scholarly journals Hepatosplenic Abscess From Klebsiella pneumoniae in Poorly Controlled Diabetic

2021 ◽  
Vol 9 ◽  
pp. 232470962110330
Author(s):  
Chidinma Ejikeme ◽  
Onyeka Nwachukwu ◽  
Sarah Ayad ◽  
Payal Rath ◽  
Ifunanya Ejikeme ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
Asian Population ◽  
Pyogenic Liver Abscess ◽  
The United States ◽  
African American Female ◽  
Uncontrolled Diabetes ◽  
Diabetic Population ◽  
Multiple Antibiotics

Invasive Klebsiella pneumoniae infection and pyogenic liver abscess in patients with underlying diabetes mellitus has been well described over the past 3 decades, predominantly in the Southeast Asian population, especially in Taiwan and Korea. K pneumoniae has now become the most common causative pathogen of pyogenic liver abscess in Asian countries. This shift from Escherichia coli to K pneumoniae may also be increasingly occurring in the United States of America and European countries. Compared with the >80% incidence described in Taiwan, the incidence in the United States is still reported to be lower, around 30% to 40%. However, as more evidence and reports come to light, it has become of prime importance to recognize Klebsiella as a significant emerging cause of metastatic infections in patients with uncontrolled diabetes in the United States and not just Southeast Asia, given the significant morbidity and mortality associated with the condition. In this article, we discuss the case of a 53-year-old African American female who presented with diabetic ketoacidosis and was subsequently found to have K pneumoniae pyogenic liver abscess primarily in the left hepatic lobe, bacteremia, and septic metastases to the spleen. She required extensive percutaneous drainage of abscesses and a prolonged course of multiple antibiotics. This case illustrates the growing incidence of invasive K pneumoniae infection in the diabetic population in the United States, and better patient outcomes from prompt recognition and treatment.

scholarly journals 1675. Epidemiology of Urinary Tract Infections in the United States, 2009 - 2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S823-S823
Author(s):  
Kendra Foster ◽  
Linnea A Polgreen ◽  
Brett Faine ◽  
Philip M Polgreen
Keyword(s):  
United States ◽  
Urinary Tract ◽  
Klebsiella Pneumoniae ◽  
Urinary Tract Infections ◽  
Proteus Mirabilis ◽  
Antibiotic Use ◽  
The United States ◽  
Drug Resistant ◽  
E Coli ◽  
Tract Infections

Abstract Background Urinary tract infections (UTIs) are one of the most common bacterial infections. There is a lack of large epidemiologic studies evaluating the etiologies of UTIs in the United States. This study aimed to determine the prevalence of different UTI-causing organisms and their antimicrobial susceptibility profiles among patients being treated in a hospital setting. Methods We used the Premier Healthcare Database. Patients with a primary diagnosis code of cystitis, pyelonephritis, or urinary tract infection and had a urine culture from 2009- 2018 were included in the study. Both inpatients and patients who were only treated in the emergency department (ED) were included. We calculated descriptive statistics for uropathogens and their susceptibilities. Multi-drug-resistant pathogens are defined as pathogens resistant to 3 or more antibiotics. Resistance patterns are also described for specific drug classes, like resistance to fluoroquinolones. We also evaluated antibiotic use in this patient population and how antibiotic use varied during the hospitalization. Results There were 640,285 individuals who met the inclusion criteria. Females make up 82% of the study population and 45% were age 65 or older. The most common uropathogen was Escherichia Coli (64.9%) followed by Klebsiella pneumoniae (8.3%), and Proteus mirabilis (5.7%). 22.2% of patients were infected with a multi-drug-resistant pathogen. We found that E. Coli was multi-drug resistant 23.8% of the time; Klebsiella pneumoniae was multi-drug resistant 7.4%; and Proteus mirabilis was multi-drug resistant 2.8%. The most common antibiotics prescribed were ceftriaxone, levofloxacin, and ciprofloxacin. Among patients that were prescribed ceftriaxone, 31.7% of them switched to a different antibiotic during their hospitalization. Patients that were prescribed levofloxacin and ciprofloxacin switched to a different antibiotic 42.8% and 41.5% of the time, respectively. Conclusion E. Coli showed significant multidrug resistance in this population of UTI patients that were hospitalized or treated within the ED, and antibiotic switching is common. Disclosures All Authors: No reported disclosures

scholarly journals Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hussam Mousa ◽  
Ghada Salameh Mohammed Al-Bluwi ◽  
Zainab Fathi Mohammed Al Drini ◽  
Huda Imam Gasmelseed ◽  
Jamal Aldeen Alkoteesh ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
United Arab Emirates ◽  
Liver Abscess ◽  
Hospital Admissions ◽  
Indian Subcontinent ◽  
Pyogenic Liver Abscess ◽  
Primary Diagnosis ◽  
Incidence Rates ◽  
Liver Abscesses ◽  
Potential Risk Factors

Abstract Background There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. Methods We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. Results Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35–52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2–48.0) and 5.9/100,000 inhabitants (95% CI 4.3–7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1–60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7–8.5) than in PLA (14 days, IQR 9–17). No deaths were recorded within 30 days of hospitalisation. Conclusions ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

scholarly journals Colistin Heteroresistance Is Largely Undetected among Carbapenem-Resistant Enterobacterales in the United States

mBio ◽  
2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Victor I. Band ◽  
Sarah W. Satola ◽  
Richard D. Smith ◽  
David A. Hufnagel ◽  
Chris Bower ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
Diagnostic Testing ◽  
Cladistic Analysis ◽  
The United States ◽  
Clinical Diagnostics ◽  
Infection Model ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Clinical Diagnostic

ABSTRACT Heteroresistance is a form of antibiotic resistance where a bacterial strain is comprised of a minor resistant subpopulation and a majority susceptible subpopulation. We showed previously that colistin heteroresistance can mediate the failure of colistin therapy in an in vivo infection model, even for isolates designated susceptible by clinical diagnostics. We sought to characterize the extent of colistin heteroresistance among the highly drug-resistant carbapenem-resistant Enterobacterales (CRE). We screened 408 isolates for colistin heteroresistance. These isolates were collected between 2012 and 2015 in eight U.S. states as part of active surveillance for CRE. Colistin heteroresistance was detected in 10.1% (41/408) of isolates, and it was more common than conventional homogenous resistance (7.1%, 29/408). Most (93.2%, 38/41) of these heteroresistant isolates were classified as colistin susceptible by standard clinical diagnostic testing. The frequency of colistin heteroresistance was greatest in 2015, the last year of the study. This was especially true among Enterobacter isolates, of which specific species had the highest rates of heteroresistance. Among Klebsiella pneumoniae isolates, which were the majority of isolates tested, there was a closely related cluster of colistin-heteroresistant ST-258 isolates found mostly in Georgia. However, cladistic analysis revealed that, overall, there was significant diversity in the genetic backgrounds of heteroresistant K. pneumoniae isolates. These findings suggest that due to being largely undetected in the clinic, colistin heteroresistance among CRE is underappreciated in the United States. IMPORTANCE Heteroresistance is an underappreciated phenomenon that may be the cause of some unexplained antibiotic treatment failures. Misclassification of heteroresistant isolates as susceptible may lead to inappropriate therapy. Heteroresistance to colistin was more common than conventional resistance and was overwhelmingly misclassified as susceptibility by clinical diagnostic testing. Higher proportions of colistin heteroresistance observed in certain Enterobacter species and clustering among heteroresistant Klebsiella pneumoniae strains may inform colistin treatment recommendations. Overall, the rate of colistin nonsusceptibility was more than double the level detected by clinical diagnostics, suggesting that the prevalence of colistin nonsusceptibility among CRE may be higher than currently appreciated in the United States.

scholarly journals IMP-Producing Carbapenem-Resistant Klebsiella pneumoniae in the United States

2011 ◽  
Vol 49 (12) ◽  
pp. 4239-4245 ◽  
Author(s):  
B. M. Limbago ◽  
J. K. Rasheed ◽  
K. F. Anderson ◽  
W. Zhu ◽  
B. Kitchel ◽  
...  
Keyword(s):  
United States ◽  
Klebsiella Pneumoniae ◽  
The United States ◽  
Carbapenem Resistant

The Melting Pot of the Pacific

2013 ◽  
Author(s):  
Ellen D. Wu
Keyword(s):  
United States ◽  
World War Ii ◽  
Indigenous Population ◽  
Ethnically Diverse ◽  
Asian Population ◽  
The United States ◽  
World War ◽  
Melting Pot ◽  
The Pacific ◽  
Racial Harmony

This chapter deals with the concept of Hawaiʻi as a racial paradise. In the 1920s and 1930s, intellectuals began to tout the islands' ethnically diverse composition—including the indigenous population, white settler colonists, and imported labor from Asia and other locales—as a Pacific melting pot free of the mainland's social taboos on intermingling. After World War II, the association of Hawaiʻi with racial harmony and tolerance received unprecedented national attention as Americans heatedly debated the question of whether or not the territory, annexed to the United States in 1898, should become a state. Statehood enthusiasts tagged the islands' majority Asian population, with its demonstrated capability of assimilation, as a forceful rationale for admission.

scholarly journals 1047. Global Surveillance: Susceptibility of Ceftolozane–Tazobactam Against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa Isolates Collected From Bloodstream Infections in the United States From 2015 to 2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S313-S313
Author(s):  
S J Ryan Arends ◽  
Dee Shortridge ◽  
Mariana Castanheira ◽  
Jennifer M Streit ◽  
Robert K Flamm
Keyword(s):  
United States ◽  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infections ◽  
The United States ◽  
Research Support ◽  
Broth Microdilution Method ◽  
The Us ◽  
Tract Infections

Abstract Background Ceftolozane–tazobactam (C-T) is an antibacterial combination of a novel antipseudomonal cephalosporin and a β-lactamase inhibitor. C-T was approved by the US Food and Drug Administration in 2014 and by the European Medicines Agency in 2015 to treat complicated urinary tract infections, acute pyelonephritis, and complicated intra-abdominal infections. The Program to Assess Ceftolozane-Tazobactam Susceptibility (PACTS) monitors Gram-negative (GN) isolates resistant to C-T worldwide. In the current study, isolates were collected from patients hospitalized with bloodstream infections (BSIs) from 2015 to 2017 within the United States. Methods A total of 3,377 prevalence-based BSI GN isolates, including Escherichia coli (EC; 1,422), Klebsiella pneumoniae (KPN, 630), and Pseudomonas aeruginosa (PSA; 344), were collected during 2015 to 2017 from 32 PACTS hospitals in the United States. Isolates were tested for C-T susceptibility by CLSI broth microdilution method in a central monitoring laboratory (JMI Laboratories). Other antibiotics tested were amikacin (AMK), cefepime (FEP), ceftazidime (CAZ), colistin (COL), levofloxacin (LVX), meropenem (MEM), and piperacillin–tazobactam (TZP). Antibiotic-resistant phenotypes analyzed (CLSI, 2018) for EC and KPN included carbapenem-R (CR) and non-CR extended-spectrum β-lactamase (ESBL); as well as CAZ-nonsusceptible (CAZ-NS), MEM-NS, and COL-NS PSA. Results Of the 3,377 BSI GN isolates, 3,219 (95.3%) had a C-T MIC ≤ 4 mg/L. The three most prevalent GN species isolated from BSIs were EC (42.1%), KPN (18.7%), and PSA (10.2%). The %S of C-T and comparators for the top three pathogens are shown in the table. C-T showed activity against these isolates with %S of ≥96.0% against all three species. Of the comparators tested, AMK and COL also had high %S against these isolates. Conclusion C-T demonstrated activity against the most prevalent contemporary GN isolates from BSIs in the US. C-T was the only beta-lactam that had ≥96%S against all three species: EC, KPN, and PSA. For PSA, C-T maintained activity (>90%S) against isolates resistant to CAZ, TZP, and MEM. These data suggest that C-T may be a useful treatment for GN BSI. Disclosures S. J. R. Arends, Merck: Research Contractor, Research support. D. Shortridge, Merck: Research Contractor, Research support. M. Castanheira, Merck: Research Contractor, Research support. J. M. Streit, Merck: Research Contractor, Research support. R. K. Flamm, Merck: Research Contractor, Research support.

scholarly journals Novel complication of an emerging disease: Invasive Klebsiella pneumoniae liver abscess syndrome as a cause of acute respiratory distress syndrome

2018 ◽  
Author(s):  
Anupam Gupta ◽  
Saad Bhatti ◽  
Anatoly Leytin ◽  
Oleg Epelbaum
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Klebsiella Pneumoniae ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Liver Abscess ◽  
English Language ◽  
Distress Syndrome ◽  
Pyogenic Liver Abscess ◽  
The Subject ◽  
Language Literature

Klebsiella pneumoniae is an increasingly recognized cause of a unique invasive syndrome manifesting as pyogenic liver abscess and hematogenous extrahepatic dissemination to a variety of sites, including the lung. Originally described only in Asia, this entity has now been reported across continents and ethnicities. Intrathoracic complications of invasive Klebsiella pneumoniae liver abscess syndrome (IKPLAS) have been characterized sporadically but have not been the subject of an all-encompassing investigation. Review of the English-language literature yields no reports of the acute respiratory distress syndrome as a consequence of IKPLAS. Herein we report what, to our knowledge, is the first such description.

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