuang, Wen-Liang Yu, Nan Yao Lee, Chia Ming Chang, N. Y. Ko, Li Rong Wang, Wen Chien Ko

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background. Klebsiella pneumoniae, a Gram-negative bacillus usually forming glistening mucoid colonies with viscid consistency on the culture plate, is a common pathogen causing various clinical infection patterns. However, little is known about the clinical implications of this mucoid character. Objective. The purposes of this study, therefore, were to investigate the frequency of hypermucoviscosity (HV) in bacteraemic isolates of K. pneumoniae, and determine the significance of any association between HV and various clinical manifestations. Design. Retrospective observational study. Patients. Patients diagnosed with K. pneumoniae bacteraemia at a community-based university hospital between June 1999 and June 2001 were enrolled in this analysis. Measurements. Clinical data concerning comorbid diseases and infection patterns was collected. K. pneumoniae bacteraemic isolates were examined for the presence of HV using a modified string test. The clinical impact of HV and risk factors for the invasive syndrome were assessed using statistical analysis. Polymerase chain reaction (PCR) was performed to detect magA, a gene related to HV phenotype. Results. Overall, 200 (64.9%) of the 308 cases of K. pneumoniae bacteraemia were community-acquired infections. Compared with hospital-acquired K. pneumoniae bacteraemia (HA-KpB), community-acquired K. pneumoniae bacteraemia (CA-KpB) was more likely to be monomicrobial in nature (83.5% vs. 64.8%; P <0.001) and caused by HV strains (41.5% vs. 14.8%; P <0.001). The prevalence rate of magA among HV phenotypical K. pneumoniae strains was 24.1%. Patients infected with HV-positive strains were more likely to have the distinctive invasive syndrome (i.e. liver abscess, meningitis, pleural empyaema or endophthalmitis) than those infected with HV-negative variants (37.3% vs. 6.8%; P <0.001). Multivariate logistic regression analysis, adjusted for age, showed that HV phenotype in K. pneumoniae strains (OR 8.86; 95% CI, 3.70-21.25; P <0.001) was positively associated with the development of the invasive syndrome in CA-KpB cases. Conclusions. The HV phenotype of K. pneumoniae bacteraemic isolates was associated with the development of a distinctive invasive syndrome. Identification of the HV phenotype should prompt clinicians to initiate aggressive investigations for invasive diseases.

Original languageEnglish
Pages (from-to)606-614
Number of pages9
JournalJournal of Internal Medicine
Volume259
Issue number6
DOIs
Publication statusPublished - Jun 2006

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Klebsiella pneumoniae
Bacteremia
Phenotype
Community-Acquired Infections
Liver Abscess
Endophthalmitis
Infection
Meningitis
Bacillus
Observational Studies
Retrospective Studies
Logistic Models
Regression Analysis
Polymerase Chain Reaction

Keywords

  • Bacteraemia
  • Hypermucoviscosity
  • Invasive syndrome
  • Klebsiella pneumoniae
  • magA gene

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates : Association with invasive syndrome in patients with community-acquired bacteraemia. / Lee, Hsin Chun; Chuang, Yin Ching; Yu, Wen-Liang; Lee, Nan Yao; Chang, Chia Ming; Ko, N. Y.; Wang, Li Rong; Ko, Wen Chien.

In: Journal of Internal Medicine, Vol. 259, No. 6, 06.2006, p. 606-614.

Research output: Contribution to journalArticle

Lee, Hsin Chun ; Chuang, Yin Ching ; Yu, Wen-Liang ; Lee, Nan Yao ; Chang, Chia Ming ; Ko, N. Y. ; Wang, Li Rong ; Ko, Wen Chien. / Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates : Association with invasive syndrome in patients with community-acquired bacteraemia. In: Journal of Internal Medicine. 2006 ; Vol. 259, No. 6. pp. 606-614.
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abstract = "Background. Klebsiella pneumoniae, a Gram-negative bacillus usually forming glistening mucoid colonies with viscid consistency on the culture plate, is a common pathogen causing various clinical infection patterns. However, little is known about the clinical implications of this mucoid character. Objective. The purposes of this study, therefore, were to investigate the frequency of hypermucoviscosity (HV) in bacteraemic isolates of K. pneumoniae, and determine the significance of any association between HV and various clinical manifestations. Design. Retrospective observational study. Patients. Patients diagnosed with K. pneumoniae bacteraemia at a community-based university hospital between June 1999 and June 2001 were enrolled in this analysis. Measurements. Clinical data concerning comorbid diseases and infection patterns was collected. K. pneumoniae bacteraemic isolates were examined for the presence of HV using a modified string test. The clinical impact of HV and risk factors for the invasive syndrome were assessed using statistical analysis. Polymerase chain reaction (PCR) was performed to detect magA, a gene related to HV phenotype. Results. Overall, 200 (64.9{\%}) of the 308 cases of K. pneumoniae bacteraemia were community-acquired infections. Compared with hospital-acquired K. pneumoniae bacteraemia (HA-KpB), community-acquired K. pneumoniae bacteraemia (CA-KpB) was more likely to be monomicrobial in nature (83.5{\%} vs. 64.8{\%}; P <0.001) and caused by HV strains (41.5{\%} vs. 14.8{\%}; P <0.001). The prevalence rate of magA among HV phenotypical K. pneumoniae strains was 24.1{\%}. Patients infected with HV-positive strains were more likely to have the distinctive invasive syndrome (i.e. liver abscess, meningitis, pleural empyaema or endophthalmitis) than those infected with HV-negative variants (37.3{\%} vs. 6.8{\%}; P <0.001). Multivariate logistic regression analysis, adjusted for age, showed that HV phenotype in K. pneumoniae strains (OR 8.86; 95{\%} CI, 3.70-21.25; P <0.001) was positively associated with the development of the invasive syndrome in CA-KpB cases. Conclusions. The HV phenotype of K. pneumoniae bacteraemic isolates was associated with the development of a distinctive invasive syndrome. Identification of the HV phenotype should prompt clinicians to initiate aggressive investigations for invasive diseases.",
keywords = "Bacteraemia, Hypermucoviscosity, Invasive syndrome, Klebsiella pneumoniae, magA gene",
author = "Lee, {Hsin Chun} and Chuang, {Yin Ching} and Wen-Liang Yu and Lee, {Nan Yao} and Chang, {Chia Ming} and Ko, {N. Y.} and Wang, {Li Rong} and Ko, {Wen Chien}",
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T1 - Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates

T2 - Association with invasive syndrome in patients with community-acquired bacteraemia

AU - Lee, Hsin Chun

AU - Chuang, Yin Ching

AU - Yu, Wen-Liang

AU - Lee, Nan Yao

AU - Chang, Chia Ming

AU - Ko, N. Y.

AU - Wang, Li Rong

AU - Ko, Wen Chien

PY - 2006/6

Y1 - 2006/6

N2 - Background. Klebsiella pneumoniae, a Gram-negative bacillus usually forming glistening mucoid colonies with viscid consistency on the culture plate, is a common pathogen causing various clinical infection patterns. However, little is known about the clinical implications of this mucoid character. Objective. The purposes of this study, therefore, were to investigate the frequency of hypermucoviscosity (HV) in bacteraemic isolates of K. pneumoniae, and determine the significance of any association between HV and various clinical manifestations. Design. Retrospective observational study. Patients. Patients diagnosed with K. pneumoniae bacteraemia at a community-based university hospital between June 1999 and June 2001 were enrolled in this analysis. Measurements. Clinical data concerning comorbid diseases and infection patterns was collected. K. pneumoniae bacteraemic isolates were examined for the presence of HV using a modified string test. The clinical impact of HV and risk factors for the invasive syndrome were assessed using statistical analysis. Polymerase chain reaction (PCR) was performed to detect magA, a gene related to HV phenotype. Results. Overall, 200 (64.9%) of the 308 cases of K. pneumoniae bacteraemia were community-acquired infections. Compared with hospital-acquired K. pneumoniae bacteraemia (HA-KpB), community-acquired K. pneumoniae bacteraemia (CA-KpB) was more likely to be monomicrobial in nature (83.5% vs. 64.8%; P <0.001) and caused by HV strains (41.5% vs. 14.8%; P <0.001). The prevalence rate of magA among HV phenotypical K. pneumoniae strains was 24.1%. Patients infected with HV-positive strains were more likely to have the distinctive invasive syndrome (i.e. liver abscess, meningitis, pleural empyaema or endophthalmitis) than those infected with HV-negative variants (37.3% vs. 6.8%; P <0.001). Multivariate logistic regression analysis, adjusted for age, showed that HV phenotype in K. pneumoniae strains (OR 8.86; 95% CI, 3.70-21.25; P <0.001) was positively associated with the development of the invasive syndrome in CA-KpB cases. Conclusions. The HV phenotype of K. pneumoniae bacteraemic isolates was associated with the development of a distinctive invasive syndrome. Identification of the HV phenotype should prompt clinicians to initiate aggressive investigations for invasive diseases.

AB - Background. Klebsiella pneumoniae, a Gram-negative bacillus usually forming glistening mucoid colonies with viscid consistency on the culture plate, is a common pathogen causing various clinical infection patterns. However, little is known about the clinical implications of this mucoid character. Objective. The purposes of this study, therefore, were to investigate the frequency of hypermucoviscosity (HV) in bacteraemic isolates of K. pneumoniae, and determine the significance of any association between HV and various clinical manifestations. Design. Retrospective observational study. Patients. Patients diagnosed with K. pneumoniae bacteraemia at a community-based university hospital between June 1999 and June 2001 were enrolled in this analysis. Measurements. Clinical data concerning comorbid diseases and infection patterns was collected. K. pneumoniae bacteraemic isolates were examined for the presence of HV using a modified string test. The clinical impact of HV and risk factors for the invasive syndrome were assessed using statistical analysis. Polymerase chain reaction (PCR) was performed to detect magA, a gene related to HV phenotype. Results. Overall, 200 (64.9%) of the 308 cases of K. pneumoniae bacteraemia were community-acquired infections. Compared with hospital-acquired K. pneumoniae bacteraemia (HA-KpB), community-acquired K. pneumoniae bacteraemia (CA-KpB) was more likely to be monomicrobial in nature (83.5% vs. 64.8%; P <0.001) and caused by HV strains (41.5% vs. 14.8%; P <0.001). The prevalence rate of magA among HV phenotypical K. pneumoniae strains was 24.1%. Patients infected with HV-positive strains were more likely to have the distinctive invasive syndrome (i.e. liver abscess, meningitis, pleural empyaema or endophthalmitis) than those infected with HV-negative variants (37.3% vs. 6.8%; P <0.001). Multivariate logistic regression analysis, adjusted for age, showed that HV phenotype in K. pneumoniae strains (OR 8.86; 95% CI, 3.70-21.25; P <0.001) was positively associated with the development of the invasive syndrome in CA-KpB cases. Conclusions. The HV phenotype of K. pneumoniae bacteraemic isolates was associated with the development of a distinctive invasive syndrome. Identification of the HV phenotype should prompt clinicians to initiate aggressive investigations for invasive diseases.

KW - Bacteraemia

KW - Hypermucoviscosity

KW - Invasive syndrome

KW - Klebsiella pneumoniae

KW - magA gene

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