Exploring Raoultella planticola: Implications for Pediatric Health.

The case presentation discusses the clinical evaluation and treatment of a two-year-old female exhibiting symptoms such as dysuria, constipation, and foul-smelling urine. Upon evaluation, the patient was found to be co-infected with Raoultella planticola and Escherichia coli. This co-infection poses unique challenges in diagnosis and treatment, as both pathogens may contribute to the manifestation of symptoms. The initial diagnosis of Raoultella planticola is notable, given its relatively rare occurrence and the potential for misdiagnosis. This case study contributes to our understanding of diagnosing and distinguishing symptoms at various stages of the illness, particularly in cases of co-infection. Following an initial urinalysis and urine culture confirming the presence of both pathogens, a 10-day course of antibiotics was prescribed. Subsequent examinations at Rady Children's Hospital-San Diego included kidney and abdomen imaging to rule out underlying issues. The co-infection underscores the importance of thorough diagnostic procedures and tailored treatment approaches. Additionally, it highlights the need for heightened awareness among healthcare providers regarding emerging pathogens and their potential clinical implications.

Prognosis and Characteristics of Hypermucoviscous Klebsiella pneumoniae Infection in Critically Ill Patients: A Case Series.

Introduction Hypermucoviscous Klebsiella pneumoniae (hvKP) is related to invasive infections; however, there have been very few comprehensive reports on the clinical features and prognosis of critically ill patients with the infection. Methods We conducted a retrospective case series in a general intensive care unit in Japan. Patients with positive blood cultures for KP between January 1, 2020 and December 31, 2022 were included. hvKP was defined by the positivity in the string test. We analyzed the patient's characteristics at baseline, including comorbidities, abscess formation, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score, septic shock, duration of hospitalization, 30-day mortality, and infection site. Results A total of 24 patients had a positive blood culture for KP; nine patients (37.5%) were positive for the string test (hvKP) while 15 (62.5%) were negative (non-hvKP). In both groups, the patients were old (mean age, hvKP 80.4 vs. non-hvKP 75.7 years) and more often male (five patients (55.6%) vs. 12 patients (80.0%)). No statistically significant difference was found between the two groups in terms of comorbidities, such as diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, and malignancy. No statistical difference was seen in abscess formation (two patients [22.2%] vs. one patient (6.7%)), SOFA score (5.2±4.8 vs. 4.7±3.4), APACHE II score (19.6 (15.0-20.0) vs. 17.0 (11.2-20.8)), septic shock (five patients (55.6%) vs. four patient (26.7%)), duration of hospitalization (37.2 (12.0-51.0) vs. 32.3 (9.5-21.0)), and 30-day mortality (two patients (22.2%) vs. two patients (13.3%)). Two cases with hvKP died within 24 h. No significant difference was seen in the infection sources; respiratory infection (2 (22.2%) vs. 1 (6.7%)), hepatobiliary infection (2 (22.2%) vs. 7 (46.7%)), and genitourinary infection (1 (11.1%) vs. 5 (33.3%)). Conclusions Critically ill patients with hvKP infection showed characteristics similar to those reported previously. However, the disease could rapidly become severe and have a poor prognostic outcome.

A Study on the Etiology and Clinical Manifestations of Community-Acquired Pneumonia in Adults in Western India.

BACKGROUND:  Community-acquired pneumonia (CAP) is an acute lung infection affecting the alveoli in individuals who have not had recent exposure to healthcare settings. It is characterized by newly detected pulmonary infiltration on a chest X-ray or computed tomography scan, accompanied by at least two of the following symptoms: a new or worsening cough, shortness of breath, increased sputum production, fever or hypothermia, pleuritic chest pain, hypoxia, confusion, or an abnormal WBC count (either leukopenia or leukocytosis). It is a major contributor to global mortality and morbidity, especially in elderly populations. This study aims to investigate the etiology of CAP in our region and analyze the clinical characteristics of patients diagnosed with CAP. METHODOLOGY:  This prospective, hospital-based study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, a 2,011-bed multispecialty hospital. The study included 100 patients over 18 years old, diagnosed with CAP, and hospitalized between January 2023 and January 2024. All patients underwent a thorough clinical assessment, and sputum cultures were collected on the day of admission. Patients under 18 years old, those who had been hospitalized within the preceding two weeks, individuals with pneumonia caused by tuberculosis or aspiration pneumonia, patients with compromised immune systems, and pregnant women were excluded. RESULTS:  The study included 100 patients with a mean age of 53.13 years (±18.31). The most common age group was 59-68 years, which included 25 (25%) cases, followed by the 69-78 year age group with 18 (18%) cases and the 18-28 year age group with 15 (15%) cases. The majority were male, with 61 (61%) cases. Common symptoms included fever in 78 cases (78%), chest pain in 69 cases (69%), dyspnea in 65 cases (65%), and cough in 51 cases (51%). Sputum cultures showed growth in 65 cases (65%), with Klebsiella pneumoniae being the most prevalent pathogen in 28 cases (43%), followed by Streptococcus pneumoniae in 18 cases (28%). Together, these two pathogens accounted for 46 out of 65 positive samples (70%). CONCLUSIONS:  This study highlights the clinical profile and rising etiology of K. pneumoniae in CAP in adults in Western India, particularly in the elderly. These findings underscore the need for periodic updates on CAP etiology to inform empirical treatment strategies effectively. Future research should use advanced diagnostics and diverse samples to refine CAP management, with continuous monitoring to update treatment protocols.

A Systematic Review of Community-Acquired Pneumonia in Indian Adults.

This systematic review aimed to consolidate findings on the etiology of community-acquired pneumonia (CAP) among Indian adults. We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Guidelines 2020 and conducted a comprehensive search across databases including PubMed, Scopus-Elsevier, and hand-searched reference lists using key terms such as "Community-Acquired Pneumonia," "CAP," "Indian," and "adults." Articles published between January 2010 and January 2024 were included, with exclusions for studies involving pediatric populations, non-Indian patients, or those published before 2010. From an initial pool of 344 articles, duplicates were removed and titles and abstracts were screened, resulting in nine studies meeting the inclusion criteria. The analysis of pooled data comprising 1,643 Indian adult participants revealed the following pathogen distribution: Streptococcus pneumoniae was the most common organism, accounting for 33% of the cases. This was followed by Klebsiella pneumoniae at 23%, Staphylococcus aureus at 10%, Mycoplasma pneumoniae and Legionella pneumophila each at 7%, and Chlamydia pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa each at 4%. Notably, the review highlights a rising incidence of K. pneumoniae in CAP cases, which is a significant concern and should be considered when treating CAP patients in India. The findings emphasize the importance of comprehensive diagnostic testing, including advanced methods such as bronchoalveolar lavage, urinary antigen tests, serology for atypical pathogens, and enzyme-linked immunosorbent assays, to improve diagnostic yield and guide targeted antibiotic therapy. This review underscores the need for updated empirical treatment guidelines that account for dominant pathogens. Future research should focus on employing advanced diagnostic methods to enhance understanding of CAP etiology.

Pneumorrhachis Secondary to Klebsiella pneumoniae Gas-Forming Paraspinal Abscess: A Case report and Review of Literature.

Pneumorrhachis is a rare entity, where air pockets are found in the spinal canal and the etiology can be categorized into traumatic and non-traumatic, the latter further categorized into spontaneous, iatrogenic, and associated with infections. Infective causes are often associated with gas-forming organisms and are associated with significant morbidity and mortality. Often the diagnosis is not suspected until imaging is done. We report the case of a 57-year-old man who presented with fever, backache, lower leg weakness, and dysuria. A computed tomography scan for evaluation of intra-abdominal sepsis incidentally showed pneumorrhachis affecting the thoracic and lumbar levels, gas-forming paraspinal abscess, prostate abscess, liver cirrhosis, and sigmoid colon carcinoma. Blood culture isolated Klebsiella pneumoniae. The patient recovered after six weeks of intravenous antibiotics followed later by sigmoid colectomy and chemotherapy. A literature review identified 63 cases of pneumorrhachis associated with infections and can be categorized into infections with spontaneous pneumorrhachis (predominantly respiratory tract infections), infections with pneumorrhachis (predominantly with emphysematous infections), and iatrogenic with infections and pneumorrhachis (predominantly postspinal interventions). Infections with pneumorrhachis occurred in older age groups and were associated with higher mortality compared to the other two categories.

Klebsiella, a Clever Survivor Presenting As Pyogenic Liver Abscess Years After Travel.

Klebsiella pneumoniae is a known cause of pyogenic liver abscess and has an increased prevalence in Southeast Asia. We present two cases of individuals with remote travel history to southeast Asia presenting with fevers, chills, and abdominal pain secondary to pyogenic liver abscess. Neither individual had a comorbid medical condition or history of prior hepato-biliary pathology that would predispose them to bacterial translocation and abscess formation. These patients were both successfully treated with percutaneous drainage and antibiotics. We present these cases to add to the growing body of literature surrounding hyper-mucoid strains of Klebsiella pneumonia causing a pyogenic liver abscess.

A Case of Primary Sclerosing Cholangitis Complicated With Liver Abscess Caused by Hyperviscous Klebsiella pneumoniae.

Liver abscesses caused by Klebsiella pneumoniae with a positive string test for hyperviscosity are more likely to develop invasive conditions than those with a negative string test. Here, we report the case of primary sclerosing cholangitis (PSC) who developed a treatment-resistant liver abscess caused by hyperviscous Klebsiella pneumoniae. A 67-year-old woman with PSC and a history of pancreaticoduodenectomy developed a fever. She had recurrent bacterial cholangitis after pancreaticoduodenectomy. This time, she was diagnosed with a liver abscess and bacterial cholangitis and then admitted to a local hospital. As her condition did not improve with intravenous administration of meropenem, she was transferred from another hospital to our hospital on the 7th day of admission. The percutaneous transhepatic abscess drainage was performed, and intravenous administration of cefepime and metronidazole was started. Klebsiella pneumoniae with a positive string test was detected in the blood culture test and the pus culture of the liver abscess. Although the liver abscess was reduced in size, the infection did not subside completely. Her general condition gradually deteriorated. She passed away on the 45th day of illness. In PSC patients, the formation of a liver abscess caused by hyperviscous Klebsiella pneumoniae can be life-threatening. In such cases, pus should be collected as soon as possible to identify the causative bacteria.

A Case of Septic Pulmonary Embolism Caused by Pyelonephritis With Klebsiella pneumoniae in a Patient With Poorly Controlled Type 2 Diabetes Mellitus.

Septic pulmonary embolism (SPE) is caused by the microbe that is responsible for any clinical condition that may include urinary tract infections as in this case. We report a case of pyelonephritis with Klebsiella pneumoniae that led to SPE in an 80-year-old woman with poorly controlled diabetes mellitus (DM). Computed tomography (CT) revealed multiple nodules in the peripheral area of the bilateral lung and a contrast defect in the right renal vein, which was suspected to be an embolism. Blood and urine cultures revealed Klebsiella pneumoniae infection. These results confirmed the diagnosis of pyelonephritis and SPE. Treatment with ceftriaxone, cefazolin, and ciprofloxacin improved the patient's condition.

Klebsiella pneumoniae Infection as a Mimicker of Multiple Metastatic Lesions.

We describe the case of a 42-year-old man with cirrhosis who presented with fever and imaging concerning for metastatic disease from suspected renal cell carcinoma. He had a right renal mass with multiple pulmonary masses and underwent a lung biopsy and oncology consultation. Blood cultures revealed Klebsiella pneumoniae, and all the lesions disappeared after intravenous (IV) antibiotics. Our case attempts to increase awareness of this unique presentation of invasive Klebsiella infections and discusses host factors that can predispose to this condition.

Klebsiella Pneumoniae Brain Abscess in a Patient With Chronic Lymphocytic Leukemia.

Klebsiella Pneumoniae (K. pneumoniae) is a common nosocomial pathogen. However, Klebsiella-associated meningitis and brain abscess formation are extremely rare in the United States. We present a case of a 73-year-old male who initially presented for a tonsillar abscess of unknown etiology. While awaiting an abscess biopsy, the patient underwent molar extraction for chronic periodontitis and decay. The patient subsequently developed K. pneumoniae bacteremia and meningitis. As he clinically declined, repeat imaging revealed a brain abscess with eventual hemorrhagic transformation. Notably, the patient had underlying hypogammaglobulinemia from chronic lymphocytic leukemia (CLL), which we believe contributed to the invasive disease. Given the global spread of virulent strains of Klebsiella (such as hypervirulent or hypermucoviscous K. pneumoniae), clinicians must bear this pathogen in mind while treating critically ill and immunocompromised patients.

1,25(OH)2D3 promotes the elimination of Klebsiella pneumoniae infection by inducing autophagy through the VDR-ATG16L1 pathway.

OBJECTIVE: Previous studies have shown that vitamin D has regulatory functions in both innate and adaptive immune responses, indicating that it can perform essential roles in host resistance to pathogen infections. This study aimed to verify its effects on Klebsiella pneumoniae (Kp) infection and explore the underlying mechanisms. METHODS: THP-1-derived macrophages were infected with Kp and then incubated with 1,25(OH)2D3. Autophagy induced by 1,25(OH)2D3 was investigated by western blotting and immunofluorescence. Real-time PCR (qPCR) was performed to determine the expression of inflammatory mediators. Baf A1 and 3-MA were used to inhibit autophagy. The intracellular killing of Kp was measured using qPCR and colony-forming unit assays. RNA interference assays were used to silence VDR or ATG16L1. The lungs of C57BL/6 mice were infected with Kp via intratracheal instillation, and the established pneumonia models were used for in vivo validation experiments. RESULTS: Treatment with 1,25(OH)2D3 enhanced the bactericidal activity of macrophages and concomitantly reduced the expression of the pro-inflammatory mediators TNF-α and IL-6. Kp infection led to a lower expression level of VDR in macrophages than in the control, whereas co-treatment with 1,25(OH)2D3 up-regulated VDR expression and robustly induced autophagy via the VDR signaling pathway. Silencing ATG16L1 significantly counteracted autophagy induced by 1,25(OH)2D3 in Kp-infected macrophages. Furthermore, we found that when autophagy activity was diminished by ATG16L1 siRNA or blocked by Baf A1, the ability of 1,25(OH)2D3 to promote macrophages to eliminate Kp infection was obviously impaired, as were its anti-inflammatory effects. These protective efficacies of 1,25(OH)2D3 against Kp infection were also validated in vivo using a mouse model of pneumonia. CONCLUSIONS: The present study demonstrated the protective features of 1,25(OH)2D3 in macrophages against Kp infection and may provide evidence for further exploration of its potential as an adjunctive therapy agent for the treatment of bacterial infections.

Emerging Multiorgan Klebsiella pneumoniae Invasive Syndrome Leading to Septic Shock: A Case Report and Review of the Literature.

Klebsiella pneumoniae (K. pneumoniae) is a community-acquired pathogen that typically causes pneumonia and urinary tract infections. Rarely, it can affect other organ systems such as the gastrointestinal tract, as well as the meninges, ears, eyes, and spine. We present the case of a 62-year-old male admitted with septic shock secondary to necrotizing pneumonia and multiple hepatic liver abscesses, which to the best of our knowledge, is the first reported case of multiorgan invasive K. pneumoniae infection, including the presence of a newly recognized syndrome referred as Invasive Liver Abscess Syndrome (ILAS). It is important to maintain both ILAS and K. pneumoniae invasive syndrome (KPIS) in the differential diagnosis, especially in areas of the world with a large number of tourists and immigrants, such as New York City, where the presented case took place.

A Rare Case of Ascariasis-Induced Cholangitis Complicated With Klebsiella pneumoniae Bacteremia and Liver Microabscesses.

Ascariasis, which is caused by Ascaris lumbricoides, is the most common gastrointestinal parasitic infection worldwide, with occasional invasion of the biliary tract leading to a variety of complications. In rare cases, pathogens carried on the surface of A. lumbricoides can complicate the course of the disease and lead to superimposed bacterial infections. In this article, we present a case of ascariasis-induced cholangitis complicated with Klebsiella pneumoniae bacteremia and multiple hepatic microabscesses. This article, which shows an association that was not reported in the literature before, aims to increase the awareness of clinicians for the possibility of the association between ascariasis and superimposed bacterial infection, specifically with K. pneumoniae.

Detection of Klebsiella pneumoniae cfDNA in pleural fluid and its clinical value.

BACKGROUND: Klebsiella pneumoniae (KP) is an important opportunistic pathogen that can easily cause pneumonia and pleural effusion when body resistance is reduced. However, the positive rate of KP detected from clinical pleural effusion by traditional methods, including bacterial culture, is meager. Therefore, new detection methods are urgently needed to improve the positive detection rate of KP and other bacteria in pleural effusion. METHODS: Simulated pleural fluid of KP infection was first set up. Then circulating cell-free DNA (cfDNA) was extracted from cultured hydrothorax and detected by fluorescence polymerase chain reaction (PCR) to verify KP cfDNA in the pleural fluid. The specificity, sensitivity, and repeatability of this method are verified by detecting the cfDNAs in pleural effusion, samples of malignant pleural effusion, tuberculous pleural effusion, and other common microbial infections. Finally, this method was compared with three traditional methods, pleural effusion, precipitation DNA, sputum culture, and pleural effusion culture to explore the clinical diagnostic value of this method. RESULTS: KP cfDNA was positive by fluorescence PCR from the simulated KP infected pleural effusion, which confirmed KP cfDNA in pleural effusion. KP cfDNA was positive by fluorescence PCR from the pleural effusion of KP infected patients, while with the same detection method, KP cfDNA in clinical carcinomatous hydrothorax, tuberculosis hydrothorax, and other standard microbial infection samples was negative, which confirmed the method had high specificity, high sensitivity, and reproducibility. Compared with the three traditional methods, this method has a higher positive rate. Compared with the gold standard, sputum bacterial culture, the sensitivity, specificity, positive predictive value, and negative predictive value of this method were 91.67%, 95.45%, 91.7%, and 95.5%, respectively. CONCLUSIONS: The detection of cfDNA by fluorescence PCR is possible. Moreover, the positive rate of this method in clinical pleural effusions is high.

Investigation on the Genetic Signatures of Antibiotic Resistance in Multi-Drug-Resistant Klebsiella Pneumoniae Isolates From National Guard Hospital, Riyadh.

Introduction Despite a large number of antibiotics available to treat Klebsiella (K.) pneumoniae (KP), resistance against these antibiotics is ever-increasing and has now become a global threat to human life. The most frequently observed resistant genes in Klebsiella pneumoniae are CTX-M, OXA-48, IMP, and NDM; some are clone-specific while others form a reservoir for infection. Methods Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) was employed for the identification of the pathogens and automated VITEK-2 (bioMérieux, Marcy-l'Étoile, France) was used for minimum inhibitory concentration (MIC) determination, followed by polymerase chain reaction (PCR) amplification of target genes and Sanger sequencing of amplicons. Results Forty-three out of 50 isolates (86%) were OXA gene-positive, and 49 out of 50 (98%) isolates were CTX-M gene positive. Two phenotypes of OXA were identified in 33 samples sequenced, OXA-505 (70%) and OXA-232 (30%). Sixteen isolates (32%) were positive for NDM-1. Twelve isolates were positive for both OXA and NDM. Multilocus sequence typing (MLST) on these isolates showed that they were distributed in 12 sequence types (STs). Thirty-six out of 50 were grouped in four clonal complexes. ST-14 was the predominant genotype. Conclusion This study has revealed that CTX-M-15 is the most common extended-spectrum beta-lactamase (ESBL) present in almost all isolates. The study also shows the presence of OXA as the main carbapenemase gene, alone or in combination with other carbapenemases such as NDM-1. Multilocus sequence typing revealed the incidence of polyclonal KP pool with ST-14, ST-29, ST-307, and ST-15 being the predominant ones.

Dipeptidyl peptidase-4 inhibitor treatment could decrease Klebsiella pneumoniae pneumonia in patients with type 2 diabetes.

OBJECTIVES: To investigate the effect of dipeptidyl peptidase-4 inhibitor (DPP4i) for Klebsiella pneumoniae (KP) pneumonia in patients with diabetes. PATIENTS AND METHODS: Patients newly diagnosed with type 2 diabetes from 2009 to 2012 were recruited for this population-based and observational study. Diabetes complications severity index (DCSI) score and defined daily dose (DDD) were used for analysis. The multivariable Cox proportional hazards models were used to estimate the risk of KP pneumonia by DPP4i use, with adjustments for propensity score. The Kaplan-Meier method with the log-rank test was used to estimate the risk of KP pneumonia for DPP4i users. RESULTS: 34774 patients were included. The incidence rate of KP pneumonia in DDP4i users was 1.51 per 1000 person-years and that for the comparison was 2.25 per 1000 person-years. DDP4i users also had a significantly lower cumulative incidence of KP pneumonia (log-rank test p-value = 0.03). DDP4i users had a significantly lower risk of developing KP pneumonia compared with nonusers (adjusted HR = 0.67, 95% CI = 0.48-0.95). CONCLUSIONS: For public health issue with type2 diabetes and infection, DPP4i use decreased KP pneumonia. Male gender, patients with co-morbidities, patients with higher DSCI score and higher DDD of DPP4i were observed to decrease KP pneumonia infection in our analysis. The possible role of DPP4i causing immunological disturbances should be considered.

Characterization of a multidrug-resistant Klebsiella pneumoniae ST3330 clone responsible for a nosocomial outbreak in a neonatal intensive care unit.

BACKGROUND: The incidence of Klebsiella pneumonia (Kp), which has often been found to produce, extended spectrum beta-lactamase (ESBL), is rising rapidly and poses a serious risk to neonates. To date, the mechanisms related to the spread of ESBL-Kp have not been fully elucidated. This study aimed to investigate the phenotypes, genotypes, and genetic relatedness of ESBL-KP that caused an outbreak of sepsis among neonates in an intensive care unit of a Beijing hospital. METHODS: Between April 2016 and May 2018, 21 non-repetitive clinical ESBL-Kp isolates were collected from a neonatal intensive care unit (NICU) in Beijing, China and were retrospectively analyzed. Pulsed-field gel electrophoresis (PFGE) was used to analyze genetic relatedness, a VITEK 2 AST test kit was used to test antimicrobial susceptibility, sequence type (ST) was analyzed through multilocus sequence typing (MLST), and resistance genes were identified by PCR. Virulence gene profiles, biofilm formation assay, and serum killing assay were used for virulence-associated determinants. RESULTS: All strains expressed the same antibiotype, combining ESBL production, third generation cephalosporins resistance and carbapenems sensitive. Sixteen of them produced ß-lactamases (CTX-M-3 and TEM-1B), while others possessed CTX-M-15, CTX-M-24, CTX-M-66, TEM-1C, SHV-26, SHV172, and OXA-1. PFGE confirmed 5 types (A, B, C, D and E) and MLST identified a ST3330 clone (16 strains), a ST2791 clone (2 strains), a ST37 clone (1 strain), a ST34 clone (1 strain), and a ST2740 clone (1 strain). PFGE type A strains, which belong to ST3330, were identified as the main pathogens involved in the outbreak. All isolates contained virulence genes iutA and mrk. PFGE type A carried both mrk (type 3 fimbriae, biofilm formation) and fimH (type 1 fimbriae), and other STs possessed mrk. Isolates belonging to the endemic ST3330 lineage produced more biofilm than other ST isolates (median OD590 1.829 vs. 0.2280, respectively; P<0.0001). All five PFGE types isolates showed serum high sensitivity (grade 1). CONCLUSIONS: The dissemination and outbreak of ESBL-producing K. pneumoniae in this study seemed to be clonal, and the outbreak was mainly caused by ST3330 K. pneumoniae. The detection of genes (mrk and fimH) belonging to the biofilm formation may partly explain the epidemic strain has high colonization and diffusion potential.

Clinical characteristics and risk factors of catheter-associated urinary tract infections caused by Klebsiella Pneumoniae.

BACKGROUND: The clinical characteristics and risk factors of catheter-associated urinary tract infections (CAUTIs) caused by Klebsiella pneumoniae (KP) have not been well investigated. METHODS: This retrospective study performed at a university teaching hospital in China from January 2012 to November 2017 analyzed data for 227 patients with urinary tract infection (UTI) caused by KP. Patients' demographic characteristics and clinical outcomes were recorded. Risk factors were analyzed using a binary logistic regression model. RESULTS: Of 227 patients with Klebsiella pneumoniae-related urinary tract Infection (KP-UTI), the infection was catheter-associated in 90 patients. More than half of them were male (60%), over 60 years old, hospitalized in general ward, always acquired in hospital, and got a longer hospitalization more than one month. The Klebsiella pneumoniae-related catheter-associated urinary tract infections (KP-CAUTIs) patients always combined with lots of chronic comorbidities. A high proportion of invasive device, extendedspectrum ß-lactamase (ESBL) expression and multidrug resistance (MDR) were found in KP-CAUTIs patients. When taken antimicrobial activity into consideration, KP-CAUTIs patients performed resistance to most antibiotics in varying degrees. Logistic regression analysis revealed that after grouping by ESBL expression and in-hospital mortality among patients with KP-CAUTI, complicated urinary tract infection (cUTI) was an independent risk factor for ESBL positive KP-CAUTIs [odds ratio (OR) 59.256; 95% CI, 3.417-1,027.628; P=0.005], whereas congestive heart failure was identified as an independent risk factor for in-hospital mortality (OR 25.592; 95% CI, 2.376-275.629; P=0.008) in KP-CAUTI patients. CONCLUSIONS: Patients with KP-CAUTI displayed distinctive characteristics. cUTI and congestive heart failure were independently associated with ESBL expression and in-hospital mortality in patients with KPCAUTI.

Clinical epidemiology and outcomes of biliary tract infections caused by Klebsiella pneumoniae.

BACKGROUND: Biliary tract infection (BTI) is a common cause of bacteremia, and is associated with high morbidity and mortality. The clinical epidemiology and outcomes of BTI caused by Klebsiella pneumoniae (KP) have not been well investigated. METHODS: This was a retrospective study performed at a university teaching hospital in China from May 2012 to June 2017 that analyzed data for 119 patients with BTI caused by KP. We identified KP from bile cultures obtained before endoscopic or surgical treatment. Patients' demographic characteristics and clinical outcomes were also recorded. RESULTS: Forty-seven KP strains (39.5%) were positive for the extended spectrum beta-lactamase (ESBL) phenotype. The ESBL-positive group had a higher rate of stay in ICU [12.8% vs. 1.4% (ESBL-negative group); P=0.015] and a significantly longer hospital stay (30.79±31.512 vs. 20.06±23.945 days, respectively; P=0.037). There were no significant differences for 30-day mortality between the two groups; 112 (94.1%) patients survived and 7 (5.9%) died within 30-days of onset. Univariate analysis showed that nonsurvivors were significantly more likely to be older (66.46±22.34 vs. 46±14.84 years, respectively; P=0.001), and have hypoproteinemia (5/7, 71.4% vs. 21/112, 18.8%; P=0.006), immunosuppression (3/7, 42.9% vs. 4/112, 3.6%; P=0.004), solid tumors (5/7, 71.4% vs. 20/112, 17.9%; P=0.004), bloodstream infections (6/7, 85.7% vs. 22/112, 19.6%; P=0.001), and lower surgery rates (1/7, 14.3% vs. 66/112, 58.9%; P=0.042) compared with survivors, respectively. However, we found no significant independent risk factor for mortality. The malignant biliary obstruction group was significantly more likely to have chronic liver disease (P=0.035) than the benign biliary obstruction group, and mortality was higher for the malignant biliary obstruction group (5/25, 20% vs. 2/94, 2.1%, respectively; P=0.05). The malignant biliary group also had higher alkaline phosphatase, and direct and total bilirubin direct levels. Multivariate analysis showed that chronic liver disease was an independent risk factor in patients with malignant biliary disease [odds ratio (OR), 2.431; 95% confidence interval, 1.834-4.031; P=0.001]. CONCLUSIONS: Patients with BTI caused by KP were more likely to have the ESBL phenotype, and antibiotic resistance was not associated with overall survival. Patients with malignant biliary obstruction had higher mortality, and chronic liver disease was an independent risk factor.

Graphene oxide as an efficient antimicrobial nanomaterial for eradicating multi-drug resistant bacteria in vitro and in vivo.

Graphene is a novel two-dimensional nanomaterial with a growing number of practical applications across numerous fields. In this work, we explored potential biomedical applications of graphene oxide (GO) by systematically studying antibacterial capacity of GO in both macrophages and animal models. Three types of bacteria, including Klebsiella pneumoniae (Kp), Escherichia coli (E. coli) and P. aeruginosa (Pa) were used for in vitro study. Kp was also selected as a representative multidrug resistant (MDR) bacterium for in vivo study. In in vitro study, GO effectively eradicated Kp in agar dishes and thus protected alveolar macrophages (AM) from Kp infection in the culture. In the in vivo evaluation, GO were introduced intranasally into mouse lungs followed by testing organ tissue damage including lung, liver, spleen, and kidneys, polymorphonuclear neutrophil (PMN) penetration, bacterial dissemination, and mortality in Kp-infected mice. We found that GO can prohibit the growth and spread of Kp both in vitro and in vivo, resulting in significantly increased cell survival rate, less tissue injury, subdued inflammatory response, and prolonged mice survival. These findings indicate that GO could be a promising biomaterial for effectively controlling MDR pathogens.