Open AccessResistance patterns and clinical outcomes of Klebsiella pneumoniae and invasive Klebsiella variicola in trauma patients
Author(s) -
John L Kiley,
Katrin Mende,
Miriam L. Beckius,
Susan J Kaiser,
M. Leigh Carson,
Dan Lu,
Timothy J. Whitman,
Joseph Petfield,
David R. Tribble,
Dana M Blyth
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0255636
Subject(s) - klebsiella pneumoniae , microbiology and biotechnology , klebsiella , biology , multiple drug resistance , drug resistance , antibiotic resistance , bacteremia , antibiotics , escherichia coli , gene , genetics
Recent reclassification of the Klebsiella genus to include Klebsiella variicola , and its association with bacteremia and mortality, has raised concerns. We examined Klebsiella spp. infections among battlefield trauma patients, including occurrence of invasive K . variicola disease. Klebsiella isolates collected from 51 wounded military personnel (2009–2014) through the Trauma Infectious Disease Outcomes Study were examined using polymerase chain reaction (PCR) and pulsed-field gel electrophoresis. K . variicola isolates were evaluated for hypermucoviscosity phenotype by the string test. Patients were severely injured, largely from blast injuries, and all received antibiotics prior to Klebsiella isolation. Multidrug-resistant Klebsiella isolates were identified in 23 (45%) patients; however, there were no significant differences when patients with and without multidrug-resistant Klebsiella were compared. A total of 237 isolates initially identified as K . pneumoniae were analyzed, with 141 clinical isolates associated with infections (remaining were colonizing isolates collected through surveillance groin swabs). Using PCR sequencing, 221 (93%) isolates were confirmed as K . pneumoniae , 10 (4%) were K . variicola , and 6 (3%) were K . quasipneumoniae . Five K . variicola isolates were associated with infections. Compared to K . pneumoniae , infecting K . variicola isolates were more likely to be from blood (4/5 versus 24/134, p = 0.04), and less likely to be multidrug-resistant (0/5 versus 99/134, p<0.01). No K . variicola isolates demonstrated the hypermucoviscosity phenotype. Although K . variicola isolates were frequently isolated from bloodstream infections, they were less likely to be multidrug-resistant. Further work is needed to facilitate diagnosis of K . variicola and clarify its clinical significance in larger prospective studies.