Klebsiella variicola Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to K. pneumoniae

Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae...

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Vydáno v:	PloS one Ročník 9; číslo 11; s. e113539
Hlavní autoři:	Maatallah, Makaoui, Vading, Malin, Kabir, Muhammad Humaun, Bakhrouf, Amina, Kalin, Mats, Nauclér, Pontus, Brisse, Sylvain, Giske, Christian G.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Public Library of Science 26.11.2014 Public Library of Science (PLoS)
Témata:	Adult Aged Analysis Anti-Bacterial Agents - therapeutic use Bacterial Capsules - genetics Catheters Clinical isolates Cloning Drug resistance Drug Resistance, Bacterial Female Genes Genomics Health aspects Humans Infections Infectious diseases Klebsiella Klebsiella - drug effects Klebsiella - genetics Klebsiella - isolation & purification Klebsiella Infections - blood Klebsiella Infections - drug therapy Klebsiella Infections - epidemiology Klebsiella Infections - mortality Klebsiella pneumoniae Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - genetics Klebsiella pneumoniae - isolation & purification Laboratories Liver Male Medical records Medicine and Health Sciences Middle Aged Mortality Multilocus Sequence Typing Multiplexing Multivariate analysis Nosocomial infections Patients Phylogenetics Phylogeny Pneumonia Risk analysis Risk factors Serotypes Statistical analysis Sweden - epidemiology Virulence Virulence (Microbiology) Virulence factors Virulence Factors - genetics Sweden France Tunisia Scandinavia
ISSN:	1932-6203, 1932-6203
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Abstract	Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.
AbstractList	Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10–8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype. Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to K. variicola. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.
Audience	Academic
Author	Vading, Malin Brisse, Sylvain Giske, Christian G. Kabir, Muhammad Humaun Kalin, Mats Maatallah, Makaoui Bakhrouf, Amina Nauclér, Pontus
AuthorAffiliation	University of Mississippi Medical Center, United States of America 1 Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia 5 CNRS, Paris, France 4 Institut Pasteur, Microbial Evolutionary Genomics, Paris, France 2 Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden 3 Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
AuthorAffiliation_xml	– name: 2 Clinical Microbiology, MTC – Karolinska Institutet, Karolinska University, Hospital Solna, Stockholm, Sweden – name: 1 Laboratoire d’Analyse, Traitement et Valorisation des Polluants de l’Environnement et des Produits, Faculté de Pharmacie, University of Monastir, Montasir, Tunisia – name: University of Mississippi Medical Center, United States of America – name: 3 Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden – name: 5 CNRS, Paris, France – name: 4 Institut Pasteur, Microbial Evolutionary Genomics, Paris, France
Author_xml	– sequence: 1 givenname: Makaoui surname: Maatallah fullname: Maatallah, Makaoui – sequence: 2 givenname: Malin surname: Vading fullname: Vading, Malin – sequence: 3 givenname: Muhammad Humaun surname: Kabir fullname: Kabir, Muhammad Humaun – sequence: 4 givenname: Amina surname: Bakhrouf fullname: Bakhrouf, Amina – sequence: 5 givenname: Mats surname: Kalin fullname: Kalin, Mats – sequence: 6 givenname: Pontus surname: Nauclér fullname: Nauclér, Pontus – sequence: 7 givenname: Sylvain surname: Brisse fullname: Brisse, Sylvain – sequence: 8 givenname: Christian G. surname: Giske fullname: Giske, Christian G.
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/25426853$$D View this record in MEDLINE/PubMed http://kipublications.ki.se/Default.aspx?queryparsed=id:130694087$$DView record from Swedish Publication Index (Karolinska Institutet)
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ContentType	Journal Article
Copyright	COPYRIGHT 2014 Public Library of Science 2014 Maatallah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2014 Maatallah et al 2014 Maatallah et al
Copyright_xml	– notice: COPYRIGHT 2014 Public Library of Science – notice: 2014 Maatallah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. – notice: 2014 Maatallah et al 2014 Maatallah et al
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Competing Interests: CGG has received speaker’s honorariums from Cubist, AstraZeneca, Pfizer, and Cepheid. He has also received conference support from Cubist, Cepheid and ABBiodisk. Other authors have no interests to declare. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials. Conceived and designed the experiments: MM MV CGG SB MK PN. Performed the experiments: MM MHK MV. Analyzed the data: MM MV CGG SB MK PN. Contributed reagents/materials/analysis tools: CGG. Wrote the paper: MM MV CGG SB MK PN AB.
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SubjectTerms	Adult Aged Analysis Anti-Bacterial Agents - therapeutic use Bacterial Capsules - genetics Catheters Clinical isolates Cloning Drug resistance Drug Resistance, Bacterial Female Genes Genomics Health aspects Humans Infections Infectious diseases Klebsiella Klebsiella - drug effects Klebsiella - genetics Klebsiella - isolation & purification Klebsiella Infections - blood Klebsiella Infections - drug therapy Klebsiella Infections - epidemiology Klebsiella Infections - mortality Klebsiella pneumoniae Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - genetics Klebsiella pneumoniae - isolation & purification Laboratories Liver Male Medical records Medicine and Health Sciences Middle Aged Mortality Multilocus Sequence Typing Multiplexing Multivariate analysis Nosocomial infections Patients Phylogenetics Phylogeny Pneumonia Risk analysis Risk factors Serotypes Statistical analysis Sweden - epidemiology Virulence Virulence (Microbiology) Virulence factors Virulence Factors - genetics
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Title	Klebsiella variicola Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to K. pneumoniae
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