BV
Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae ; SENTRY Participant Group North America. Lineages are boxed and labeled with their multi-locus sequence type (ST). Pea
For 5/7 patients the resistance profiles for the follow-up isolate remained the same as the baseline isolate, and for 2/7 patients the follow-up isolate was more resistant (see Supplementary Tables 1 and 3).
It has been reported that gastrointestinal colonization (GI) is likely to be a common and significant reservoir for the transmission and infections of K. pneumoniae in both adults and neonates. Individuals in the community-associated (CA) screening group include patients who were both (i) admitted to the Alfred Hospital ICU either directly (day 0) or via another ward on day 0, 1, or 2 of the original hospital admission; and (ii) first swabbed on day 0, 1, or 2 of that admission. Most of the infections associated with transmission were MDR (3/4 donors and 3/6 recipients), yielding a strong association between MDR infections and transmission in the ICU (OR = 13.6, P = .002). 6 Huynh BT, Passet V, Rakotondrasoa A, Diallo T, Kerleguer A, Hennart M, Lauzanne A, Herindrainy P, Seck A, Bercion R, Borand L, Pardos de la Gandara M, Delarocque-Astagneau E, Guillemot D, Vray M, Garin B, Collard JM, Rodrigues C, Brisse S. Gut Microbes. Of all ICU patients who developed K. pneumoniae infections and contributed baseline screening swabs, 48% (n = 13/27) tested positive for K. pneumoniae GI carriage at baseline (including 8 who were screened >2 days prior to developing the infection). A
Klebsiella pneumoniae : Prevalence, Reservoirs, Antimicrobial V
A similar study introduced screening for ESBL K. pneumoniae in order to limit and prevent current and future outbreaks [29]. This likely reflects acquisition of bacteria in the hospital (transmission of strains was directly observed in 5% of cases) and/or selection for growth of pre-existing K. pneumoniae in the GI microbiome during hospitalization (MDR rate was 18% in HA baseline carriage and 15% at follow-up, but MDR was not detected in CA baseline carriage). Abbreviation: SNP, single-nucleotide polymorphism. These included 2 episodes of pneumonia, 2 wound infections, and 2 UTIs, one of which disseminated to cause bacteremia with sepsis (Table 2, Supplementary Table 3).
C
Laurent C, Rodriguez-Villalobos H, Rost F, et al. RN
As a library, NLM provides access to scientific literature.
H
Tip colours indicate isolate source as per inset legend.
Clinical Epidemiology, Risk Factors, and Control Strategies of
Patients suffering from CP K. pneumoniae infections (typically ST258), or from pyogenic liver abscess caused by hypervirulent K. pneumoniae (ST23), have been shown to carry their infecting strain in their GI tract for between 30 days (74%) and 6 months (<30%) following discharge from hospital [10]. The rate of K. pneumoniae infection was significantly higher among patients who were culture-positive for GI carriage at baseline compared to those who were culture-negative (16% vs 3%; OR = 6.9, 95% CI, 2.3 19.7, P < .001, see Figure 1). As such, the CA/Day 02 screening groups represent individuals admitted directly to the hospital from the community, whereas the HA/D3+ group includes individuals with recent hospital exposure. In sum, 49% of K. pneumoniae infections were caused by the patients own unique strain, and 48% of screened patients with infections were positive for prior colonization. H
Intensive care unit outbreak of extended-spectrum beta-lactamase-producing, Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, http://creativecommons.org/licenses/by/4.0/, cix270_suppl_supplementary_information.pdf. The overall GI carriage rate at follow-up was 15.3% (n = 26/170), similar to the HA GI carriage rate of 19% (OR = 1.3; 95% CI, 0.712.38). To determine whether infections were caused by patients own colonizing bacteria and to identify transmission between ICU patients, we sequenced the genomes of all K. pneumoniae isolated from patients who had spent any time in the ICU during their hospital stay(s). Note the log10 scale which excludes display of 1 strain pair that was separated by 0 SNPs. N
Genome Med. Here, we assessed the prevalence of K. pneumoniae colonization in an at-risk cohort in an intensive care unit (ICU) within a modern, well-equipped, and well-managed tertiary teaching hospital in Australia.
Klebsiella pneumoniae : when a colonizer turns bad - Nature Evidence suggests that some same-strain recurrences in women with frequent urinary tract infections (UTIs) may emanate from a persistent intravesicular reservoir. Edwards
Klebsiella pneumoniae Graphical abstract Download high-res image (217KB) Download : Download full-size image Current Opinion in Microbiology 2018, 45 :131-139 This review comes from a themed issue on Antimicrobials Edited by Gilles van Wezel and Gerard Wright For a complete overview see the Issue and the Editorial Available online 1st May 2018 WC
A maximum likelihood phylogenetic tree was inferred from an alignment of all single-nucleotide polymorphisms (SNPs) identified within core K. pneumoniae genes using FastTree v2.1.8 [13, 14]. Would you like email updates of new search results? Because these species are very closely related to K. pneumoniae sensu stricto (~4% nucleotide divergence), are clinically indistinguishable, and are typically identified as K. pneumoniae in diagnostic laboratories, comparable studies reporting K. pneumoniae carriage encompass the entire K. pneumoniae complex.
A maximum likelihood phylogenetic tree was inferred from an alignment of all single-nucleotide polymorphisms (SNPs) identified within core K. pneumoniae genes using FastTree v2.1.8 [13, 14]. Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections. . Because these species are very closely related to K. pneumoniae sensu stricto (~4% nucleotide divergence), are clinically indistinguishable, and are typically identified as K. pneumoniae in diagnostic laboratories, comparable studies reporting K. pneumoniae carriage encompass the entire K. pneumoniae complex. All statistical analyses were conducted using R (v3.3.1) (details in Supplementary Methods). Using culture-free methods, K. pneumoniae was detected in approximately 10% of Human Microbiome Project samples from the mouth, nares, and skin, and 3.8% of stool samples [7]. There is likely a significant false negative rate. To assess whether K. pneumoniae GI carriage on admission to ICU was a risk factor for subsequent K. pneumoniae infection during hospital stay, we examined the subset of 491 individuals whose baseline screening swab was obtained at least 2 days prior to collection of any clinical specimen from which K. pneumoniae was isolated (Figure 1). Chandrasekhar
S
Additionally, we investigated whether colonization on admission enhances risk of subsequent K. pneumoniae infection among ICU patients and the relative contribution of patients own gut microbiota and intra-hospital transmission to the burden of K. pneumoniae carriage and infection in the ICU. *These indicate 2 patients from whom swabs yielded isolates that were identified in the hospital laboratory as K. pneumoniae, but sequencing of subcultures identified substantial E. coli, indicating likely presence of both species. Hussein K, Raz-Pasteur A, Finkelstein R, et al.
Note that 3 patients had UTI and bacteremia with sepsis; they are represented here in the bacteremia with sepsis column. A 2016 study at the University of Michigan Health System tertiary care hospital reported similar colonization rates (23%) and increased risk of infection following colonization (5.2% in colonized vs 1.3% in noncolonized) [12]. Malays J Med Sci. A total of 143 high-quality whole genome sequences were obtained from 106 patients, including 56 clinical, 80 GI carriage, and 7 throat carriage isolates. Open Access Peer-reviewed Research Article Whole genome sequencing of Klebsiella pneumoniae clinical isolates sequence type 627 isolated from Egyptian patients Shymaa Enany , Samira Zakeer, Aya A. Diab, Usama Bakry, Ahmed A. Sayed Whole genome sequencing of Klebsiella pneumoniae clinical isolates sequence type 627 isolated from Egyptian patients B
Potential conflict of interest. Epub 2023 Apr 18. Strikingly, each of these groups comprised patients with overlapping admissions, making them epidemiologically plausible intra-hospital transmission chains (Figure 4). The antimicrobial resistance profiles and the virulence profiles of these strains vary with the former tagged as notorious [3, 5].Notwithstanding, several clones of these ncKp have also . Klebsiella [klebseeelluh] is a type of gram-negative bacteria that can cause different types of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. A total of 498 patients expected to spend 3 days in ICU were recruited and screened for K. pneumoniae carriage. These included 2 episodes of pneumonia, 2 wound infections, and 2 UTIs, one of which disseminated to cause bacteremia with sepsis (Table 2, Supplementary Table 3). Timelines for all lineages detected in multiple patients that show any inter-patient pairwise genetic distance between isolates of 25 SNPs per 5 Mbp. A recent study of CP K. pneumoniae in Israel suggested screening and isolation of carriers could help end current outbreaks and prevent future ones [3].
In sum, 49% of K. pneumoniae infections were caused by the patients own unique strain, and 48% of screened patients with infections were positive for prior colonization. As such, the CA/Day 02 screening groups represent individuals admitted directly to the hospital from the community, whereas the HA/D3+ group includes individuals with recent hospital exposure. 3
Intensive care unit (ICU) patients are particularly at risk. et al. R
The HA GI carriage rate, among patients who were first swabbed in the ICU on or after the third day of admission to the Alfred hospital or following referral from another hospital (HA/D3+ group, Supplementary Figure 3), was significantly higher at 19% (95% CI, 13.6% 25.7%, odds ratio [OR] = 3.75, P = .00001). Abbreviations: GI, gastrointestinal; ICU, intensive care unit; MDR, multidrug-resistant; UTI, urinary tract infection. Conway
WGS demonstrated that some isolates identified as K. pneumoniae by MALDI-TOF actually belonged to closely related groups that have recently been described as separate species [24], K. quasipneumoniae and K. variicola (Figure 2). WL
L
Information on age, sex, dates of hospital and ICU admission/s, surgery in the last 30 days, and antibiotic treatment in the last 7 days were extracted from hospital records at the time each swab was taken. A
Klebsiella pneumoniae is a leading cause of antimicrobial-resistant (AMR) healthcare-associated infections, neonatal sepsis and community-acquired liver abscess, and is associated with . Dehal
The Klebsiella pneumoniae carbapenemase (KPC) was .
Abbreviations: ICU, intensive care unit; SNP, single-nucleotide polymorphism.
GI carriage of MDR strains was detected at similar rates among HA baseline isolates (18%, including 4 ESBL and 2 CP isolates, all in patients who had received antibiotics in the last 7 days) and follow-up screening isolates (16% of patients, including 4 with ESBL and 1 with CP isolates). 1 A 1971 study found 18.5% of patients admitted to various wards in the Denver Veterans Administration Hospital were culture-positive for rectal carriage of K. pneumoniae, and carriage was significantly associated with risk of subsequent HA infection (45% vs 11%) [11]. *Possible mixed isolate (0.020.1 het/hom SNP ratio, excluded from pairwise SNP analysis in Figure 3). Isolates falling within the same lineage were further investigated to identify pairwise SNPs via assembly and read mapping; full details of genomic analyses are given in Supplementary Methods. Scale bars indicate average number of substitutions per site across the genome. The https:// ensures that you are connecting to the
A major reservoir in the patient population could not be unveiled. official website and that any information you provide is encrypted These studies have demonstrated transmission of ESBL or CP K. pneumoniae between patients and show that gastrointestinal (GI) tract colonization with ESBL or CP K. pneumoniae can be a risk factor for infection [3, 4]. In this review, the prevalence, reservoirs, AMR, Raman spectroscopy detection, and pathogenicity of K. pneumoniaeare summarized and various extraintestinal infection pathways are further narrated to extend our understanding of its adaptation and survival ability in reservoirs, and associated disease risks. A total of 498 patients expected to spend 3 days in ICU were recruited and screened for K. pneumoniae carriage. Wiener-Well
Klebsiella pneumoniae, belonging to the Enterobacteriaceae family, is a natural inhabitant of the gastrointestinal tract microbiome of healthy human and animals. Thank you for submitting a comment on this article.
Clinical features, diagnosis, and treatment of Klebsiella pneumoniae We found strong evidence that a large proportion of ICU K. pneumoniae infections are attributable to patients own GI microbiota: (i) of all 49 K. pneumoniae infections diagnosed in ICU patients during the study period, 49% were associated with K. pneumoniae lineages unique to the patient; and (ii) of the 27 K. pneumoniae infections diagnosed in ICU patients from whom screening swabs were obtained, 48% occurred in patients who tested positive for prior GI colonization with K. pneumoniae. (A), Unrooted tree of all isolates, revealing three distinct species that are typically identified as K. pneumoniae in diagnostic laboratories. et al.
The human gut serves as a reservoir of hypervirulent Klebsiella pneumoniae
Unknown source includes those infections for which there is no genetic or epidemiological evidence to indicate whether the infection has arisen from a patients own carriage strains or through transmission from another source; numbers in brackets indicate the number of such infections associated with a lineage that was unique to that patient. National Library of Medicine For the last 3 months a universal surveillance study for multidrug resistant organisms was conducted for which consent was waived; samples and data from this period were also included in KASPAH (see Supplementary Methods and Supplementary Figure 1).
A total of 700 milk samples from symptomatic mastitic cows were screened for MDR K. Pneumoniae. Accessibility
Adler
Keywords: Foreknowledge of the antimicrobial susceptibility profiles of K. pneumoniae, as well as other opportunistic pathogens resident in the microbiome, could guide the choice of prophylactic and therapeutic antimicrobial treatment [21, 22, 25].
Frontiers | Fecal Klebsiella pneumoniae Carriage Is Intermittent and of
Notably, similar culture-positive rates were observed for swabs collected on day 0, 1, or 2 of admission (Supplementary Table 2), so it is unlikely that this had a significant impact on CA colonization results.
Klebsiella pneumoniae - ScienceDirect Buchan
Each horizontal dashed line indicates the time line for a patient, labelled to the left (crosses indicate date of death where applicable).
Highly conserved composite transposon harbouring aerobactin Accessibility A
Evaluation and Management of Diabetes-related Foot Infections, T-SPOT.TB reactivity in Southern African children with and without in utero HIV exposure, Burden of lower respiratory tract infections preventable by adult immunization with 15- and 20-valent pneumococcal conjugate vaccines in the United States, Dolutegravir-based antiretroviral therapy for HIV-2 infection: Progress for People Living with HIV-2, About the Infectious Diseases Society of America, http://creativecommons.org/licenses/by/4.0/, Receive exclusive offers and updates from Oxford Academic, Gastrointestinal Microbiota Disruption and Risk of Colonization With Carbapenem-resistant, Molecular Epidemiology, Natural History, and Long-Term Outcomes of Multidrug-Resistant Enterobacterales Colonization and Infections Among Solid Organ Transplant Recipients, Handwashing Sink Contamination and Carbapenem-resistant. Wiener-Well Y, Rudensky B, Yinnon AM, et al. AP
In the general community, 5% to 38% of individuals carry the organism in their stool and 1% to 6% in the nasopharynx. Feldman
It is a common opportunistic hospital-associated pathogen, accounting for about one third of all Gram-negative infections overall. Segre
Jones
These data confirm K. pneumoniae colonization is a significant risk factor for infection in ICU, and indicate ~50% of K. pneumoniae infections result from patients own microbiota. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. PMC FOIA Klebsiella pneumoniae isolated from screening swabs and clinical diagnostic samples were characterized using whole genome sequencing and combined with epidemiological data to identify likely transmission events. RA
Homology analysis between clinically isolated extraintestinal and Hagstrm
Rudensky
D
The HA rate estimated here is similar to the culture-positive GI carriage rates estimated in other hospital studies [11, 12].
Klebsiella species are found ubiquitously in nature, including in plants, animals, and humans. Safety profile of subdural and depth electrode implantations in invasive EEG exploration of drug-resistant focal epilepsy. 2017 Feb 21;8(1):e01976-16. Orange boxes indicate groups of isolates for which all patients have at least one pairwise genetic distance of 10 SNPs per 5 Mbp with another in the group; similarly for yellow (25 SNPs) and blue (100 SNPs) boxes. Intensive care unit (ICU) patients are particularly at risk. Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, and. The site is secure. et al. Holt
Hypervirulent Klebsiella pneumoniae (hvKp) can cause serious infections and has been increasingly reported clinically. 2021 Feb 8;52(1):16. doi: 10.1186/s13567-020-00875-w. Front Cell Infect Microbiol.
government site. The emergence of multidrug-resistant (MDR) Klebsiella pneumoniae has resulted in a dramatic increase in research into reservoirs and risk factors for healthcare-associated (HA) K. pneumoniae infections, largely focused on extended spectrum beta-lactamase (ESBL) or carbapenemase-producing (CP) bacteria isolated from infections and intrahospital outbreaks [13]. H
Lundberg
Wyres KL, Nguyen TNT, Lam MMC, Judd LM, van Vinh Chau N, Dance DAB, Ip M, Karkey A, Ling CL, Miliya T, Newton PN, Lan NPH, Sengduangphachanh A, Turner P, Veeraraghavan B, Vinh PV, Vongsouvath M, Thomson NR, Baker S, Holt KE. Glick
All clinical isolates recovered from ICU patients and identified as K. pneumoniae infections by the hospital diagnostic laboratory as part of routine care were included in the study.
et al. Hussein
C
T
R
Starlander
8600 Rockville Pike Type of infection and source of infection outlined (position/presence in transmission chain, prior colonization, unknown). Severin
Phylogenetic lineages to which more than one ICU isolate belongs are highlighted and labeled with their corresponding multi-locus sequence type (ST) and the total number of SNPs identified between isolates in the lineage; darker shading indicates multiple patients contributed isolates in that cluster, as per inset legend. The site is secure. Five likely transmission chains were identified, responsible for 12% of K. pneumoniae infections in ICU. Although those studies focus on screening for CP or ESBL K. pneumoniae, our results indicate that routine screening for general K. pneumoniae carriage in the ICU could also be a valuable tool. Canbck
The string test based on hypermucoviscous phenotype (string 5 mm) was widely used as a marker for hvKp, with 90% predicted accuracy for clinical hvKp strains ( Russo et al., 2018 ). However, we still lack the knowledge to what degree hvKp colonize the. Selden R, Lee S, Wang WL, Bennett JV, Eickhoff TC. What is Klebsiella pneumoniae?. Eligible patients (adults aged 18 years and expected to spend 3 days in ICU) were recruited as soon as possible after admission, and baseline rectal and throat screening swabs were collected. Notably, similar culture-positive rates were observed for swabs collected on day 0, 1, or 2 of admission (Supplementary Table 2), so it is unlikely that this had a significant impact on CA colonization results. Reyes
The average distance between lineages within each species was 0.5% nucleotide divergence, representing thousands of years of evolutionary separation based on molecular clock estimates for K. pneumoniae [17]. **Clinical isolate from sputum (KC0048), may not represent an infection. doi: 10.1128/mBio.01976-16. Niche environments, including plants, animals, and humans appear to be colonized by different phylogroups, among which KpI (K. pneumoniae) is commonly associated with human infection. HHS Vulnerability Disclosure, Help
Farrah
Crdova-Espinoza MG, Giono-Cerezo S, Sierra-Atanacio EG, Escamilla-Gutirrez A, Carrillo-Tapia E, Carrillo-Vzquez LI, Mendoza-Prez F, Leyte-Lugo M, Gonzlez-Vzquez R, Mayorga-Reyes L, Gonzlez-Vzquez R. Pathogens. AB
Klebsiella pneumoniae in Healthcare Settings | HAI | CDC M
.
Duchne
Screening for colonization on admission could limit risk of infection in the colonized patient and others. Gaynes
.
WGS also demonstrated that a small number of isolates identified as K. pneumoniae were contaminated to varying degrees with non-Klebsiella DNA (n = 6) or multiple Klebsiella strains (n = 8) (Supplementary Methods). Each horizontal dashed line indicates the time line for a patient, labelled to the left (crosses indicate date of death where applicable). Key strengths of this study are the prospective cohort design and the use of WGS to confirm species identification and strain relatedness for all K. pneumoniae isolated from ICU patients, regardless of antimicrobial susceptibility. Director, Clinical Research Computing Unit (CRCU) (Standing Faculty Sr.
Using bacteriological culture, a 2010 study detected nasopharyngeal carriage in 15% of Indonesian adults and 7% of children [8], whereas a 2014 study detected nasopharyngeal carriage in 2.7% of Vietnamese adults and throat carriage in 14% [9]. . Potential conflict of interest.
AM
To distinguish these possibilities we compared intra-patient and inter-patient pairwise SNP distances (Figure 3).
Cheesman MJ, Shivashekaregowda NKH, Cock IE. N
Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae None of the 19 CA baseline carriage isolates were MDR (Table 1). National Library of Medicine . Claire L. Gorrie and others, Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients, Clinical Infectious Diseases, Volume 65, Issue 2, 15 July 2017, Pages 208215, https://doi.org/10.1093/cid/cix270.
Acknowledgments. DJ
PS
A
Dates of discharge and/or death were extracted from hospital records at the conclusion of the study. These may reflect coinfection followed by selection for different subpopulations in the laboratory used for the different tests. Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Hypervirulent Klebsiella pneumoniae; healthy people; human gut; reservoir Introduction Klebsiella pneumoniae is a member of the family Enterobacteriaceae that is best known for its capa-city to cause infections, including healthcare- associated infections and community-acquired infections (CAIs). JR
Klebsiella pneumoniae is part of the healthy human microbiome, providing a potential reservoir for infection. Vet Res. Von Gottberg
Inclusion in an NLM database does not imply endorsement of, or agreement with, Vats
animals, may be associated with high K. pneumoniae abundance, and these can constitute a reservoir for further transmission of strains and genetic elements.
Microbiology Unit, Alfred Health, Melbourne, Victoria, Australia; 4
Weber
Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation: What We Need to Know and How to Manage for Prolonged Casualty Care. KbvR mutant of Klebsiella pneumoniae affects the synthesis of type 1 fimbriae and provides protection to mice as a live attenuated vaccine.