Liver abscess due to Klebsiella pneumoniae: Risk factors for metastatic infection

Yoon, Jin‐Kook; Kim, Youn Jeong; Jun, Yoon Hee; Kim, Sang Il; Kang, Ji Young; Suk, Ki Tae; Kim, Dong Joon

doi:10.3109/00365548.2013.851414

Cited by 38 publications

(56 citation statements)

References 19 publications

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“…We observed that the crude annual incidence of PLA and KP-PLA increased significantly from 1994–2004 to 2004–2015, which could be due to larger number of inpatients and improved early diagnostic techniques. In short, PLA and KP-PLA are common health problems in mainland China, which consistent with the recent epidemiological trends observed in other countries and regions6121319202122232425.…”

Section: Discussionsupporting

confidence: 87%

“…Klebsiella pneumoniae (K. pneumoniae ) is a gram-negative bacterium. In the late 1980’s, K. pneumoniae induced PLA (KP-PLA) was first described in Taiwan5, and highlighted with subsequent case reports and clinical studies in the Asia-Pacific region678910. Up to now, K. pneumoniae is considered to surpass Escherichia coli (E. coli ) to become the predominant cause of PLA over the past three decades1112.…”

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confidence: 99%

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A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Qian

Wong

Lai

et al. 2016

Sci Rep

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Pyogenic liver abscess (PLA) is a common intra-abdominal infection in adults. In this study, we aim to explore demographic and clinical characteristics of PLA focusing on Klebsiella pneumoniae (K. pneumoniae) induced PLA (KP-PLA) in mainland China. A retrospective review of medical records from all patients with KP-PLA admitted to a tertiary teaching hospital over a 21-year period (1994–2015) was performed. Among 296 PLA cases with confirmed culture-positive data, K. pneumoniae was revealed as the predominant pathogen (n = 189, 63.9%), followed by Escherichia coli (n = 39, 13.2%). Strikingly, KP-PLA patients had a higher incidence of metabolic disorders, such as diabetes mellitus (49.7% vs. 36.4%, P = 0.027; odds ratio (OR): 1.725; 95% confidence interval (CI): 1.061–2.805), hypertension (38.1% vs. 19.6%, P = 0.001; OR: 2.520; 95% CI: 1.439–4.413), and fatty liver (32.3% vs. 14.0%, P = 0.001; OR: 2.923; 95% CI: 1.564–5.462) than those with non-K. pneumoniae induced PLA (non-KP-PLA). Moreover, patients with KP-PLA had higher susceptibility to septic metastatic infection at distant sites compared to those with non-KP-PLA (10.6% vs. 3.7%, p = 0.038). Our results indicate that K. pneumoniae is the predominant pathogen of PLA in mainland China. KP-PLA is frequently diagnosed in patients with metabolic diseases and has a higher risk for septic metastatic infection.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Qian

Wong

Lai

et al. 2016

Sci Rep

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“…In addition, because of the acquisition of extended-spectrum β-lactamases and carbapenemases, such as the recently described NDM-1 [4], multi, extremely or pan-drug resistant clinical strains are more frequently isolated [5,6]. In addition, K. pneumoniae has re-emerged as a cause of community-acquired infections including pneumonia and the characteristic syndrome of pyogenic liver abscess, with possible complications including endophthalmitis or meningitis [7,8]. K. pneumoniae is, thus, an important virulent pathogen able to cause serious infections in ambulatory, otherwise healthy hosts and to spread within patients [5,9] that requires a better understanding of the molecular mechanisms underlying the various forms of its pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of Klebsiella pneumoniae genomes identifies a phospholipase D family protein as a novel virulence factor

et al. 2014

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BackgroundKlebsiella pneumoniae strains are pathogenic to animals and humans, in which they are both a frequent cause of nosocomial infections and a re-emerging cause of severe community-acquired infections. K. pneumoniae isolates of the capsular serotype K2 are among the most virulent. In order to identify novel putative virulence factors that may account for the severity of K2 infections, the genome sequence of the K2 reference strain Kp52.145 was determined and compared to two K1 and K2 strains of low virulence and to the reference strains MGH 78578 and NTUH-K2044.ResultsIn addition to diverse functions related to host colonization and virulence encoded in genomic regions common to the four strains, four genomic islands specific for Kp52.145 were identified. These regions encoded genes for the synthesis of colibactin toxin, a putative cytotoxin outer membrane protein, secretion systems, nucleases and eukaryotic-like proteins. In addition, an insertion within a type VI secretion system locus included sel1 domain containing proteins and a phospholipase D family protein (PLD1). The pld1 mutant was avirulent in a pneumonia model in mouse. The pld1 mRNA was expressed in vivo and the pld1 gene was associated with K. pneumoniae isolates from severe infections. Analysis of lipid composition of a defective E. coli strain complemented with pld1 suggests an involvement of PLD1 in cardiolipin metabolism.ConclusionsDetermination of the complete genome of the K2 reference strain identified several genomic islands comprising putative elements of pathogenicity. The role of PLD1 in pathogenesis was demonstrated for the first time and suggests that lipid metabolism is a novel virulence mechanism of K. pneumoniae.

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“…Olgumuzda da diabetes mellitus saptanmadı. Yapılan çalışmalarda metastatik infeksiyon sıklığı %9.9-13 arasında değişmekte olup en sık göz tutulumu izlenmektedir (5)(6)(7)15,16). Benzer şekilde olgumuzda da endoftalmi gelişti.…”

Section: İrdelemeunclassified

“…Chang ve arkadaşları (20) tarafından yapılan bir çalışmada K. pneumoniae'ye bağlı tek apsenin varlığıyla metastatik infeksiyon gelişmesi arasında ilişki olduğu bulunmuştur. Bir diğer çalışmada özellikle diabetes mellitus varlığı ve trombositopeninin saptanması metastatik infeksiyonla ilişkili bulunmuştur (16). Olgumuzun da tek apsesi vardı; ancak diabetes mellitus ve trombositopenisi yoktu.…”

Section: İrdelemeunclassified

Invasive Liver Abscess Syndrome Caused by Klebsiella pneumoniae and Metastatic Infection Causing Vision Loss: A Case Report

Hamidi¹,

Öncül²,

Cetin³

et al. 2015

Klimik Dergisi

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Pyojenik karaciğer apsesi intraabdominal ve biliyer sistem infeksiyonlarının yaygın olmayan bir komplikasyonudur. İnfeksiyon komşuluk yoluyla direkt olarak ya da apandisit ve divertikülit gibi infeksiyon odaklarından hematojen yayılıma bağlı olarak gelişir (1-3). Pyojenik karaciğer apseleri gastrointestinal kanal yoluyla asandan olarak geliştiğinden genellikle polimikrobiktir (1). Ancak Tayvan ve bazı Doğu Asya ülkelerinden yapılan yayınlar-da, özellikle diyabetik hastalarda, intraabdominal ve biliyer sistemle ilgili predispozan faktörler olmaksızın Klebsiella pneumoniae'nin tek etken olarak saptandığı bir invazif karaciğer apsesi sendromu tanımlanmıştır (4-7). Bu olgularda %13 oranında metastatik infeksiyon olarak göz ve merkezi sinir sistemi tutulumu görülmüştür (7). K. pneumoniae'nin K1 ve K2 serotipinin özellikle diya- AbstractInvasive liver abscess syndrome caused by Klebsiella pneumoniae was first reported from Taiwan and related researches were generally conducted in Eastern Asian countries. However, in recent years similar cases are described all around the world. A minority of patients with primary liver abscess develop metastatic infection at other site of the body, but it is more prevalent when the etiologic agent is K. pneumoniae, especially K1 and K2 serotypes. The most common manifestations of metastatic infection are endophthalmitis, meningitis and brain abscess. A 49-year-old non-diabetic male who presented with primary liver abscess due to K. pneumoniae accompanied by endophthalmitis as a metastatic infection is reported to draw attention to this syndrome with high morbidity. Permanent complete vision loss occurred despite systemic and local antibiotic treatment and percutaneous drainage. Serologic subtyping and virulence analysis of the etiologic agent should be performed when this syndrome is suspected. Klimik Dergisi 2015; 28(3): 129-31.

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Liver abscess due to Klebsiella pneumoniae: Risk factors for metastatic infection

Abstract: Clinicians must be aware of potential metastatic infections in patients with KPLA, especially if they have diabetes mellitus and thrombocytopenia. The APACHE II score was predictive of mortality in patients with KPLA.

Cited by 38 publications

References 19 publications

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Comparative analysis of Klebsiella pneumoniae genomes identifies a phospholipase D family protein as a novel virulence factor

Invasive Liver Abscess Syndrome Caused by Klebsiella pneumoniae and Metastatic Infection Causing Vision Loss: A Case Report

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