Klebsiella pneumoniae bacteraemia in a region of Canada

Abstract

The second case of magA+ rmpA+ hypermucoviscosity phenotype Klebsiella pneumoniae infection was documented in Canada, in an immigrant from Algeria. To ascertain whether this represented recent importation of the strain or local transmission within Canada, a retrospective study of K. pneumoniae bacteraemia was conducted in the region, from 1997 to 2007, and 411 episodes were identified. No epidemiological evidence for local transmission of this strain was found. However, for the first time, the population incidence of K. pneumoniae bacteraemia was determined, which increased by 82% between 1997 and 2007, from 10.2 to 18.7 per 100 000 inhabitants. Incidence increased dramatically with age and with the presence of diabetes, but remained stable over time within each stratum. The proportion of patients with K. pneumoniae bacteraemia who were diabetic increased from 26% (1997-2004) to 42% (2005-2007). The rising incidence of K. pneumoniae bacteraemia may represent an unexpected consequence of the expanding population of adult diabetics.

Population‐Based Surveillance for Hypermucoviscosity Klebsiella pneumoniae Causing Community‐Acquired Bacteremia in Calgary, Alberta

“…Division of Microbiology, Calgary Laboratory Services; Departments of 2 Pathology & Laboratory Medicine; 3 Medicine; 4 Microbiology and Infectious Diseases; 5 Critical Care, University of Calgary, Calgary, Alberta Correspondence: Dr Daniel B Gregson, Calgary Laboratory Services, #9, 3535 Research Road Northwest, Calgary, Alberta T2L 2K8.…”

“…During the past decade, community-acquired infections due to hypermucoviscous K pneumoniae, consisting of primary liver abscess, meningitis and endophthalmitis, were first recognized in Southeast Asia. These phenotypes of K pneumoniae have also been associated with bacteremia (2) and pneumonia (3,4), especially in patients with comorbid conditions such as diabetes mellitus (1). Hypermucoviscous isolates of K pneumoniae appear to be common in Taiwan and South Africa (5) but rare in Western Europe and North America (5,6).…”

Occurrence and determinants of Klebsiella species bloodstream infection in the western interior of British Columbia, Canada

“…A number of studies have identified co-morbidities most notably cancer and diabetes as risk factors for development of Klebsiella species BSI [1,14,[30][31][32][33][34]. However, with the exception of the population-based investigation reported by Meatherall et al, these studies have been within selected cohorts that are at significant potential risk for bias.…”

“…Population-based studies minimize a number of important biases and have been recognized as optimal designs to evaluate the epidemiology of BSIs [12]. However, to our knowledge only three previous studies have evaluated Klebsiella species BSI in non-selected populations [1,13,14].…”

“…illnesses were identified as significant risks and included (incidence rate ratio; 95% confidence interval) cerebrovascular accident (5.9; 3.3-9.9), renal disease 4.3; 2.5-7.0), cancer (3.8; 2.6-5.5), congestive heart failure (3.5; 1.6-6.6), dementia (2.9; 1.5-5.2), diabetes mellitus (2.6; 1.7-3.9), and chronic obstructive pulmonary disease (2.3; 1.5-3.5). Of the 141 (93%) patients admitted to hospital, the median hospital length stay was 8 days (interquartile range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. The in-hospital and 30-day all cause case-fatality rates were 24/141 (17%) and 27/151 (18%), respectively.CONCLUSIONS Klebsiella species BSI is associated with a significant burden of illness particularly among those with chronic comorbid illnesses.…”