Clinical and Molecular Characteristics and Antibacterial Strategies of Klebsiella pneumoniae in Pyogenic Infection

Zhiyu Yang; Runmei Zhou; Yusheng Chen; Xiaotuan Zhang; Luogen Liu; Min Luo; Jinlin Chen; Kuilin Chen; Tong Zeng; Bin Liu; Yuan Wu; Jielite Huang; Zhuoran Liu; Jinglin Ouyang

doi:10.1128/spectrum.00640-23

Microbiology Spectrum (Aug 2023)

Clinical and Molecular Characteristics and Antibacterial Strategies of Klebsiella pneumoniae in Pyogenic Infection

Zhiyu Yang,
Runmei Zhou,
Yusheng Chen,
Xiaotuan Zhang,
Luogen Liu,
Min Luo,
Jinlin Chen,
Kuilin Chen,
Tong Zeng,
Bin Liu,
Yuan Wu,
Jielite Huang,
Zhuoran Liu,
Jinglin Ouyang

Affiliations

Zhiyu Yang: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Runmei Zhou: Department of Pharmacy, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Yusheng Chen: Department of Pharmacy, Ningyuan County Hospital of Traditional Chinese Medicine, Ningyuan, Hunan, China
Xiaotuan Zhang: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Luogen Liu: Clinical Research Center, Second Affiliated Hospital, University of South China, Hengyang, China
Min Luo: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Jinlin Chen: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Kuilin Chen: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Tong Zeng: Key Laboratory of Medical Imaging and Artificial Intelligence of Hunan Province, Xiangnan University, Chenzhou, China
Bin Liu: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Yuan Wu: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Jielite Huang: Clinical Laboratory, Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
Zhuoran Liu: Department of Clinical Laboratory, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
Jinglin Ouyang: Clinical Research Center, Second Affiliated Hospital, University of South China, Hengyang, China

DOI: https://doi.org/10.1128/spectrum.00640-23
Journal volume & issue: Vol. 11, no. 4

Abstract

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ABSTRACT Treatment of Klebsiella pneumoniae causing pyogenic infections is challenging. The clinical and molecular characteristics of Klebsiella pneumoniae causing pyogenic infections are poorly understood, and antibacterial treatment strategies are limited. We analyzed the clinical and molecular characteristics of K. pneumoniae from patients with pyogenic infections and used time-kill assays to reveal the bactericidal kinetics of antimicrobial agents against hypervirulent K. pneumoniae (hvKp). A total of 54 K. pneumoniae isolates were included, comprising 33 hvKp and 21 classic K. pneumoniae (cKp) isolates, and the hvKp and cKp isolates were identified using five genes (iroB, iucA, rmpA, rmpA2, and peg-344) that have been applied as hvKp strain markers. The median age of all cases was 54 years (25th and 75th percentiles, 50.5 to 70), 62.96% of individuals had diabetes, and 22.22% of isolates were sourced from individuals without underlying disease. The ratios of white blood cells/procalcitonin and C-reactive protein/procalcitonin were potential clinical markers for the identification of suppurative infection caused by hvKp and cKp. The 54 K. pneumoniae isolates were classified into 8 sequence type 11 (ST11) and 46 non-ST11 strains. ST11 strains carrying multiple drug resistance genes have a multidrug resistance phenotype, while non-ST11 strains carrying only intrinsic resistance genes are generally susceptible to antibiotics. Bactericidal kinetics revealed that hvKp isolates were not easily killed by antimicrobials at susceptible breakpoint concentrations compared with cKp. Given the varied clinical and molecular features and the catastrophic pathogenicity of K. pneumoniae, it is critical to determine the characteristics of such isolates for optimal management and effective treatment of K. pneumoniae causing pyogenic infections. IMPORTANCE Klebsiella pneumoniae may cause pyogenic infections, which are potentially life-threatening and bring great challenges for clinical management. However, the clinical and molecular characteristics of K. pneumoniae are poorly understood, and effective antibacterial treatment strategies are limited. We analyzed the clinical and molecular features of 54 isolates from patients with various pyogenic infections. We found that most patients with pyogenic infections had underlying diseases, such as diabetes. The ratio of white blood cells to procalcitonin and the ratio of C-reactive protein to procalcitonin were potential clinical markers for differentiating hypervirulent K. pneumoniae strains from classical K. pneumoniae strains that cause pyogenic infections. K. pneumoniae isolates of ST11 were generally more resistant to antibiotics than non-ST11 isolates. Most importantly, hypervirulent K. pneumoniae strains were more tolerant to antibiotics than classic K. pneumoniae isolates.

Published in Microbiology Spectrum

ISSN: 2165-0497 (Online)
Publisher: American Society for Microbiology
Country of publisher: United States
LCC subjects: Science: Microbiology
Website: https://journals.asm.org/journal/spectrum

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