Antibiotic Resistance and Clinical Presentation of Healthcare-associated Hypervirulent Klebsiella pneumoniae Infection

Background: Hypervirulent K. pneumoniae is usually presented as community acquired liver abscess associated with rmpA and magA genes that confers a mucoid phenotype. The aim of present study is to evaluate antibiotic resistance and clinical presentation of hypevirulent K. pneumoniaein healthcare-associated infection.

Methods: The study was performed on 414 K. pneumoniae isolates recovered from different specimens collected from Keimyung university of Dongsan medical center from December 2013 through November 2015. Asymptomatic colonizers were excluded. The hypermucoviscous phenotype was found in 155 isolates (37.4%) among the 414 isolates. We compared healthcare-associated hypervirulent K. pneumoniaeinfection with community acquired infection.

Results: In healthcare-associated infection, 60 isolates (24.2%) were hypervirulent K. pneumoniae. In community acquired infection 90 isolates (53.8%) were hypervirulent. Sputum origin K. pneumoniae was more associated with healthcare-associated infection (25(41.7%) vs. 26(27.4%), p=0.048). Also respiratory infection was most common source in healthcare-associated infection (32(53.3%) vs. 31(32.6%), p=0.012). Antibiotic resistance was higher in most usable antibiotics. In healthcare-associated hypervirulent K. pneumoniae was more correlated with non-K1/K2 serotype and less association with rmpAgene(40(67.8%) vs. 81(86.2%), p=0.008).

Conclusion: In our study 38% of hypervirulent K. pneumoniae is healthcare-associated infection. This is higher than previous data and also showed higher antibiotic resistance than classical phenotype. Pneumonia is most common infection source beside intraabdominal infection in community origin. Also, well known association with K1/K2 serotype and rmpA gene is differ in healthcare-associated infection. This result suggests that healthcare-associated hypervirulent K. pneumoniae may have different microbiological characteristics from classical community origin. Further investigation is needed for other virulent factor associate with healthcare-associated hypervirulent K. pneumoniae.