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Survey of Klebsiella pneumoniae bacteraemia in two South Australian hospitals and detection of hypermucoviscous phenotype and magA/rmpA genotypes in K . pneumoniae isolates

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Abstract

Purpose

Clinical patterns of Klebsiella pneumoniae bacteraemia vary geographically. An invasive syndrome involving abscess formation has emerged in recent years. Putative virulence factors associated with this syndrome include colony hypermucoviscosity, and magA and rmpA genes. We studied epidemiologic and microbiologic characteristics of K. pneumoniae bacteraemia at two South Australian hospitals and identified cases of K. pneumoniae invasive syndrome. We determined the frequency of the hypermucoviscosity, magA and rmpA genes among bacteraemic and selected non-bacteraemic isolates.

Methods

Thirty-one patients with K. pneumoniae bacteraemia treated between June 2010 and July 2011 were included. Existing records were examined for relevant clinical and microbiological data. Urinary and wound isolates were also examined. Hypermucoviscosity was identified by a positive string test, whilst polymerase chain reaction detected magA and rmpA positive isolates.

Results

Of 31 blood culture isolates, 22 were associated with community-acquired infection. Biliary infection was the commonest source, occurring in ten patients. Three patients had K. pneumoniae invasive syndrome, all of Asian extraction (p = 0.0044). Four blood isolates demonstrated one or more of hypermucoviscosity, magA or rmpA; three were from patients with liver abscesses. Liver abscess isolates were all K1 serotype and had similar PFGE profiles.

Conclusions

This study augments understanding of local epidemiology and microbiology of K. pneumoniae bacteraemia. It confirms local emergence of K. pneumoniae invasive syndrome and implicates the role of magA and rmpA genes in its pathogenesis.

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Acknowledgments

Rolf Wise and Allan Goodwin (SA Pathology) provided guidance and supervision in performing PCR testing for magA and rmpA. Adam Jenney at Alfred Hospital supplied magA/rmpA positive isolates for PCR controls. John Field at Basil Hetzel Institute assisted with statistical analysis and data presentation. Microbiological Diagnostic Unit at the University of Melbourne performed capsular serotyping and PFGE. Peter Speck reviewed the manuscript and provided feedback.

Conflict of interest

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Authors and Affiliations

  1. SA Pathology, Adelaide, SA, Australia

    Lisa Chang, Ivan Bastian & Morgyn Warner

  2. The Queen Elizabeth Hospital, Woodville South, SA, Australia

    Lisa Chang & Morgyn Warner

  3. Royal Adelaide Hospital, Adelaide, SA, Australia

    Lisa Chang & Morgyn Warner

  4. The University of Adelaide, Adelaide, SA, Australia

    Ivan Bastian & Morgyn Warner

  5. Department of Microbiology, St Vincent’s Hospital, Fitzroy 3065, Victoria, Australia

    Lisa Chang

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  1. Lisa Chang
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  2. Ivan Bastian
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Correspondence to Lisa Chang.

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Chang, L., Bastian, I. & Warner, M. Survey of Klebsiella pneumoniae bacteraemia in two South Australian hospitals and detection of hypermucoviscous phenotype and magA/rmpA genotypes in K . pneumoniae isolates. Infection 41, 559–563 (2013). https://doi.org/10.1007/s15010-012-0374-y

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  • DOI: https://doi.org/10.1007/s15010-012-0374-y

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