Klebsiella pneumoniae genotype K1: An emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess
Journal
Clinical Infectious Diseases
Journal Volume
45
Journal Issue
3
Pages
284-293
Date Issued
2007
Author(s)
Abstract
Background. Since 1986, researchers have noted a syndrome of Klebsiella pneumoniae pyogenic liver abscess that is complicated by endophthalmitis or central nervous system infections. There are limited data regarding the role of bacterial genotype in the pathogenesis of this syndrome. Methods. We conducted a retrospective cohort study involving 177 cases of K. pneumoniae pyogenic liver abscess treated during 1997-2005 at a tertiary university hospital in Taiwan. We performed bacterial cps genotyping by polymerase chain reaction detection of serotype-specific alleles at wzy and wzx loci and used an in vitro serum assay to evaluate the virulence of bacterial strains. Results. Septic ocular or central nervous system complications developed in 23 patients (13%). Logistic regression analysis showed that genotype K1 was the only significant risk factor (adjusted odds ratio, 4.8; 95% confidence interval, 1.5-15.7, P = .009). The serum resistance assay indicated that, on average, K1 strains (n = 100) were significantly more virulent than were strains of K2 (n = 36), K20/K5/K54 (n = 21), or other genotypes (n = 20) (P < .001 for each comparison). In addition to the serotype-specific cps region, the genomic background of K1 strains also differed significantly from that of non-K1 strains (20-kb kfu/PTS region, 97/100 vs. 13/77; P < .001). Of the 19 cases in which genotype K1 strains caused complications, 8 patients (42%) did not have identifiable underlying medical diseases. Conclusions. K. pneumoniae genotype K1 is an emerging pathogen capable of causing catastrophic septic ocular or central nervous system complications from pyogenic liver abscess independent of underlying diseases in the host. ? 2007 by the Infectious Diseases Society of America. All rights reserved.
SDGs
Other Subjects
adult; aged; allele; article; assay; bacterial gene; bacterial strain; bacterial virulence; central nervous system infection; clinical article; cohort analysis; confidence interval; controlled study; cps gene; dysmetria; endophthalmitis; gene locus; genotype; human; hydrocephalus; in vitro study; Klebsiella pneumoniae; logistic regression analysis; nonhuman; nucleotide sequence; pathogenesis; polymerase chain reaction; priority journal; pyogenic liver abscess; quadriplegia; retrospective study; risk factor; serotype; serum resistance assay; Taiwan; university hospital; visual impairment; Central Nervous System Diseases; Disease Susceptibility; Eye Infections, Bacterial; Genotype; Humans; Klebsiella pneumoniae; Liver Abscess, Pyogenic; Serotyping
Type
journal article