AccScience Publishing / MI / Online First / DOI: 10.36922/mi.2600
Submit to MI
Cite this article
69
Download
849
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
CASE SERIES

Klebsiella pneumoniae-related rare multi-site infections: A case series

Shanshan Jin1† ,  Yu Zhang1† ,  Lina Zhao1 ,  Qiuping Huang1 ,  Hui Xie1 ,  Jian Lu1* ,  Ruilan Wang1,2*
Show Less
1 Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200080, China
2 Department of Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai 200080, China
MI 2024, 1(1), 112–120; https://doi.org/10.36922/mi.2600
Submitted: 31 December 2023 | Accepted: 27 February 2024 | Published: 27 March 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

The incidence of Klebsiella pneumoniae (KP)-related rare multi-site infections has been progressively rising in China, highlighting the need for heightened awareness of the devastating complications associated with metastatic infections caused by this bacterium. This article describes the cases of six adult patients diagnosed with KP-related multi-site infections at a tertiary hospital in China from 2020 to 2022. The cases report a detailed examination of clinical features, laboratory test findings, bacterial culture results, imaging examinations, treatments administered, and subsequent outcomes. Notably, metastatic infections developed in four patients with uncontrolled diabetes. Despite strict glycemic control and timely antibiotic administration in three patients, their conditions deteriorated rapidly. The unfavorable prognosis in these patients may be attributed to delayed medical intervention, inadequate diabetes control, and unattended abscesses. The findings of this case series underscore the importance of glycemic control, percutaneous abscess drainage, and appropriate antibiotic selection in managing KP infections. Attaining early diagnosis and treatment of KP-related multi-site infections could potentially enhance patient outcomes.

Keywords
Klebsiella pneumoniae
Meningitis
Liver abscess
Metastatic infections
Case report
Funding
This study was supported by the Shen Kang Hospital Development Center Project for Technical Standardization Management and Promotion (Grant no. SHDC22023239), and the Shanghai Hospital Development Center Foundation (Grant no. SHDC22022206).
Conflict of interest
The authors declare no conflicts of interest.
References
  1. Friedlander C. On the schizomycetes in acute fibrous pneumonia. Virchows Arch Pathol Anat Physiol Clin Med. 1882;87:319-324. doi: 10.1007/BF01880516

 

  1. Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: A new and dangerous breed. Virulence. 2013;4(2):107-118. doi: 10.4161/viru.22718

 

  1. Lin YT, Liu CJ, Chen TJ, Fung CP. Long-term mortality of patients with septic ocular or central nervous system complications from pyogenic liver abscess: A population-based study. PLoS One. 2012;7(3):e33978. doi: 10.1371/journal.pone.0033978

 

  1. Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae - clinical and molecular perspectives. J Intern Med. 2020;287(3):283-300. doi: 10.1111/joim.13007

 

  1. Yang X, Dong N, Chan EW, Zhang R, Chen S. Carbapenem resistance-encoding and virulence-encoding conjugative plasmids in Klebsiella pneumoniae. Trends Microbiol. 2021;29(1):65-83. doi: 10.1016/j.tim.2020.04.012

 

  1. Chelvaraj R, Thamotaran T, Yee CM, Fong CM, Zhe NQ, Azhany Y. The invasive Klebsiella pneumoniae syndrome: Case series. J Taibah Univ Med Sci. 2021;17(2):332-339. doi: 10.1016/j.jtumed.2021.10.012

 

  1. Kaza P, Xavier BB, Mahindroo J, et al. Extensively drug-resistant Klebsiella pneumoniae associated with complicated urinary tract infection in Northern India. Jpn J Infect Dis. 2024;77(1):7-15. doi: 10.7883/yoken.JJID.2023.009

 

  1. Pham MH, Hoi LT, Beale MA, et al. Evidence of widespread endemic populations of highly multidrug resistant Klebsiella pneumoniae in hospital settings in Hanoi, Vietnam: A prospective cohort study. Lancet Microbe. 2023;4(4):e255-e263. doi: 10.1016/S2666-5247(22)00338-X

 

  1. Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29(12):1099- 1106. doi: 10.1086/592412

 

  1. Saccente M. Klebsiella pneumoniae liver abscess, endophthalmitis, and meningitis in a man with newly recognized diabetes mellitus. Clin Infect Dis. 1999;29(6):1570-1571. doi: 10.1086/313519

 

  1. Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: A new invasive syndrome. Lancet Infect Dis. 2012;12(11):881-887. doi: 10.1016/S1473-3099(12)70205-0

 

  1. Yu WL, Chan KS, Ko WC, Lee CC, Chuang YC. Lower prevalence of diabetes mellitus in patients with Klebsiella pneumoniae primary liver abscess caused by isolates of K1/ K2 than with non-K1/K2 capsular serotypes. Clin Infect Dis. 2007;45(12):1529-1532. doi: 10.1086/523006

 

  1. Casanova C, Lorente JA, Carrillo F, Pérez-Rodríguez E, Núñez N. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1989;149(7): 1467-1473. doi: 10.1001/archinte.1989.00390060171048

 

  1. Sheu SJ, Kung YH, Wu TT, Chang FP, Horng YH. Risk factors for endogenous endophthalmitis secondary to Klebsiella pneumoniae liver abscess: 20-year experience in Southern Taiwan. Retina. 2011;31(10):2026-2031. doi: 10.1097/IAE.0b013e31820d3f9e

 

  1. Barichello T, Simões LR, Valvassori SS, et al. Klebsiella pneumoniae meningitis induces memory impairment and increases pro-inflammatory host response in the central nervous system of Wistar rats. J Med Microbiol. 2014;63(Pt 1): 111-117. doi: 10.1099/jmm.0.063289-0

 

  1. Jung J, Park KH, Park SY, et al. Comparison of the clinical characteristics and outcomes of Klebsiella pneumoniae and Streptococcus pneumoniae meningitis. Diagn Microbiol Infect Dis. 2015;82(1):87-91. doi: 10.1016/j.diagmicrobio.2015.02.006

 

  1. Sun R, Zhang H, Xu Y, Zhu H, Yu X, Xu J. Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: A review of the literature and description of three cases. BMC Infect Dis. 2021;21(1):15. doi: 10.1186/s12879-020-05702-3

 

  1. Dvoretsky LI, Yakovlev SV, Sergeeva EV, Kolendo SE. Abscess of the spleen in a patient with infectious endocarditis. Ter Arkh. 2018;90(11):98-101. doi: 10.26442/terarkh2018901198-101

 

  1. Grubor N, Colovic R, Colovi N, Radak V. Abscess of the spleen. Srp Arh Celok Lek. 2005;133(1-2):46-51. doi: 10.2298/SARH0502046G

 

  1. Sarda AK, Lal P, Singh L, Bhalla SA, Goyal A. Splenic abscess due to enteric fever. JIACM. 2004;5(3):269-271.

 

  1. Kusuhara K, Nakao F, Saito M, et al. Pyogenic splenic abscess in an infant with serological evidence of cat scratch disease. Eur J Pediatr. 2007;166(12):1289-1291. doi: 10.1007/s00431-006-0386-7

 

  1. Radojevic N, Vukmirovic F, Curovic I, Soc M. Asymptomatic syphilitic massive necrosis of the spleen in late syphilis. Int J STD AIDS. 2013;24(11):912-915. doi: 10.1177/0956462413490145

 

  1. Yu WY, Zhu KJ, Li QP, Lou C, He DW. Successful medical drainage and surgical treatment for vertebral osteomyelitis and bilateral psoas abscess with gas formation caused by Klebsiella pneumoniae in a diabetic patient. Rev Assoc Med Bras (1992). 2019;65(5):678-681. doi: 10.1590/1806-9282.65.5.678

 

  1. Rahim GR, Gupta N, Maheshwari P, Singh MP. Monomicrobial Klebsiella pneumoniae necrotizing fasciitis: An emerging life-threatening entity. Clin Microbiol Infect. 2019;25(3):316-323. doi: 10.1016/j.cmi.2018.05.008

 

  1. Dylewski JS, Dylewski I. Necrotizing fasciitis with Klebsiella liver abscess. Clin Infect Dis. 1998;27(6):1561-1562. doi: 10.1086/517760

 

  1. Cheng NC, Tai HC, Chang SC, Chang CH, Lai HS. Necrotizing fasciitis in patients with diabetes mellitus: Clinical characteristics and risk factors for mortality. BMC Infect Dis. 2015;15:417. doi: 10.1186/s12879-015-1144-0

 

  1. Rahim GR, Gupta N, Maheshwari P, Singh MP. Monomicrobial Klebsiella pneumoniae necrotizing fasciitis: An emerging life-threatening entity. Clin Microbiol Infect. 2019;25(3):316-323. doi: 10.1016/j.cmi.2018.05.008

 

  1. Chiu CY, Miller SA. Clinical metagenomics. Nat Rev Genet. 2019;20(6):341-355. doi: 10.1038/s41576-019-0113-7

 

  1. Gu W, Deng X, Lee M, et al. Rapid pathogen detection by metagenomic next-generation sequencing of infected body fluids. Nat Med. 2021;27(1):115-124. doi: 10.1038/s41591-020-1105-z

 

  1. Peng JM, Du B, Qin HY, Wang Q, Shi Y. Metagenomic next-generation sequencing for the diagnosis of suspected pneumonia in immunocompromised patients. J Infect. 2021;82:22-27. doi: 10.1016/j.jinf.2021.01.029

 

  1. Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY. Klebsiella pneumoniae liver abscess: A new invasive syndrome. Lancet Infect Dis. 2012;12(11):881-887. doi: 10.1016/S1473-3099(12)70205-0

 

  1. Zerem E, Hadzic A. Sonographically guided percutaneous catheter drainage versus needle aspiration in the management of pyogenic liver abscess. AJR Am J Roentgenol. 2007;189(3):W138-W142. doi: 10.2214/AJR.07.2173

 

  1. Ch Yu S, Hg Lo R, Kan PS, Metreweli C. Pyogenic liver abscess: Treatment with needle aspiration. Clin Radiol. 1997;52(12):912-916. doi: 10.1016/S0009-9260(97)80223-1

 

  1. Cai YL, Xiong XZ, Lu J, et al. Percutaneous needle aspiration versus catheter drainage in the management of liver abscess: A systematic review and meta-analysis. HPB (Oxford). 2015;17(3):195-201. doi: 10.1111/hpb.12332

 

  1. Jun JB. Klebsiella pneumoniae liver abscess. Infect Chemother. 2018;50(3):210-218. doi: 10.3947/ic.2018.50.3.210

 

  1. Akhondi H, Sabih DE. Liver abscess. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538230 [Last accessed on 2023 Jul 03].

 

  1. Chen SC, Lee YY, Chen YH, Lin HS, Wu TT, Sheu SJ. Klebsiella pneumoniae infection leads to a poor visual outcome in endogenous endophthalmitis: A 12-year experience in Southern Taiwan. Ocul Immunol Inflamm. 2017;25(6):870-877. doi: 10.1080/09273948.2016.1193616

 

  1. Lu X, Ng DS, Zheng K, et al. Risk factors for endophthalmitis requiring evisceration or enucleation. Sci Rep. 2016;6:28100. doi: 10.1038/srep28100

 

  1. Levitz RE, Quintiliani R. Trimethoprim-sulfamethoxazole for bacterial meningitis. Ann Intern Med. 1984;100(6):881-890. doi: 10.7326/0003-4819-100-6-881

 

  1. Cherubin CE, Marr JS, Sierra MF, Becker S. Listeria and gram-negative bacillary meningitis in New York City, 1972- 1979. Frequent causes of meningitis in adults. Am J Med. 1981;71(2):199-209. doi: 10.1016/0002-9343(81)90106-6

 

  1. Yang KC, Shrestha T, Kolakshyapati M, et al. Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult: A case report. Medicine (Baltimore). 2018;97(25):e11017. doi: 10.1097/MD.0000000000011017

 

  1. Santaella RO, Fishman EK, Lipsett PA. Primary vs secondary iliopsoas abscess. Arch Surg. 1995;130(12):1309-1313. doi: 10.1001/archsurg.1995.01430120063009
Share
Back to top
Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept