The increased recurrence rate of liver abscess caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae

2019 ◽  
Author(s):  
Zhihui Chang ◽  
Yue Ren ◽  
Hairui Wang ◽  
Zhaoyu Liu
Keyword(s):  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Recurrence Rate ◽  
Liver Abscess ◽  
Biliary Tract Disease ◽  
Gas Production ◽  
Esbl Production ◽  
Extended Spectrum ◽  
Recurrence Group

Abstract Background The pathogenic bacterium Klebsiella pneumoniae (KP) is the major causative agent of pyogenic liver abscess (PLA). But reports about the prognosis of KP-caused PLA (KPLA) are rare. This study aimed to ascertain the recurrence rate of KPLA after initial treatment, and its contributing factors.Methods The medical records data were retrospectively analyzed of KPLA patients who were admitted to Shengjing Hospital of China Medical University from January 2012 to January 2018. According to whether or not there was recurrence of KPLA during follow-up, the patients were divided into a ‘recurrence’ and a ‘non-recurrence’ group. The clinical and CT characteristics of patients were compared between the two groups, and those factors related to KPLA recurrence were further analyzed.Results A total of 110 patients who had first-time episodes of KPLA were included into the study. The average follow-up time was 3.65±2.18 years. Twenty (18.18%) KPLA patients experienced recurrence. Those in the recurrence group had a significantly greater incidence of extended-spectrum β-lactamase (ESBL) production compared to the non-recurrence group (30.0% vs 8.89%, P=0.018). Diabetes, biliary tract disease, and history of malignancy was not associated with recurrence (all P>0.05). No difference in the CT characteristics of KPLA (including abscess size, location, whether multilocular, gas production of KPLA, and thrombophlebitis) was found between the two groups. Multivariate regression analysis showed that ESBL production (OR, 6.3; 95% CI, 1.02–38.59; P=0.04) was an independent risk factor for the recurrence of KPLA.Conclusions KPLA has a high recurrence rate, and ESBL production is a risk factor for recurrent KPLA.

scholarly journals Risk factors for and mortality of extended-spectrum-β-lactamase-producing Klebsiella pneumoniae and Escherichia coli nosocomial bloodstream infections

2009 ◽  
Vol 51 (4) ◽  
pp. 211-216 ◽  
Author(s):  
Silvana Vargas Superti ◽  
Gustavo Augusti ◽  
Alexandre Prehn Zavascki
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Esbl Production ◽  
E Coli ◽  
Extended Spectrum ◽  
Esbl Producers

A case-control study, involving patients with positive blood cultures for Klebsiella pneumoniae (KP) or Escherichia coli (EC) EC and controls with positive blood cultures for non-ESBL-KP or EC, was performed to assess risk factors for extended-spectrum-β-lactamase (ESBL) production from nosocomial bloodstream infections (BSIs). Mortality among patients with BSIs was also assessed. The study included 145 patients (81, 59.5% with K. pneumoniae and 64, 44.1% with E. coli BSI); 51 (35.2%) isolates were ESBL producers and 94 (64.8%) nonproducers. Forty-five (55.6%) K. pneumoniae isolates were ESBL producers, while only six (9.4%) E. coli isolates produced the enzyme. Multivariate analysis showed that recent exposure to piperacillin-tazobactam (adjusted Odds Ratio [aOR] 6.2; 95%CI 1.1-34.7) was a risk factor for ESBL BSI. K. pneumoniae was significantly more likely to be an ESBL-producing isolate than E. coli (aOR 6.7; 95%CI 2.3-20.2). No cephalosporin class was independently associated with ESBLs BSI; however, in a secondary model considering all oxymino-cephalosporins as a single variable, a significant association was demonstrated (aOR 3.7; 95%CI 1.3-10.8). Overall 60-day mortality was significantly higher among ESBL-producing organisms. The finding that piperacillin-tazobactam use is a risk factor for ESBL-production in KP or EC BSIs requires attention, since this drug can be recommended to limit the use of third-generation cephalosporins.

The First Unprovoked Seizure in Typically Developing Children: A Real-Life Setting in Southern Brazil

2020 ◽  
pp. 155005942096539
Author(s):  
Mayara de Rezende Machado ◽  
Isac Bruck ◽  
Luciano de Paola ◽  
Mônica Nunes Lima Cat ◽  
Sérgio Antonio Antoniuk ◽  
...  
Keyword(s):  
Risk Factor ◽  
Recurrence Rate ◽  
Real Life ◽  
Typically Developing ◽  
Southern Brazil ◽  
Seizure Recurrence ◽  
Typically Developing Children ◽  
Unprovoked Seizure ◽  
Real Life Setting

Aim To describe the first unprovoked seizure in typically developing children, its clinical characteristics, recurrence rate, and possible risk factors in a real-life setting in Southern Brazil. Method In this retrospective cohort study, medical records of typically developing children aged 28 days to 14 years who had a first unprovoked seizure in a single tertiary care center were reviewed, in a 10-year period (2006-2016). Results Seventy-four children were included, 41 males and 33 females. The most frequent age group of the first seizure was 5 to 10 years and seizure main type was focal (50%). Most seizures occurred while children were awake (70%). All patients underwent an electroencephalogram (EEG), which was normal in 44.6%. Neuroimaging was performed in 81%, in 2 cases the etiology was considered structural, the remaining was classified as unknown. Median follow-up period was 32.5 months. Seizure recurrence rate was 56.7% and age younger than 5 years was a possible risk factor. Interpretation In the subpopulation of Brazilian typically developing children with a first unprovoked epileptic seizure there is a high recurrence rate. An abnormal EEG was a common finding, although it was not associated with a higher risk of seizure recurrence. A possible risk factor was age younger than 5 years, which may suggest a more rigorous follow-up of these patients.

scholarly journals Community-Acquired Liver Abscess Caused by Serotype K1 Klebsiella pneumoniae with CTX-M-15-Type Extended-Spectrum β-Lactamase

2007 ◽  
Vol 52 (2) ◽  
pp. 804-805 ◽  
Author(s):  
Sheng-Chiang Su ◽  
L. K. Siu ◽  
Kuo-Ming Yeh ◽  
Chang-Phone Fung ◽  
Jung-Chung Lin ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
Extended Spectrum

Risk factor analysis of invasive liver abscess caused by the K1 serotype Klebsiella pneumoniae

2008 ◽  
Vol 28 (1) ◽  
pp. 109-111 ◽  
Author(s):  
J.-K. Kim ◽  
D. R. Chung ◽  
S. H. Wie ◽  
J. H. Yoo ◽  
S. W. Park ◽  
...  
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
Risk Factor Analysis

scholarly journals Klebsiella pneumoniae pneumonia in patients with rheumatic autoimmune diseases: clinical characteristics, antimicrobial resistance and factors associated with extended-spectrum β-lactamase production

2020 ◽  
Author(s):  
Yang Liu ◽  
Yecheng Liu ◽  
Jiayuan Dai ◽  
Anlei Liu ◽  
Yi Li ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Klebsiella Pneumoniae ◽  
Autoimmune Diseases ◽  
Multivariate Logistic Regression Analysis ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Esbl Production ◽  
Factors Associated ◽  
Susceptibility Data ◽  
Extended Spectrum

Abstract Background: Over the past decades, Klebsiella pneumoniae (K. pneumoniae) infections have been increasing and affected immunocompromised patients nosocomially and communally, with extended-spectrum β-lactamase (ESBL) production becoming a major concern. Patients with rheumatic autoimmune diseases, mostly receiving immunosuppressive therapy, are vulnerable to various infections, including K. pneumoniae. However, few have investigated K. pneumoniae infections in this specific population. This study aimed to identify factors associated with ESBL production and mortality of K. pneumoniae pneumonia among patients with rheumatic autoimmune diseases in the Emergency Department. Methods: We retrospectively investigated patients with rheumatic diseases who were diagnosed with pneumonia, with K. pneumoniae isolated from their respiratory tract samples. Prognostic factors and risk factors for ESBL production were determined with univariate and multivariate logistic regression analysis. Empirical therapy and antimicrobial susceptibility data were also collected. Results: Of 477 K. pneumoniae pneumonia patients, 60 were enrolled into this study. The in-hospital mortality was 28.3%. Septic shock, ICU admission, the need for mechanical ventilation and change of antibiotics due to clinical deterioration, all related to mortality, were included as unfavorable clinical outcomes. Multivariate analysis suggested that ESBL production (OR, 6.793; p = 0.012), initial PCT≥0.5 ng/ml (OR, 5.024; p = 0.033) and respiratory failure at admission (OR, 4.401; p = 0.046) predicted increased mortality. ESBL production was significantly associated with dose of corticosteroids (OR, 1.031; p = 0.013) and CMV viremia (OR, 4.697; p = 0.043), instead of previous hospitalization and antibiotic use, in patients with rheumatic autoimmune diseases. The most commonly used empirical antibiotic was ceftazidime, while most isolates showed less resistance to carbapenems and amikacin in susceptibility testing. Conclusions: K. pneumoniae pneumonia could be life-threatening in patients with rheumatic autoimmune diseases. Our findings suggested that ESBL production, initial PCT≥0.5 ng/ml and respiratory failure at admission were independent factors associated with poor prognosis. Dose of corticosteroids and CMV viremia, predicting ESBL production in K. pneumoniae pneumonia, may help make individualized antibiotic decisions in clinical practice.

scholarly journals A Rare Case of Recurrent Klebsiella pneumoniae Liver Abscess

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Magdelene Amoateng ◽  
Pius Osei-Bagyina ◽  
Reba Varughese ◽  
Achsah Mathew ◽  
Ishan Malhotra
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
High Mortality ◽  
Rare Case ◽  
Pyogenic Liver Abscess ◽  
Important Risk Factor ◽  
Aggressive Treatment

Klebsiella pneumoniae liver abscess (KPLA) is an emerging syndrome with the initial cases described in Taiwan in the 1980s. There is high mortality with this condition, and immediate aggressive treatment is necessary. Diabetes mellitus (D.M.) is the single most important risk factor for developing KPLA. Here, we describe a rare case of recurrent cryptogenic Klebsiella pneumoniae pyogenic liver abscess (KPLA) in a young man with poorly controlled type 1 D.M.

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