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Infection

, Volume 38, Issue 6, pp 459–464 | Cite as

Clinical and microbiological characteristics of Klebsiella pneumoniae isolates causing community-acquired urinary tract infections

  • W.-H. Lin
  • M.-C. Wang
  • C.-C. Tseng
  • W.-C. Ko
  • A.-B. Wu
  • P.-X. Zheng
  • J.-J. WuEmail author
Clinical and Epidemiological Study

Abstract

Background

Klebsiella pneumoniae is the second most common species causing urinary tract infections (UTI). However, the host factors and virulence genes of K. pneumoniae related to UTI are poorly understood. The aim of this study was to analyze the capsular phenotype and virulence genes of K. pneumoniae isolates and host factors potentially relevant to community-acquired UTI.

Methods

Fifty-four K. pneumoniae isolates from patients with community-acquired UTI, 76 isolates from healthy adults, and 29 from patients with community-acquired pneumonia were compared. The virulence genes (rmpA, magA, uge, and wabG) and serotype (K1, K2, K5, K20, K54, or K57) were characterized by polymerase chain reaction (PCR). The modified string test was used to determine the hypermucoviscosity.

Results

Diabetes mellitus was the most frequent underlying disease among UTI patients (53.7%, 29/54). No predominant K serotype was found in UTI strains. The hypermucoviscosity phenotype and rmpA gene were more often found in UTI isolates than in those from healthy adults (27.8 vs. 2.6%, P < 0.01; 29.6 vs. 11.8%, P < 0.01, respectively), whereas no significant difference in the frequency of magA, uge, wabG, or serotype genes was found. The prevalence of rmpA was significantly lower in isolates from patients with immunosuppression, chronic renal insufficiency, and urinary tract obstruction. Multivariate analysis showed that immunosuppression was negatively associated with the prevalence of rmpA.

Conclusion

Hypermucoviscosity was highly correlated with the presence of the rmpA gene in UTI strains, and rmpA may have a role in community-acquired UTI, especially in hosts without immunosuppression.

Keywords

Urinary tract infection Hypermucoviscosity Klebsiella pneumoniae Virulence factor 

Notes

Acknowledgments

We are very grateful to Robert M. Jonas for his helpful comments on the manuscript. This work was supported in part by grants NSC97-2311-B-006-004-MY3 and NSC96-2320-B-006-008 from the National Science Council and by grant NCKUH-9804021 from the National Cheng-Kung University Hospital, Taiwan.

Conflict of interest

None.

References

  1. 1.
    Foxman B, Zhang L, Tallman P, Palin K, Rode C, Bloch C, Gillespie B, Marrs CF. Virulence characteristics of Escherichia coli causing first urinary tract infection predict risk of second infection. J Infect Dis. 1995;172:1536–41.PubMedGoogle Scholar
  2. 2.
    Russo TA, Stapleton A, Wenderoth S, Hooton TM, Stamm WE. Chromosomal restriction fragment length polymorphism analysis of Escherichia coli strains causing recurrent urinary tract infections in young women. J Infect Dis. 1995;172:440–5.PubMedGoogle Scholar
  3. 3.
    Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med. 2000;160:797–805.CrossRefPubMedGoogle Scholar
  4. 4.
    Tseng CC, Huang JJ, Ko WC, Yan JJ, Wu JJ. Decreased predominance of papG class II allele in Escherichia coli strains isolated from adults with acute pyelonephritis and urinary tract abnormalities. J Urol. 2001;166:1643–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Tseng CC, Wu JJ, Liu HL, Sung JM, Huang JJ. Roles of host and bacterial virulence factors in the development of upper urinary tract infection caused by Escherichia coli. Am J Kidney Dis. 2002;39:744–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Tseng CC, Wu JJ, Wang MC, Hor LI, Ko YH, Huang JJ. Host and bacterial virulence factors predisposing to emphysematous pyelonephritis. Am J Kidney Dis. 2005;46:432–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Tseng CC, Huang JJ, Wang MC, Wu AB, Ko WC, Chen WC, Wu JJ. PapG II adhesin in the establishment and persistence of Escherichia coli infection in mouse kidneys. Kidney Int. 2007;71:764–70.CrossRefPubMedGoogle Scholar
  8. 8.
    Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon. 2003;49:71–82.CrossRefPubMedGoogle Scholar
  9. 9.
    Ko WC, Paterson DL, Sagnimeni AJ, Hansen DS, Von Gottberg A, Mohapatra S, Casellas JM, Goossens H, Mulazimoglu L, Trenholme G, Klugman KP, McCormack JG, Yu VL. Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis. 2002;8:160–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, Fung CP, Chuang YC. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 2006;42:1351–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Izquierdo L, Coderch N, Piqué N, Bedini E, Corsaro MM, Merino S, Fresno S, Tomás JM, Regué M. The Klebsiella pneumoniae wabG gene: role in biosynthesis of the core lipopolysaccharide and virulence. J Bacteriol. 2003;185:7213–21.CrossRefPubMedGoogle Scholar
  12. 12.
    Regué M, Hita B, Piqué N, Izquierdo L, Merino S, Fresno S, Benedí VJ, Tomás JM. A gene, uge, is essential for Klebsiella pneumoniae virulence. Infect Immun. 2004;72:54–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Ma LC, Fang CT, Lee CZ, Shun CT, Wang JT. Genomic heterogeneity in Klebsiella pneumoniae strains is associated with primary pyogenic liver abscess and metastatic infection. J Infect Dis. 2005;192:117–28.CrossRefPubMedGoogle Scholar
  14. 14.
    Gerlach GF, Clegg S, Allen BL. Identification and characterization of the genes encoding the type 3 and type 1 fimbrial adhesins of Klebsiella pneumoniae. J Bacteriol. 1989;171:1262–70.PubMedGoogle Scholar
  15. 15.
    Yeh KM, Kurup A, Siu LK, Koh YL, Fung CP, Lin JC, Chen TL, Chang FY, Koh TH. Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan. J Clin Microbiol. 2007;45:466–71.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee HC, Chuang YC, Yu WL, Lee NY, Chang CM, Ko NY, Wang LR, Ko WC. Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: association with invasive syndrome in patients with community-acquired bacteraemia. J Intern Med. 2006;259:606–14.CrossRefPubMedGoogle Scholar
  17. 17.
    Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med. 2004;199:697–705.CrossRefPubMedGoogle Scholar
  18. 18.
    Ku YH, Chuang YC, Yu WL. Clinical spectrum and molecular characteristics of Klebsiella pneumoniae causing community-acquired extrahepatic abscess. J Microbiol Immunol Infect. 2008;41:311–7.PubMedGoogle Scholar
  19. 19.
    Nassif X, Fournier JM, Arondel J, Sansonetti PJ. Mucoid phenotype of Klebsiella pneumoniae is a plasmid-encoded virulence factor. Infect Immun. 1989;57:546–52.PubMedGoogle Scholar
  20. 20.
    Farmer JJ III. Enterobacteriaceae: introduction and identification. In: Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology. Washington: American Society for Microbiology; 2007. p. 438–49.Google Scholar
  21. 21.
    Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.CrossRefPubMedGoogle Scholar
  22. 22.
    Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146:1913–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Struve C, Bojer M, Nielsen EM, Hansen DS, Krogfelt KA. Investigation of the putative virulence gene magA in a worldwide collection of 495 Klebsiella isolates: magA is restricted to the gene cluster of Klebsiella pneumoniae capsule serotype K1. J Med Microbiol. 2005;54:1111–3.CrossRefPubMedGoogle Scholar
  24. 24.
    Yu WL, Fung CP, Ko WC, Cheng KC, Lee CC, Chuang YC. Polymerase chain reaction analysis for detecting capsule serotypes K1 and K2 of Klebsiella pneumoniae causing abscesses of the liver and other sites. J Infect Dis. 2007;195:1235–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45:284–93.CrossRefPubMedGoogle Scholar
  26. 26.
    Lin JC, Chang FY, Fung CP, Xu JZ, Cheng HP, Wang JJ, Huang LY, Siu LK. High prevalence of phagocytic-resistant capsular serotypes of Klebsiella pneumoniae in liver abscess. Microbes Infect. 2004;6:1191–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Kabha K, Nissimov L, Athamna A, Keisari Y, Parolis H, Parolis LAS, Grue RM, Schlepper-Schafer J, Ezekowitz AR, Ohman DE, Ofek I. Relationships among capsular structure, phagocytosis, and mouse virulence in Klebsiella pneumoniae. Infect Immun. 1995;63:847–52.PubMedGoogle Scholar
  28. 28.
    Simoons-Smit AM, Verweij-van Vught AM, MacLaren DM. The role of K antigens as virulence factors in Klebsiella. J Med Microbiol. 1986;21:133–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Fung CP, Chang FY, Lee SC, Hu BS, Kuo BI, Liu CY, Ho M, Siu LK. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut. 2002;50:420–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Tsay RW, Siu LK, Fung CP, Chang FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med. 2002;162:1021–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Yu VL, Hansen DS, Ko WC, Sagnimeni A, Klugman KP, von Gottberg A, Goossens H, Wagener MM, Benedi VJ; International Klebseilla Study Group. Virulence characteristics of Klebsiella and clinical manifestations of K. pneumoniae bloodstream infections. Emerg Infect Dis. 2007;13:986–93.PubMedGoogle Scholar
  32. 32.
    Stamm WE, Hooton TM, Johnson JR, Johnson C, Stapleton A, Roberts PL, Moseley SL, Fihn SD. Urinary tract infections: from pathogenesis to treatment. J Infect Dis. 1989;159:400–6.PubMedGoogle Scholar
  33. 33.
    Wiselka MJ. Bacterial and host factors in the pathogenesis of UTI. In: Cattell WR, editor. Infections of the kidney and urinary tract. New York: Oxford University Press; 1996. p. 1597–654.Google Scholar
  34. 34.
    Chuang YP, Fang CT, Lai SY, Chang SC, Wang JT. Genetic determinants of capsular serotype K1 of Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis. 2006;193:645–54.CrossRefPubMedGoogle Scholar

Copyright information

© Urban & Vogel 2010

Authors and Affiliations

  • W.-H. Lin
    • 1
    • 2
  • M.-C. Wang
    • 2
  • C.-C. Tseng
    • 2
  • W.-C. Ko
    • 2
  • A.-B. Wu
    • 2
  • P.-X. Zheng
    • 3
  • J.-J. Wu
    • 1
    • 3
    Email author
  1. 1.Institute of Clinical MedicineNational Cheng-Kung University Hospital, National Cheng Kung University College of MedicineTainanTaiwan
  2. 2.Department of Internal MedicineNational Cheng-Kung University Hospital, National Cheng Kung University College of MedicineTainanTaiwan
  3. 3.Department of Medical Laboratory Science and BiotechnologyNational Cheng-Kung University College of MedicineTainanTaiwan

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