Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>

ABSTRACT Klebsiella pneumoniae is among the most common causes of hospital-acquired infections and has emerged as an urgent threat to public health due to carbapenem antimicrobial resistance. K. pneumoniae commonly colonizes hospitalized patients and causes extraintestinal infections such as urinary...

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Autores principales:	Rebekah M. Martin, Jie Cao, Sylvain Brisse, Virginie Passet, Weisheng Wu, Lili Zhao, Preeti N. Malani, Krishna Rao, Michael A. Bachman
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2016
Materias:	Klebsiella MLST cgMLST colonization infection pneumonia Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/2242776340c3444fb0bf6e570b72c583
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spelling	oai:doaj.org-article:2242776340c3444fb0bf6e570b72c5832021-11-15T15:21:29ZMolecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>10.1128/mSphere.00261-162379-5042https://doaj.org/article/2242776340c3444fb0bf6e570b72c5832016-10-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mSphere.00261-16https://doaj.org/toc/2379-5042ABSTRACT Klebsiella pneumoniae is among the most common causes of hospital-acquired infections and has emerged as an urgent threat to public health due to carbapenem antimicrobial resistance. K. pneumoniae commonly colonizes hospitalized patients and causes extraintestinal infections such as urinary tract infection, bloodstream infection (septicemia), and pneumonia. If colonization is an intermediate step before infection, then detection and characterization of colonizing isolates could enable strategies to prevent or empirically treat K. pneumoniae infections in hospitalized patients. However, the strength of the association between colonization and infection is unclear. To test the hypothesis that hospitalized patients become infected with their colonizing strain, 1,765 patients were screened for rectal colonization with K. pneumoniae, and extraintestinal isolates from these same patients were collected over a 3-month period in a cohort study design. The overall colonization prevalence was 23.0%. After adjustment for other patient factors, colonization was significantly associated with subsequent infection: 21 of 406 (5.2%) colonized patients later had extraintestinal infection, compared to 18 of 1,359 (1.3%) noncolonized patients (adjusted odds ratio [OR], 4.01; 95% confidence interval, 2.08 to 7.73; P < 0.001). Despite a high diversity of colonizing isolates, 7/7 respiratory, 4/4 urinary, and 2/5 bloodstream isolates from colonized patients matched the patient corresponding rectal swab isolates, based on wzi capsular typing, multilocus sequence typing (MLST), and whole-genome sequence analysis. These results suggest that K. pneumoniae colonization is directly associated with progression to extraintestinal infection. IMPORTANCE K. pneumoniae commonly infects hospitalized patients, and these infections are increasingly resistant to carbapenems, the antibiotics of last resort for life-threatening bacterial infections. To prevent and treat these infections, we must better understand how K. pneumoniae causes disease and discover new ways to predict and detect infections. This study demonstrates that colonization with K. pneumoniae in the intestinal tract is strongly linked to subsequent infection. This finding helps to identify a potential time frame and possible approach for intervention: the colonizing strain from a patient could be isolated as part of a risk assessment, and antibiotic susceptibility testing could guide empirical therapy if the patient becomes acutely ill.Rebekah M. MartinJie CaoSylvain BrisseVirginie PassetWeisheng WuLili ZhaoPreeti N. MalaniKrishna RaoMichael A. BachmanAmerican Society for MicrobiologyarticleKlebsiellaMLSTcgMLSTcolonizationinfectionpneumoniaMicrobiologyQR1-502ENmSphere, Vol 1, Iss 5 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Klebsiella MLST cgMLST colonization infection pneumonia Microbiology QR1-502
spellingShingle	Klebsiella MLST cgMLST colonization infection pneumonia Microbiology QR1-502 Rebekah M. Martin Jie Cao Sylvain Brisse Virginie Passet Weisheng Wu Lili Zhao Preeti N. Malani Krishna Rao Michael A. Bachman Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
description	ABSTRACT Klebsiella pneumoniae is among the most common causes of hospital-acquired infections and has emerged as an urgent threat to public health due to carbapenem antimicrobial resistance. K. pneumoniae commonly colonizes hospitalized patients and causes extraintestinal infections such as urinary tract infection, bloodstream infection (septicemia), and pneumonia. If colonization is an intermediate step before infection, then detection and characterization of colonizing isolates could enable strategies to prevent or empirically treat K. pneumoniae infections in hospitalized patients. However, the strength of the association between colonization and infection is unclear. To test the hypothesis that hospitalized patients become infected with their colonizing strain, 1,765 patients were screened for rectal colonization with K. pneumoniae, and extraintestinal isolates from these same patients were collected over a 3-month period in a cohort study design. The overall colonization prevalence was 23.0%. After adjustment for other patient factors, colonization was significantly associated with subsequent infection: 21 of 406 (5.2%) colonized patients later had extraintestinal infection, compared to 18 of 1,359 (1.3%) noncolonized patients (adjusted odds ratio [OR], 4.01; 95% confidence interval, 2.08 to 7.73; P < 0.001). Despite a high diversity of colonizing isolates, 7/7 respiratory, 4/4 urinary, and 2/5 bloodstream isolates from colonized patients matched the patient corresponding rectal swab isolates, based on wzi capsular typing, multilocus sequence typing (MLST), and whole-genome sequence analysis. These results suggest that K. pneumoniae colonization is directly associated with progression to extraintestinal infection. IMPORTANCE K. pneumoniae commonly infects hospitalized patients, and these infections are increasingly resistant to carbapenems, the antibiotics of last resort for life-threatening bacterial infections. To prevent and treat these infections, we must better understand how K. pneumoniae causes disease and discover new ways to predict and detect infections. This study demonstrates that colonization with K. pneumoniae in the intestinal tract is strongly linked to subsequent infection. This finding helps to identify a potential time frame and possible approach for intervention: the colonizing strain from a patient could be isolated as part of a risk assessment, and antibiotic susceptibility testing could guide empirical therapy if the patient becomes acutely ill.
format	article
author	Rebekah M. Martin Jie Cao Sylvain Brisse Virginie Passet Weisheng Wu Lili Zhao Preeti N. Malani Krishna Rao Michael A. Bachman
author_facet	Rebekah M. Martin Jie Cao Sylvain Brisse Virginie Passet Weisheng Wu Lili Zhao Preeti N. Malani Krishna Rao Michael A. Bachman
author_sort	Rebekah M. Martin
title	Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_short	Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_full	Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_fullStr	Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_full_unstemmed	Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_sort	molecular epidemiology of colonizing and infecting isolates of <named-content content-type="genus-species">klebsiella pneumoniae</named-content>
publisher	American Society for Microbiology
publishDate	2016
url	https://doaj.org/article/2242776340c3444fb0bf6e570b72c583
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Molecular Epidemiology of Colonizing and Infecting Isolates of <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>

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