First two cases of severe multifocal infections caused by Klebsiella pneumoniae in Switzerland: characterization of an atypical non-K1/K2-serotype strain causing liver abscess and endocarditis.

Babouee Flury, Baharak; Donà, Valentina; Buetti, Niccolò Ivo Marco-Aurelio; Furrer, Hansjakob; Endimiani, Andrea (2017). First two cases of severe multifocal infections caused by Klebsiella pneumoniae in Switzerland: characterization of an atypical non-K1/K2-serotype strain causing liver abscess and endocarditis. Journal of global antimicrobial resistance, 10, pp. 165-170. Elsevier 10.1016/j.jgar.2017.04.006

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BACKGROUND We describe the first two multifocal invasive infections due to Klebsiella pneumoniae recently observed in Switzerland. METHODS Phenotypic (MIC assays and string test) and molecular analyses (PCR/Sequencing for bla, virulence factor genes and whole genome sequencing for one strain) were performed to characterize the causative K. pneumoniae isolates. RESULTS Both K. pneumoniae isolates (Kp1 and Kp2) were pan-susceptible to antibiotics and produced narrow-spectrum SHV β-lactamases. However, only Kp1 was string test positive. Kp1 was of ST380 and caused liver abscess as well as pneumonia and orbital phlegmon in an Eritrean patient. It belonged to the hypervirulent capsular serotype K2 and harboured the classic virulence-associated rmpA and aerobactin genes, fulfilling both the clinical and microbiological definitions for an invasive K. pneumoniae syndrome. Kp2 was of ST1043 and caused both liver abscess and endocarditis in a Swiss patient. Moreover, it did not possess the classic virulence-associated genes. Whole genome sequencing identified less well-known virulence factors in Kp2 that might have contributed to its virulence. Among these there were genes important for intestinal colonization and/or invasion, such as genes involved in adhesion (e.g., fimABCD and mrkABCD), regulation of capsule polysaccharide biosynthesis (e.g., evgS-evgA), as well as iron uptake (iroN), energy conversion, and metabolism. DISCUSSION This report confirms the continuous dissemination of hypervirulent K. pneumoniae strains among patients of non-Asian descent in Europe. Moreover, it highlights the genetic background of an atypical hypervirulent K. pneumoniae causing a severe invasive infection despite not possessing the classical virulence characteristics of hypermucoviscous strains.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Babouee Flury, Baharak; Donà, Valentina; Buetti, Niccolò Ivo Marco-Aurelio; Furrer, Hansjakob and Endimiani, Andrea

Subjects:

500 Science > 570 Life sciences; biology
600 Technology > 610 Medicine & health

ISSN:

2213-7165

Publisher:

Elsevier

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

30 Oct 2017 16:36

Last Modified:

30 Oct 2017 16:36

Publisher DOI:

10.1016/j.jgar.2017.04.006

PubMed ID:

28729207

Uncontrolled Keywords:

Capsule Hypervirulent K1 K2 Klebsiella pneumoniae WGS

BORIS DOI:

10.7892/boris.102454

URI:

https://boris.unibe.ch/id/eprint/102454

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