Convergence of carbapenem resistance and hypervirulence leads to high mortality in patients with postoperative Klebsiella pneumoniae meningitis

Yuming Li; Dakang Hu; Xiaobo Ma; Dan Li; Dongxing Tian; Ye Gong; Xiaofei Jiang

Journal of Global Antimicrobial Resistance (Dec 2021)

Convergence of carbapenem resistance and hypervirulence leads to high mortality in patients with postoperative Klebsiella pneumoniae meningitis

Yuming Li,
Dakang Hu,
Xiaobo Ma,
Dan Li,
Dongxing Tian,
Ye Gong,
Xiaofei Jiang

Affiliations

Yuming Li: Department of Intensive Care Unit, Huashan Hospital, Fudan University, Shanghai, 200040, China
Dakang Hu: Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
Xiaobo Ma: Department of Clinical Laboratory, the First Affiliated Hospital of Xiamen University (Xiamen Key Laboratory of Genetic Testing), Xiamen, 361003, China
Dan Li: Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
Dongxing Tian: Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
Ye Gong: Department of Intensive Care Unit, Huashan Hospital, Fudan University, Shanghai, 200040, China; Corresponding authors. Tel.: +86 21 5288 7354; fax: +86 21 5288 7354 (Y. Gong); tel.: +86 21 5288 8316; fax: +86 21 5288 8316 (X. Jiang).
Xiaofei Jiang: Department of Laboratory Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China; Corresponding authors. Tel.: +86 21 5288 7354; fax: +86 21 5288 7354 (Y. Gong); tel.: +86 21 5288 8316; fax: +86 21 5288 8316 (X. Jiang).

Journal volume & issue: Vol. 27
pp. 95 – 100

Abstract

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ABSTRACT: Objectives: The aims of this study were to investigate the characteristics of Klebsiella pneumoniae meningitis and the impact of convergence of carbapenem resistance and hypervirulence on patient mortality.Methods: Antimicrobial resistance and virulence-related genes were investigated in 25 K. pneumoniae strains causing meningitis. Clinical data for 25 patients from February 2009 to February 2019 were evaluated. Multilocus sequence typing (MLST), serotyping, analysis of mobile genetic elements and pulsed-field gel electrophoresis (PFGE) were performed. GraphPad Prism was used for statistical analysis.Results: The mortality rate of patients with K. pneumoniae meningitis was 30.0%. Significant differences were observed between non-survivor and survivor groups regarding mechanical ventilation, peripheral deep vein catheter insertion and GCS score, but not sex, age or meningeal integrity destruction. Multidrug resistance was observed in 21 isolates. Rates of detection for each virulence gene ranged from 4.0% for wzy-K1 to 100.0% for entB. Detection rates of carbapenem-resistant K. pneumoniae (CRKP), hypervirulent K. pneumoniae (HvKP) and hypervirulent carbapenem-resistant K. pneumoniae (Hv-CRKP) were 68.0%, 68.0% and 48.0%, respectively. In total, 16 clusters and 19 clones were identified among the 25 isolates. Mortality rates differed significantly between the non-Hv-CRKP (1/11) versus Hv-CRKP groups (5/9), but were comparable in the carbapenem-susceptible K. pneumoniae versus CRKP groups and the classical K. pneumoniae versus HvKP groups.Conclusions: Klebsiella pneumoniae meningitis is associated with high mortality. Klebsiella pneumoniae-induced meningitis has highly divergent origins. Convergence of carbapenem resistance and hypervirulence leads to high mortality in patients with K. pneumoniae meningitis, which is of great clinical concern.

Published in Journal of Global Antimicrobial Resistance

ISSN: 2213-7165 (Print); 2213-7173 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Science: Microbiology
Website: https://www.journals.elsevier.com/journal-of-global-antimicrobial-resistance

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