Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients

Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections. Intensive care unit (ICU) patients are particularly at risk. Klebsiella pneumoniae is part of the healthy human microbiome, providing a potential reservoir for infection. However, the frequency of...

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Bibliographic Details
Published in:Clinical infectious diseases Vol. 65; no. 2; p. 208
Main Authors: Gorrie, Claire L, Mirceta, Mirjana, Wick, Ryan R, Edwards, David J, Thomson, Nicholas R, Strugnell, Richard A, Pratt, Nigel F, Garlick, Jill S, Watson, Kerri M, Pilcher, David V, McGloughlin, Steve A, Spelman, Denis W, Jenney, Adam W J, Holt, Kathryn E
Format: Journal Article
Language:English
Published: United States 15.07.2017
Subjects:
Adult
Aged
Anti-Bacterial Agents - pharmacology
Carrier State - drug therapy
Carrier State - epidemiology
Carrier State - microbiology
Cohort Studies
Cross Infection - epidemiology
Cross Infection - microbiology
Female
Gastrointestinal Microbiome
Gastrointestinal Tract - microbiology
Genetic Variation
Humans
Intensive Care Units
Klebsiella Infections - drug therapy
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella Infections - transmission
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - genetics
Klebsiella pneumoniae - isolation & purification
Male
Microbial Sensitivity Tests
Middle Aged
Pharynx - microbiology
Prospective Studies
Rectum - microbiology
Risk Factors
gastrointestinal colonization
genomic epidemiology
intensive care
hospital acquired infection
Klebsiella pneumoniae
ISSN:1537-6591, 1537-6591
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Summary:Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections. Intensive care unit (ICU) patients are particularly at risk. Klebsiella pneumoniae is part of the healthy human microbiome, providing a potential reservoir for infection. However, the frequency of gut colonization and its contribution to infections are not well characterized. We conducted a 1-year prospective cohort study in which 498 ICU patients were screened for rectal and throat carriage of K. pneumoniae shortly after admission. 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. Klebsiella pneumoniae carriage frequencies were estimated at 6% (95% confidence interval [CI], 3%-8%) among ICU patients admitted direct from the community, and 19% (95% CI, 14%-51%) among those with recent healthcare contact. Gut colonization on admission was significantly associated with subsequent infection (infection risk 16% vs 3%, odds ratio [OR] = 6.9, P < .001), and genome data indicated matching carriage and infection isolates in 80% of isolate pairs. Five likely transmission chains were identified, responsible for 12% of K. pneumoniae infections in ICU. 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. 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. Screening for colonization on admission could limit risk of infection in the colonized patient and others.
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ISSN:1537-6591
1537-6591
DOI:10.1093/cid/cix270