Klebsiella pneumoniae Oropharyngeal Carriage in Rural and Urban Vietnam and the Effect of Alcohol Consumption

Dao, Trinh Tuyet; Liebenthal, Dror; Tran, Toan Khanh; Vu, Bich Ngoc Thi; Nguyen, Diep N.; Tran, Huong Kieu Thi; Nguyen, Chuc Kim Thi; Vu, Huong; Fox, Annette; Horby, Peter; Nguyen, Kinh Van; Wertheim, Heiman

doi:10.1371/journal.pone.0091999

Cited by 58 publications

(53 citation statements)

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“…In our study, ESBL production was detected among 6.1% K. pneumoniae from CABSI, which is consistent with the low ESBL prevalence of 4.1% among K. pneumoniae oropharyngeal carriers reported previously from northern Vietnam [24]. The rate of ESBL-production in E. coli (45%) was higher than in Thailand (CABSI, 11.8%) and Korea (31.3% in HABSI and 8.8% in CABSI) and comparable to the prevalence of ESBL among E. coli isolates in BSI in Cambodia (47.7%), [15, 17, 25].…”

Section: Discussionsupporting

confidence: 92%

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

Dat

The

et al. 2017

BMC Infect Dis

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BackgroundBloodstream infections (BSIs) are associated with high morbidity and mortality worldwide. However their aetiology, antimicrobial susceptibilities and associated outcomes differ between developed and developing countries. Systematic data from Vietnam are scarce. Here we present aetiologic data on BSI in adults admitted to a large tertiary referral hospital for infectious diseases in Hanoi, Vietnam.MethodsA retrospective study was conducted at the National Hospital for Tropical Diseases between January 2011 and December 2013. Cases of BSI were determined from records in the microbiology department. Case records were obtained where possible and clinical findings, treatment and outcome were recorded. BSI were classified as community acquired if the blood sample was drawn ≤48 h after hospitalization or hospital acquired if >48 h.ResultsA total of 738 patients with BSI were included for microbiological analysis. The predominant pathogens were: Klebsiella pneumoniae (17.5%), Escherichia coli (17.3%), Staphylococcus aureus (14.9%), Stenotrophomonas maltophilia (9.6%) and Streptococcus suis (7.6%). The overall proportion of extended spectrum beta-lactamase (ESBL) production among Enterobacteriaceae was 25.1% (67/267 isolates) and of methicillin-resistance in S. aureus (MRSA) 37% (40/108). Clinical data was retrieved for 477 (64.6%) patients; median age was 48 years (IQR 36–60) with 27.7% female. The overall case fatality rate was 28.9% and the highest case fatality was associated with Enterobacteriaceae BSI (34.7%) which accounted for 61.6% of all BSI fatalities.Conclusions Enterobacteriaceae (predominantly K. pneumoniae and E. coli) are the most common cause of both community and hospital acquired bloodstream infections in a tertiary referral clinic in northern Vietnam.

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Section: Discussionsupporting

confidence: 92%

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

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The

et al. 2017

BMC Infect Dis

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“…Two recent studies investigated carriage of K. pneumoniae in the respiratory tracts of healthy individuals in communities in Asia, using bacteriological culture. A 2010 study in Indonesia detected nasopharyngeal carriage in 15% of adults and 7% of children 11 , while a 2014 study in Vietnam detected nasopharyngeal carriage in 2.7% of adults and throat carriage in 14% 12 . In addition, it has recently been shown that patients suffering from CP K. pneumoniae infections (typically clonal group 258), or from pyogenic liver abscess caused by hypervirulent K. pneumoniae (typically clonal group 23), frequently carry their infecting strain in their GI tract for between 30 days (≤74%) and six months (<30%) following discharge from hospital 13 .…”

Section: Introductionmentioning

confidence: 98%

Gastrointestinal carriage is a major reservoir ofK. pneumoniaeinfection in intensive care patients

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Mirčeta

Wick

et al. 2016

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BackgroundKlebsiella pneumoniae is an opportunistic pathogen and a leading cause of hospitalassociated (HA) infections. Patients in intensive care units (ICUs) are particularly at risk, and outbreaks are frequently reported in ICUs. K. pneumoniae is also part of the healthy human microbiome, providing a potential reservoir for HA infection. However, the frequency of K. pneumoniae gut colonization and its contribution to HA infections are not well characterized.

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“…It readily colonizes human mucosal surfaces especially the gastrointestinal (GI) tract and oropharynx (Bagley, 1985; Dao et al, 2014; Rock et al, 2014). In immunocompromised hosts, it can invade other sites leading to severe infections (Paczosa and Mecsas, 2016).…”

Section: Introductionmentioning

confidence: 99%

Molecular Mechanisms of Colistin Resistance in Klebsiella pneumoniae Causing Bacteremia from India—A First Report

et al. 2017

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Colistin has long been a reserve drug used for the treatment of carbapenem resistant Klebsiella pneumoniae. Carbapenem resistance in K. pneumoniae has been increasing and is as high as 44% in India. Although a reserve agent, with rise in rates of resistance to carbapenems, the usage of colistin has increased over the years leading to slow emergence of resistance. Colistin resistance is mainly mediated by the alteration in the LPS of bacterial outer membrane with the addition of L-Ara4-N and PEtN molecules. These alterations are mediated by mutations in several genes involved in lipidA modifications and most commonly mutations in mgrB gene has been reported. Recently there is emergence of plasmid mediated resistance due to mcr-1 and mcr-2 genes which poses a threat for the rapid global spread. This study aims at characterizing eight colistin resistant K. pneumoniae from bacteremia by whole genome sequencing. Eight K. pneumoniae were isolated from blood culture during 2013 and 2014 at the Department of Clinical Microbiology, Christian Medical College, India. Antimicrobial susceptibility testing was performed and minimum inhibitory concentration (MIC) was determined for colistin and polymyxin B by broth-micro dilution method. Whole genome sequencing was performed using Ion Torrent and the genome of all eight isolates was analyzed. The eight isolates were resistant to all the antimicrobials expect tigecycline. MIC of colistin and polymyxin B were ranged from 4 to 1024 μg/ml and 0.5 to 2048 μg/ml respectively. Multiple mutations were observed in the chromosomal genes involved in lipid A modifications. mcr-1 and mcr-2 gene was absent in all the isolates. The most significant were mutations in mgrB gene. Among the eight isolates, four, three and one were belonged to sequence types ST 231, ST14 and ST147 respectively. Seven isolates had blaOXA−48 like, one co-expressed blaNDM−1 and blaOXA−48 like genes leading to carbapenem resistance. Overall, multiple numbers of alterations have been observed. This includes silent mutations, point mutations, insertions and/or deletions. Mutations in mgrB gene is responsible for resistance to colistin in this study. Due to emergence of resistance to reserve drugs, there is a need for combination therapies for carbapenem resistant K. pneumoniae and colistin must be judiciously used.

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Klebsiella pneumoniae Oropharyngeal Carriage in Rural and Urban Vietnam and the Effect of Alcohol Consumption

Cited by 58 publications

References 24 publications

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

Bacterial bloodstream infections in a tertiary infectious diseases hospital in Northern Vietnam: aetiology, drug resistance, and treatment outcome

Gastrointestinal carriage is a major reservoir ofK. pneumoniaeinfection in intensive care patients

Molecular Mechanisms of Colistin Resistance in Klebsiella pneumoniae Causing Bacteremia from India—A First Report

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