Risk Factors for Klebsiella Infections among Hospitalized Patients with Preexisting Colonization

Klebsiella is a leading cause of health care-associated infections. Patients who are intestinally colonized with Klebsiella are at a significantly increased risk of subsequent infection, but only a subset of colonized patients progress to disease.

Intracellular klebsiella infections (donovanosis and rhinoscleroma)

Two rare intracellular species of Klebsiella, a Gram-negative bacillus, cause granulomatous disease in humans that is found in small endemic foci in warm climates, linked to poverty and poor hygiene. Donovanosis is caused by Klebsiella granulomatis (previously named Calymmatobacterium granulomatis) and is presumed to be sexually transmitted. Presenting with genital ulcers or growths, often accompanied by an inguinal ‘pseudobubo’ (granuloma inguinale), it is diagnosed by demonstrating Donovan bodies (vacuoles containing capsulated coccoid bacteria) lying within histiocytes in material taken from a typical lesion. Treatment is with azithromycin; surgery may be needed for complications. Rhinoscleroma, caused by Klebsiella rhinoscleromatis, is believed to transfer from person to person; following a period of rhinitis it most typically manifests with bulky growths in the upper respiratory tract. It is diagnosed by demonstrating intracellular organisms in typical lesions, combined with culture. Treatment is with ciprofloxacin; surgical debulking of lesions and/or reconstruction may be required.

2272. Evaluation of Clinical Features, Carbapenem Resistance and Risk Factors of Klebsiella Species: A 4-Year Retrospective Study in Turkey

Background Gram-negative-resistant bacterial infections are increasing due to widespread use of antibiotics. Infections caused by Klebsiella spp. are an important part of healthcare-associated infections and cause morbidity and mortality. The aim of this study was to determine the epidemiological, clinical features, carbapenem resistance rates and risk factors of bloodstream infections of children with Klebsiella spp. Methods In this retropective study, medical records of 85 episodes of 75 patients caused by with Klebsiella spp. bacteriaemia who admitted to Ege University Faculty of Medicine, Pediatric Hospital in Turkey between 2014 and 2017 were evaluated. Conventional biochemical methods were performed using the automated systems of MALDİ-TOFF MS / VITEK 2 (Biomerieux, France). According to EUCAST recommendations, VITEK 2 (Biomerieux, France) automated microdilution method was used in sensitivity tests. Results The mean age of 85 episodes included in the study was 3.49 (±5.4) years. 58% of the patients were male and 42% were female. 18.8% of the patients were premature. The most common service was newborn service (30.6%). Neutropenia was 26% and thrombocytopenia was 55% at the time of diagnosis. Klebsiella pneumonia was 93% and Klebsiella oxytoca was 7%. Carbapenem resistance rate was found to be 30.6% in Klebsiella spp. Carbapenem resistance was found 18% in 2014, 38% in 2015, 42% in 2016 and 25% in 2017. In patients who developed carbapenem-resistant Klebsiella infection, the duration of pre-hospitalization ≥14 days (P = 0.034), the absolute neutrophil count < 100 (P = 0.048) and steroid use (P = 0.025) were statistically significant risk factors. The mean length of hospital stay was 107 (±103) days. Klebsiella spp. attributable mortality due to infection was 14% and crude mortality was 15%. No statistically significant difference was found in patients who developed resistant and susceptible infections. Conclusion Carbapenem resistance in Klebsiella infections was increased. Prolonged hospital stay, neutropenia and steroid use in the last 3 months were identified as significant risk factors for carbapenem-resistant Klebsiella infections. Disclosures All authors: No reported disclosures.

Antibiotic sensitivity profile of Klebsiella isolates and it’s impact on clinical outcome

Background: Antimicrobials are the greatest discovery of the twentieth century. To limit the emergence and spread of resistance, antibiotic therapy should be adjusted according to the results of microbiological culture. Klebsiella isolates causes various types of infections and the incidence of antibiotic resistance is also high in Klebsiella infections. So, Authors plan this study to analyze how the results of microbiological cultures influence the antibiotic use in the treatment of Klebsiella infections.Methods: It is a record based observational prospective study which assessed the impact of Klebsiella positive culture results on antibiotic prescribing pattern and its impact on clinical outcome. Patients with empirical antibiotic therapy and Klebsiella positive were included and patients with inadequate data were excluded in this study and the data were recorded. Recorded data were entered and analyzed in Microsoft Office Excel-2013. Unpaired student t-test was used to compare the mean duration of hospital stay using Past software (version 3.20).Results: There were total 400 patients in our study. Amikacin was the most common drug (n=202) used as empirical therapy. Empirical antibiotic therapy was changed in 161(40.25%) patients. Meropenem was the most commonly used definitive drug. Mean duration of hospital stay is less in empirical sensitive antibiotic therapy as compared to empirical resistance antibiotic therapy having p value <0.0001 which shows significant difference between two groups showing better clinical outcome.Conclusion: Initial empirical therapy with broad-spectrum antimicrobials is a treatment strategy for severe Klebsiella infections.

Phylogenetic Analysis of Antibiotic Resistance Genes and Virulence Genes of Klebsiella species in silico

A total of twelve isolates were screened for virulence and antibiotic resistance genes associated with Klebsiella pneumoniae infections. Virulence and antibiotic resistance genes were detected by in silico PCR amplification. Iron uptake protein entB was detected in 66.67% (n=8) of the isolates while no isolate was found to harbour chelating agent irp2. Iron uptake system kfu, involved in purulent tissue infections and capsule formation, was identified in 25% (n=3) of the isolates. Regulator of mucoid phenotype A, rmpA was not found in any of the isolates. The wabG gene, responsible for urinary tract infections was found in seven K. pneumoniae strains. Five uge positive strains might play role in the pathogenicity of K. pneumoniae infections. About 83.33% of the isolates were positive for type 1 fimbriae fimH1 while no type 3 fimbriae mrkD gene was found. Complement reaction blocked by plasmid traT gene was not observed in Klebsiella species while eight isolates harboured outer membrane lipoprotein, ycfM which protects Klebsiella species from antibiotics. Antibiotic resistance genes blaTEM and blaSHV were detected in 33.33% (n=4) and 66.67% (n=8) of the isolates while 25% isolates carried both blaTEM and blaSHV genes. Genotype 1 carried fimH1 and ycfM genes while all the virulence genes studied were present in genotype 2 and 3. The blaSHV gene was detected in all the genotypes while blaTEM gene was found in only genotype 1 and 3. The findings of this study would be helpful to predict virulence gene associated with Klebsiella infections. This data also helps us to choose antibiotics for treating Klebsiella infections. By assessing the genotypic distribution of antibiotic resistance gene, correct antibiotic can be used to treat the infection. This could help reduce emergence of antibiotic resistance since it is known that incorrect choice of antibiotics contributes to antibiotic resistance.Dhaka Univ. J. Pharm. Sci. 16(1): 119-127, 2017 (June)