Hypermucoviscous Klebsiella pneumoniae infections induce platelet aggregation and apoptosis and inhibit maturation of megakaryocytes

Wang, Zhiwei; Ren, Jianan; Liu, Qinjie; Li, Jiayang; Wu, Xiuwen; Wang, Weiping; Wu, Jie; Wang, Gefei; Li, Jieshou

doi:10.1016/j.thromres.2018.09.053

Cited by 12 publications

(12 citation statements)

References 41 publications

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“… 19 In mouse KP infection models, thrombocytopenia was observed as well. 20 Furthermore, hypermucoviscous KP strains caused more obvious thrombocytopenia than classic KP strains. 20 These may be related to lipopolysaccharide (LPS) released by KP.…”

Section: Discussionmentioning

confidence: 99%

“… 20 Furthermore, hypermucoviscous KP strains caused more obvious thrombocytopenia than classic KP strains. 20 These may be related to lipopolysaccharide (LPS) released by KP. 20 LPS could stimulate cell apoptosis via many pathways, such as TLR4/NF-κB and JNK/MAPK.…”

Section: Discussionmentioning

confidence: 99%

“… 20 These may be related to lipopolysaccharide (LPS) released by KP. 20 LPS could stimulate cell apoptosis via many pathways, such as TLR4/NF-κB and JNK/MAPK. 21 , 22 The intrinsic apoptosis pathway was of importance to platelet survival.…”

Section: Discussionmentioning

confidence: 99%

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A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

Chen¹,

Ying²,

Jiang³

et al. 2022

IDR

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Background Our study aimed to explore the risk factors in bloodstream infections Klebsiella pneumoniae (BSI-KP) patients and establish nomograms to predict the probability of BSI-CRKP and the prognosis of BSI-KP. Methods A total of 252 BSI-KP patients were enrolled from a tertiary teaching hospital between January 1, 2015, and May 31, 2020. Risk factors associated with BSI-CRKP and factors associated with the 30-day mortality were identified using LASSO analysis, univariate and multivariate analysis. Results There were 121 (48.0%) patients with carbapenem-resistant K. pneumoniae (CRKP) and 131 (52.0%) patients with carbapenem-susceptible K. pneumoniae (CSKP). The multivariate logistic regression analysis demonstrated that gastric tube indwelling before BSI (OR=2.442, P=0.043) and more types of antibiotics use before BSI (OR=1.305, P=0.009) were independent risk factors for BSI-CRKP. And previous transplantations, prior ICU stay, gastric tube indwelling before BSI, more types of antibiotics use before BSI, lower Hb and cholinesterase were associated with CRKP-BSI. The C-index of models indicated its good accuracy (C-index 0.816, 95% CI 0.763–0.868). In patients with BSI-CRKP, further logistic regression analysis revealed urinary catheterization (OR=0.298, P=0.017) was found to be an independent risk factor for 30-day mortality, while ceftazidime/avibactam use (OR=8.438, P=0.003) was an independent favorable prognostic factor. The nomogram predicated CRKP, ICU hospitalization, more types of antibiotics use, tigecycline, PLT, urinary catheterization were associated with 30-day mortality in patients with BSI-KP. The discriminative ability of the predictive model, as assessed by C-index, was 0.813 (95% CI: 0.780–0.867). Conclusion Previous transplantations, prior ICU stay, gastric tube indwelling before BSI, more types of antibiotics use before BSI, lower Hb and cholinesterase represent significant risk factors for the development of BSI-CRKP. Our nomogram predicated thrombocytopenia was a sign for poor prognosis. Tigecycline resulted in higher mortality for patients with BSI-KP. Rational use of nomograms may help clinicians make better Clinical decisions when treating BSI-KP patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

Chen¹,

Ying²,

Jiang³

et al. 2022

IDR

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“…This result is consistent with a previous study, showing that a blood-culture-confirmed bacterial infection and thrombocytopenia were associated with a poor prognosis [ 38 ]. The mechanism by which the bacteria affect the platelets is understood to involve adenosine-diphosphate-induced platelet aggregation and apoptosis and the inhibition of megakaryocytes [ 39 ]. Despite the need for subsequent studies, including a precise assessment of pathogen serotypes, adequate measures should be developed in order to achieve a better prognosis while maintaining a higher PWR.…”

Section: Discussionmentioning

confidence: 99%

Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess

Park

Kim

et al. 2022

Diagnostics

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The platelet-to-white blood cell ratio (PWR) has been reported to predict the severity of patients with various diseases. However, no previous studies have assessed the use of the PWR as a prognostic marker for pyogenic liver abscesses (PLA). This observational retrospective study was performed between January 2008 and December 2017, including 833 patients with PLA from multiple centers. The enrolled patients, on average, had a PWR of 17.05, and 416 patients had a PWR lower than 17.05. A total of 260 patients (31.2%) with PLA showed complications of metastatic infection, pleural effusion and abscess rupture. A low PWR level was identified as a strong risk factor for metastatic infection and pleural effusion. The low PWR group also had a longer hospital stay. In the multivariate analysis, old age, anemia, albumin and CRP levels and unidentified pathogens were significant factors for low PWR levels. A low PWR, old age, male sex, abscess size, albumin, ALP and unidentified causative pathogens showed significant associations with a hospital stay longer than 28 days. As a result, PLA patients presenting with a low PWR were shown to have more complications and a poor prognosis. Considering its cost-effectiveness, PWR could be a novel biomarker used to predict a prognosis of PLA.

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“…However, we did not find a correlation between ESBL-producing KPLA and hepatic venous thrombophlebitis. Studies have shown that hypermucoviscous KP infections induce platelet aggregation, and platelet hyperreactivity may be associated with a higher risk of vascular complications [42,43]. Within the inflammatory microenvironment, endothelial cell activation and endothelial barrier destruction could promote bacterial migration [44,45].…”

Section: Discussionmentioning

confidence: 99%

Clinical and computed tomography features of extended-spectrum β-lactamase-producing Klebsiella pneumoniae liver abscess

et al. 2020

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Background: Klebsiella pneumoniae (KP) is the primary pathogen associated with pyogenic liver abscesses (PLAs). Moreover, there has been an increase in the proportion of extended-spectrum beta-lactamase (ESBL)-producing KP. However, the clinical and computed tomography (CT) features of liver abscesses caused by ESBL-producing KP have not been separately described. We aimed to compare the clinical and CT features present in patients with ESBL-producing and non-ESBL-producing KP as well as to determine the risk factors for ESBL-producing KP liver abscesses (KPLAs). Methods: We performed a retrospective analysis of data obtained from the medical records of patients with a first episode of KPLA admitted to Shengjing Hospital of China Medical University between May 2015 and May 2019. We compared the clinical and CT features between patients with ESBL-producing and non-ESBL-producing KPLA. Results: We enrolled 100 patients with KPLA (14 and 86 in the ESBL-producing and non-ESBL-producing groups, respectively). There was no significant between-group difference in the proportion of patients with comorbid diabetes (71.43% vs. 66.2%, p = 0.086). The ESBL-producing KPLA group had a greater proportion of patients with a history of biliary disease (78.57% vs. 26.74%, p < 0.001) and gastrointestinal malignancy (50% vs. 6.98%, p < 0.001). Multivariate regression analysis showed that a history of biliary disease was an independent risk factor for ESBL-producing KPLA. Compared with the non-ESBL-producing KPLA group, the ESBL-producing KPLA group had a significantly higher intensive care unit (ICU) admission rate (28.57% vs. 2.33%, p < 0.001). All ESBL-producing KP isolates were susceptible to carbapenems and amikacin. Only the presence of multiloculation on CT was found to be significantly different between the groups (50% vs. 82.56%, p = 0.012). Conclusions: The presence of biliary disease was an independent risk factor for ESBL-producing KPLA. Patients with ESBLproducing KPLA had a higher ICU admission rate, with only half of patients having evidence of multiloculation on CT.

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Hypermucoviscous Klebsiella pneumoniae infections induce platelet aggregation and apoptosis and inhibit maturation of megakaryocytes

Cited by 12 publications

References 41 publications

A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

A Novel Nomogram for Predicting Risk Factors and Outcomes in Bloodstream Infections Caused by Klebsiella pneumoniae

Platelet-to-White Blood Cell Ratio: A Feasible Biomarker for Pyogenic Liver Abscess

Clinical and computed tomography features of extended-spectrum β-lactamase-producing Klebsiella pneumoniae liver abscess

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