Case of Meningitis in a Neonate Caused by an Extended-Spectrum-Beta-Lactamase-Producing Strain of Hypervirulent Klebsiella pneumoniae

Abstract

Klebsiella pneumoniae is one of the most important infectious agents among neonates. This pathogen has a potential to develop an increased antimicrobial resistance and virulence. The classic non-virulent strain of K. pneumoniae, producing an extended-spectrum beta-lactamases (ESBL), is associated with nosocomial infection mainly in preterm neonates. Hypervirulent K. pneumoniae strains are associated with invasive infection among previously healthy ambulatory patients, and most of them exhibit antimicrobial susceptibility. During the last few years, several cases of diseases caused by hypervirulent K. pneumoniae producing ESBL have been registered in different geographical regions of the world. However, reports of such cases in neonates are rare. Here, we reported that this pathogen can cause pyogenic meningitis in full-term neonate with poor prognosis. A previously healthy, full-term, 12-day-old neonate was admitted to the infectious diseases hospital with suspected meningitis. The clinical symptoms included loss of appetite, irritability, fever, seizures, and a bulging anterior fontanelle. The analysis of the cerebrospinal fluid confirmed the diagnosis of meningitis. Blood and cerebrospinal fluid cultures were positive for K. pneumoniae, producing ESBL. K. pneumoniae isolates were resistant to aminopenicillins, 3rd generation cephalosporins but were sensitive to imipenem and meropenem. The “string test” was positive. The study of the virulence factors of K. pneumoniae by PCR revealed the presence of the rmpA gene. A combination of K. pneumoniae virulence and drug resistance complicated by cerebral oedema led to the death of the neonate. We concluded that both the risk of developing severe forms of infection and the outcome of the disease due to K. pneumonia are associated with the phenotypic features of the pathogen such as its antibiotic susceptibility and virulence factors. Emergence of the ESBL-producing strain of hypervirulent K. pneumoniae could represent a new serious threat to public health, suggesting an urgent need to enhance clinical awareness and epidemiological surveillance.

Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China

“…A distinct variant of K. pneumoniae characterized by a hypermucoviscous phenotype has been recognized as an important pathogen responsible for endogenous endophthalmitis in some regions of Asian, especially in Taiwan [22] and Korea [23]. Although most HVKP strains displayed susceptibility to most classes of antibiotics, a few cases of infections caused by ESBL-producing HVKP have already been reported [8–10]. However, to the best of our knowledge, this is the first report of endophthalmitis caused by K1-serotype HVKP coharboring AmpC β-lactamase and ESBL genes.…”

“…However, an increase of antimicrobial resistance in HVKP has been observed in recent years. A series of cases including liver abscess, bacteremia and meningitis caused by extended-spectrum β-lactamase (ESBL)-producing HVKP have already been reported [8–10]. Here, we present the first case of endophthalmitis associated with multidrug resistant HVKP coharboring ESBL, AmpC β-lactamase and 16S rRNA methylase genes in China.…”

High Prevalence of Plasmid-Mediated Quinolone Resistance Determinants Among Serotype K1 Hypervirulent Klebsiella pneumoniae Isolates in China

“…K lebsiella pneumoniae is a common pathogen causing nosocomial and community-acquired infections. 1,2 Hypervirulent K. pneumoniae (hvKP) infection have been reported worldwide. 3 Serotype K1 hvKP (K1-hvKP) has emerged as the most clinically important pathogen causing liver abscess with metastatic infections at other body sites.…”

Virulence and Antibiotic Resistance of Isolates of Klebsiella Pneumoniae in Newborns With Localized and Generalized Forms of Infection

“…В настоящее время случаи клебсиеллезной инфекции, вызванной hv-KP, регистрируют по всему миру [16,17]. При этом, как показывает практика, наибольшую опасность представляют случаи, связанные с гипервирулентными штаммами, способными одновременно продуцировать и БЛРС [18,19]. Именно такое сочетание гипервирулентности с множественной лекарственной устойчивостью штаммов K. pneumoniae представляет колоссальную опасность для пациентов.…”