scholarly journals Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Chih-Han Juan ◽  
Shih-Yu Fang ◽  
Chia-Hsin Chou ◽  
Tsung-Ying Tsai ◽  
Yi-Tsung Lin
Keyword(s):  
Retrospective Study ◽  
Klebsiella Pneumoniae ◽  
Clinical Characteristics ◽  
Community Acquired Pneumonia ◽  
Drug Resistant ◽  
Hospital Acquired Pneumonia ◽  
Resistant Strains ◽  
Healthcare Associated ◽  
Drug Resistant Strains ◽  
Hospital Acquired

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

Pulmonary Infections

Chest Imaging ◽  
2019 ◽  
pp. 187-189
Author(s):  
Santiago Martínez-Jiménez
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Clinical Response ◽  
Chest Radiography ◽  
Community Acquired Pneumonia ◽  
Clinical Perspective ◽  
Immunosuppressed Patients ◽  
Hospital Acquired Pneumonia ◽  
Healthcare Associated ◽  
Hospital Acquired

Pneumonia can be classified as: community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), healthcare-associated pneumonia (HCAP), and pneumonia in immunosuppressed patients. Although the above are similar pathologically, they are very different from a clinical perspective. Chest radiography is often performed to support the diagnosis and to determine the extent of involvement prior to the onset of therapy. Radiography should not be performed in the short term in patients who are improving clinically as it can lead to the misdiagnosis of treatment failure. Chest radiography in patients treated for pneumonia should only be obtained before 4-6 weeks after the onset of therapy if there is a failure of clinical response or if complications of pneumonia are clinically suspected. The majority of pneumonias will resolve after 6 weeks of appropriate antibiotic therapy.

scholarly journals Klebsiella pneumoniae yfiRNB operon affects biofilm formation, polysaccharide production and drug susceptibility

Microbiology ◽  
2014 ◽  
Vol 160 (12) ◽  
pp. 2595-2606 ◽  
Author(s):  
Mónica G. Huertas ◽  
Lina Zárate ◽  
Iván C. Acosta ◽  
Leonardo Posada ◽  
Diana P. Cruz ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Biofilm Formation ◽  
Surface Characteristics ◽  
Opportunistic Pathogen ◽  
Drug Susceptibility ◽  
Cellulose Production ◽  
Resistant Strains ◽  
Drug Resistant Strains ◽  
Type 3 ◽  
Hospital Acquired

Klebsiella pneumoniae is an opportunistic pathogen important in hospital-acquired infections, which are complicated by the rise of drug-resistant strains and the capacity of cells to adhere to surfaces and form biofilms. In this work, we carried out an analysis of the genes in the K. pneumoniae yfiRNB operon, previously implicated in biofilm formation. The results indicated that in addition to the previously reported effect on type 3 fimbriae expression, this operon also affected biofilm formation due to changes in cellulose as part of the extracellular matrix. Deletion of yfiR resulted in enhanced biofilm formation and an altered colony phenotype indicative of cellulose overproduction when grown on solid indicator media. Extraction of polysaccharides and treatment with cellulase were consistent with the presence of cellulose in biofilms. The enhanced cellulose production did not, however, correlate with virulence as assessed using a Caenorhabditis elegans assay. In addition, cells bearing mutations in genes of the yfiRNB operon varied with respect to the WT control in terms of susceptibility to the antibiotics amikacin, ciprofloxacin, imipenem and meropenem. These results indicated that the yfiRNB operon is implicated in the production of exopolysaccharides that alter cell surface characteristics and the capacity to form biofilms – a phenotype that does not necessarily correlate with properties related with survival, such as resistance to antibiotics.

Klebsiella pneumoniae: Emergence of multi-drug-resistant strains in Northwest Italy

2012 ◽  
Vol 64 (5) ◽  
pp. 535-537 ◽  
Author(s):  
Ilaria Leone ◽  
Eleonora Mungo ◽  
Giuseppina Bisignano ◽  
Maria Gabriella Chirillo ◽  
Dianella Savoia
Keyword(s):  
Klebsiella Pneumoniae ◽  
Drug Resistant ◽  
Resistant Strains ◽  
Drug Resistant Strains

scholarly journals Potentiation of antimicrobial activity of colistin with antibiotics of different groups against multidrug- and extensively drug-resistant strains of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa

2020 ◽  
Vol 22 (2) ◽  
pp. 128-136
Author(s):  
Dmitry V. Tapalskiy ◽  
T.A. Petrovskaya ◽  
A.I. Kozlova ◽  
Mikhail V. Edelstein
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Antimicrobial Activity ◽  
Klebsiella Pneumoniae ◽  
Acinetobacter Baumannii ◽  
Bactericidal Activity ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Potentiation Effect ◽  
Resistant Strains ◽  
Drug Resistant Strains

Objective. To reveal antibiotics being capable of potentiating the antimicrobial activity of colistin against multidrug- and extensively drug-resistant strains of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa. Materials and Methods. The minimum inhibitory concentrations (MIC) of colistin alone and in combination with fixed concentrations of antibiotics of different groups were determined for 272 multidrug- and extensively drug-resistant strains of K. pneumoniae, A. baumannii and P. aeruginosa. Bactericidal activity of colistin, carbapenems, clarithromycin and their combinations were also determined at fixed PK/PD breakpoint concentrations of antibiotics. Results. Potentiation of colistin antibacterial activity in the presence of fixed concentration of rifampicin (0.5 mg/L) was observed as a 4–16-fold MIC decrease for K. pneumoniae and A. baumannii. In the presence of fixed concentrations of azithromycin (2 mg/L) or clarithromycin (1 mg/L), the colistin MICs decreased 64–512 times for K. pneumoniae, 4–32 times for A. baumannii, 16–64 times for P. aeruginosa. Two- or more-fold reduction of MIC of colistin in the presence of 1 mg/L clarithromycin was observed for 85.2% of K. pneumoniae, 86.3% of A. baumannii and 60.2% of P. aeruginosa strains. In the presence of 1 mg/L clarithromycin and 8 mg/L meropenem, the potentiation effect was enhanced and was observed for an even larger percent of isolates: 96.1% K. pneumoniae, 98.0% A. baumannii and 61.3% P. aeruginosa. Colistin-based combinations with clarithromycin-meropenem and clarithromycin-doripenem were bactericidal against most isolates of A. baumannii and P. aeruginosa (91.4–100%), and against colistin-sensitive K. pneumoniae (95.3%) and colistin-resistant K. pneumoniae (79.1%). Conclusions. The ability of macrolides to significantly potentiate the colistin antimicrobial activity against both colistin-sensitive and colistin-resistant strains of K. pneumoniae, A. baumannii and P. aeruginosa was shown. This potentiation effect was enhanced in the presence of carbapenems. The most potent bactericidal activity was revealed with dual and triple combinations of colistin-clarithromycin and colistinclarithromycin-carbapenems.

scholarly journals Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

2016 ◽  
Vol 10 (4) ◽  
pp. 339
Author(s):  
Eleonora Pistella ◽  
Claudio Santini
Keyword(s):  
Klebsiella Pneumoniae ◽  
Drug Resistant ◽  
Antibiotic Overuse ◽  
Carbapenem Resistant ◽  
Health Care Associated Infections ◽  
Antibiotic Selection Pressure ◽  
Resistant Strains ◽  
In The Beginning ◽  
Drug Resistant Strains ◽  
Consequent Increase

In the nosocomial setting, antimicrobial-resistant Enterobacteriaceae are a growing challenge, and alarming trends in resistance are currently reported all over the world. Isolates of Enterobacteriaceae producing ampC β-lactamases and extended spectrum β-lactamases are endemic in many hospitals, and are frequently resistant also to other classes of antibiotics, such as fluoroquinolones and aminoglycosides. The risk of infections due to multi-drug resistant strains should be considered also for outpatients who have had recent contact with the health system. Both nosocomial and health-care associated infections should be treated with a combination of antibiotics active against multi-drug resistant Gram negative and methicillin-resistant Staphylococcus aureus. In the absence of effective antimicrobial stewardship programs, this aggressive therapeutic approach might lead to abuse of broad-spectrum antibiotics, with consequent increase in resistances. To contain the possible antibiotic overuse, several decisional strategies, often based on risk-score systems supporting the clinical decisions, have been proposed. In this context of high antibiotic selection pressure, carbapenem-resistant pathogens recently began to spread in many hospitals. Carbapenem-resistant Klebsiella pneumoniae, as well as carbapenem-resistant Acinetobacter baumannii and P. aeruginosa, represent the new major challenges to patient safety. Against these organisms the initial empiric treatment is generally ineffective. The poor clinical outcome associated with carbapenem- resistant K. pneumoniae infections is probably due to the delete in the beginning of an appropriate antibiotic treatment, rather than to the increased virulence of pathogens. Only few therapeutic options are available, including colistin, tigecycline, aminoglycosides and carbapenems in selected cases. Several combinations of these antibiotics have been used, but no ideal regimen has been currently established.

Reduced susceptibility to chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae

2012 ◽  
Vol 81 (1) ◽  
pp. 15-19 ◽  
Author(s):  
L. Naparstek ◽  
Y. Carmeli ◽  
I. Chmelnitsky ◽  
E. Banin ◽  
S. Navon-Venezia
Keyword(s):  
Klebsiella Pneumoniae ◽  
Drug Resistant ◽  
Resistant Strains ◽  
Drug Resistant Strains

scholarly journals Resistance to Anti-infectious Chemotherapies: Risk Factors for Extensively Drug-resistant Strains in Hospitalized Patients

2019 ◽  
Vol 70 (2) ◽  
pp. 721-723
Author(s):  
Delia Ioana Horhat ◽  
Delia Muntean ◽  
Smaranda Arghirescu ◽  
Simona Cerbu ◽  
Daniela Iacob ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Antibiotic Therapy ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Drug Resistant ◽  
Electronic Database ◽  
Extensively Drug Resistant ◽  
Resistant Strains ◽  
Drug Resistant Strains

This retrospective study was conducted between January 2016 and March 2016 in the Pius Br�nzeu County Emergency Clinical Hospital of Timi�oara. Data were collected from the electronic database of the laboratory and the hospital�s electronic medical records. The purpose of this study was to identify risk factors for extensively drug-resistant (XDR) bacteria. The results obtained suggest that the catheterization, endotracheal intubation and previous antibiotic therapy or the prolonged hospitalization may be risk factors for the acquisition of XDR strains.

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