Mucoviscous characteristics of Klebsiella pneumoniae strains: A factor of clinical severity?

INTRODUCTION: Hypermucoviscous Klebsiella pneumoniae (KP) strains are responsible for complicated bacteremia with multiple septic sites (liver, central nervous system, muscles). We aimed to compare the clinical severity of patients presenting with KP bacteremia based on the hypermucoviscous or non-hypermucoviscous characteristic of the strains. METHODS: Observational retrospective study successively including all patients with KP bacteremia from May 2013 to March 2015 at the tertiary medical center of New Caledonia. The hypermucoviscous characteristic was defined by the string test results and molecular analysis to determine the capsular serotype. RESULTS: A total of 55 bacteremic patients were included in the study; 27% of isolated strains were hypermucoviscous. Hypermucoviscous strains accounted for two-thirds of community-acquired infections (72.5% vs. 33.4%, p=0.01). The rate of intensive care hospitalization was high (hypermucoviscous 46.7%; standard 52.5%) without any difference between the two groups. No significant difference was observed in case fatality (hypermucoviscous 46.7% vs. standard 15%, p=0.07) but patients with hypermucoviscous strains had longer hospital stays (73.5 days versus 50.7 days, p=0.04) and longer persistence of positive blood cultures despite an appropriate treatment (OR 1.41, 95% CI: 1.0-1.96, p=0.045). CONCLUSION: Hypermucoviscous KP bacteremia account for most community-acquired Klebsiella infections in New Caledonia and are associated with longer hospital stay and persistence of positive blood cultures despite the implementation of an appropriate treatment.

[Interest of echocardiography in the diagnosis and monitoring of a pulmonary embolism complicating a free-floating thrombus in right heart cavities]. / Intérêt de l'échocardiographie dans le diagnostic et la prise en charge d'une embolie pulmonaire grave associée à un thrombus mobile des cavités cardiaques droites.

We report the case of a 50-year-old patient admitted in ICU for a pulmonary embolism associated with a large thrombus in right heart cavities discovered during an assessment of faintness. Despite an excellent haemodynamic tolerance, there was a systolic and diastolic right ventricular failure and immediate threat to life. The treatment mainly relies on intravenous thrombolysis with excellent results both on thrombus lysis and on the right heart performance. Echocardiography proved to be an essential tool during the management of this patient to ensure the effectiveness and to monitor the whole procedure of thrombolysis.