<i>Klebsiella Pneumoniae</i> Infection on a Rehabilitation Unit: Epidemiologic Typing Methods

Thompson, William F.; Romance, L.; Bialkowska-Hobrazanska, H.; Rennie, R. P.; Ashton, F.; Nicolle, LE

doi:10.1086/646716

Cited by 15 publications

(5 citation statements)

References 30 publications

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“…Our result indicates a close relatedness of the colibactin gene cluster to K1 type. The relatively higher prevalence of colibactin genes demonstrated here might be related to the fact that serotype K1 was the most frequently identified type in Taiwan [42], but it ranked eighth in European survey [43].…”

Section: Resultsmentioning

confidence: 72%

Genotoxic Klebsiella pneumoniae in Taiwan

et al. 2014

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BackgroundColibactin is a nonribosomal peptide-polyketide synthesized by multi-enzyme complexes encoded by the pks gene cluster. Colibactin-producing Escherichia coli have been demonstrated to induce host DNA damage and promote colorectal cancer (CRC) development. In Taiwan, the occurrence of pyogenic liver abscess (PLA) has been suggested to correlate with an increasing risk of CRC, and Klebsiella pneumoniae is the predominant PLA pathogen in TaiwanMethodology/Principal FindingsAt the asn tRNA loci of the newly sequenced K. pneumoniae 1084 genome, we identified a 208-kb genomic island, KPHPI208, of which a module identical to the E. coli pks colibactin gene cluster was recognized. KPHPI208 consists of eight modules, including the colibactin module and the modules predicted to be involved in integration, conjugation, yersiniabactin production, microcin production, and unknown functions. Transient infection of BALB/c normal liver cells with K. pneumoniae 1084 increased the phosphorylation of histone H2AX, indicating the induction of host DNA damage. Colibactin was required for the genotoxicity of K. pneumoniae 1084, as it was diminished by deletion of clbA gene and restored to the wild type level by trans-complementation with a clbA coding plasmid. Besides, BALB/c mice infected with K. pneumoniae 1084 exhibited enhanced DNA damage in the liver parenchymal cells when compared to the isogenic clbA deletion mutant. By PCR detection, the prevalence of pks-positive K. pneumoniae in Taiwan is 25.6%, which is higher than that reported in Europe (3.5%), and is significantly correlated with K1 type, which predominantly accounted for PLA in Taiwan.ConclusionsOur knowledge regarding how bacteria contribute to carcinogenesis has just begun. The identification of genotoxic K. pneumoniae and its genetic components will facilitate future studies to elucidate the molecular basis underlying the link between K. pneumoniae, PLA, and CRC.

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Section: Resultsmentioning

confidence: 72%

Genotoxic Klebsiella pneumoniae in Taiwan

et al. 2014

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“…The strains studied by Putze et al came from a European collection while those studied by Lai et al , came from a collection in Taiwan. The highly virulent serotype K1 is the most frequent in Taiwan [ 31 ], but is ranked only eighth in Europe [ 32 ], and most K1 strains (66%) in the study conducted by Lai et al appeared to be positive for pks [ 30 ]. The overrepresentation of pks in K1 strains was confirmed by screening a total of 400 K. pneumoniae isolates showing that 78.8% of K1 strains were pks positive [ 33 ].…”

Section: Distribution Of the Pks Islandmentioning

confidence: 99%

Colibactin: More Than a New Bacterial Toxin

Faïs

Delmas

Barnich

et al. 2018

Toxins

177

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Cyclomodulins are bacterial toxins that interfere with the eukaryotic cell cycle. A new cyclomodulin called colibactin, which is synthetized by the pks genomic island, was discovered in 2006. Despite many efforts, colibactin has not yet been purified, and its structure remains elusive. Interestingly, the pks island is found in members of the family Enterobacteriaceae (mainly Escherichia coli and Klebsiella pneumoniae) isolated from different origins, including from intestinal microbiota, septicaemia, newborn meningitis, and urinary tract infections. Colibactin-producing bacteria induce chromosomal instability and DNA damage in eukaryotic cells, which leads to senescence of epithelial cells and apoptosis of immune cells. The pks island is mainly observed in B2 phylogroup E. coli strains, which include extra-intestinal pathogenic E. coli strains, and pks E. coli are over-represented in biopsies isolated from colorectal cancer. In addition, pks E. coli bacteria increase the number of tumours in diverse colorectal cancer mouse models. Thus, colibactin could have a major impact on human health. In the present review, we will focus on the biological effects of colibactin, the distribution of the pks island, and summarize what is currently known about its synthesis and its structure.

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“…Plasmid profile analysis has been widely used to differentiate K. pneumoniae strains in epidemiological studies. This method is of limited value because genetically unrelated strains may harbor the same plasmids (2,4) and related strains may lose unstable plasmids (22,23). In our study, all ESBL-producing K. pneumoniae isolates tested had detectable plasmids, allowing their classification into three different plasmid profiles that were in agreement with clusters defined by chromosomal fingerprints.…”

Section: Discussionmentioning

confidence: 50%

“…Serotyping of capsular antigen displayed six serotypes. Although this classical method is valued for its reproducibility and stability, its usefulness was limited in some studies by a high proportion of nontypeable strains (23). In our experience, this method correlated poorly with molecular typing techniques; isolates concordantly grouped in the same clone by all genomic methods displayed as many as three distinct serotypes, indicating antigenic instability.…”

Section: Discussionmentioning

confidence: 83%

“…Understanding the epidemiology of ESBL-producing K. pneumoniae requires the use of accurate epidemiological markers able to differentiate between the spread of resistance plasmids and strain dissemination. Initially, K. pneumoniae strains were characterized by capsular serotyping and plasmid analysis (2,21,23). Subsequently, pulsed-field gel electrophoresis (PFGE) analysis of genome macrorestriction fragments was shown to be a more discriminating typing technique (1,22).…”

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confidence: 99%

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Comparison of pulsed-field gel electrophoresis and randomly amplified DNA polymorphism analysis for typing extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae

et al. 1996

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The incidence and transmission patterns of extended-spectrum-␤-lactamase (ESBL)-producing Klebsiella pneumoniae in patients admitted to the intensive care unit (ICU) of a university hospital were investigated over a 3-year period. K. pneumoniae isolates were characterized by antibiotic susceptibility, capsular serotyping, plasmid profiles, and pulsed-field gel electrophoresis (PFGE) of genome macrorestriction patterns with XbaI, and the results were compared with those obtained by typing with the randomly amplified polymorphic DNA (RAPD) patterns. The discriminatory power of RAPD typing was evaluated for three primers. The incidence of isolation of ESBL-producing K. pneumoniae was 2.5 cases per 1,000 admissions to the ICU versus 0.35 cases per 1,000 admissions to other units (relative risk, 7.03; 95% confidence interval, 3.89 to 12.69). Infection developed in 53% of evaluable patients. Thirty-six percent of the cases were possibly acquired in other institutions. Isolates from ICU patients were subdivided into six capsular serotypes and into four clonal groups based on antibiotype, plasmid content, and PFGE and RAPD patterns. Two clones were associated with clusters of cross-infection, involving 5 and 12 patients, respectively. Following implementation of contact isolation precautions, the incidence of nosocomial acquisition of ESBL-producing K. pneumoniae decreased from 0.55 to 0.26 cases per 1,000 admissions (P ‫؍‬ 0.03). PFGE and RAPD analysis showed concordant results and comparable discrimination for differentiation between groups of epidemiologically related strains of ESBLproducing K. pneumoniae. More subclonal variants were determined among epidemic clones by PFGE analysis than by RAPD analysis. Both methods are useful for typing K. pneumoniae strains in epidemiological investigations, although RAPD analysis is more efficient.

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Klebsiella Pneumoniae Infection on a Rehabilitation Unit: Epidemiologic Typing Methods

Cited by 15 publications

References 30 publications

Genotoxic Klebsiella pneumoniae in Taiwan

Genotoxic Klebsiella pneumoniae in Taiwan

Colibactin: More Than a New Bacterial Toxin

Comparison of pulsed-field gel electrophoresis and randomly amplified DNA polymorphism analysis for typing extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae

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