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Introduction Carbapenems are frequently used in the treatment of multidrug-resistant infections caused by Klebsiella pneumoniae. The aim of the study is to definition and incidence of transferable carbapenemase genes of carbapenem resistant K. pneumoniae (CRKP) and to determine clonal relatedness of these strains in tertiary care hospital in Turkey. Methods Identification of all 100 K. pneumoniae isolates and low sensitivity to any of the carbapenem group antibiotics were determined by Vitek-2 (BioMerieux, France). The frequency of carbapenemase genes (blaOXA-48, blaNDM, blaKPC, blaVIM, blaIMP) and extended spectrum beta-lactamase (ESBL) genes (blaCTX-M, blaSHV, blaTEM) which frequently detected in Turkey, have been investigated by multiplex polymerase chain reaction (PCR). Clonal relatedness was determined using Pulsed-field gel electrophoresis(PFGE). Results Ninety five isolates carried at least one of the carbapenemase genes (81.05% blaOXA-48, 38.9% blaNDM, 9.47% blaKPC,1.05% blaVIM). One isolate was carried the blaOXA-48+KPC and the two isolates were carried the blaKPC+NDM. PFGE demonstrated the presence of 24 pulse types and 63.09% of the isolates were in four main pulse types. Conclusions This study demonstrated the incidence of blaNDM is beginning to reach endemic levels, in addition to blaOXA-48 found endemic in Turkey. To our knowledge, this is the first report of the co-production of these two genes (blaKPC + NDM and blaOXA-48 + KPC) in CRKP isolates.

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) are a global threat. Here, we describe the clinical and molecular characteristics of Centers for Disease Control and Prevention (CDC)-defined CRE in the US. METHODS: The second Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE-2, ClinicalTrials.gov: NCT03646227) is a prospective, multicenter, cohort study. Patients hospitalized in 49 US hospitals, with clinical cultures positive for CDC-defined CRE between 30 April 2016 and 31 August 2017 were included. Primary outcome was desirability of outcome ranking (DOOR) at 30 days. Clinical data and bacteria were collected, and whole genome sequencing (WGS) was performed. FINDINGS: 1,040 patients with unique isolates were included; 449 (43%) with infection and 591 (57%) with colonization. CDC-defined CRE admission rate was 57 CDC-defined CRE admissions/100,000 admissions (95% CI: 45–71). Three subsets of CDC-defined CRE were identified: carbapenemase-producing Enterobacteriaceae (618/1,040, 59%); non-carbapenemase-producing CRE (194/1,040, 19%); and unconfirmed CRE (228/1,040, 22%; initially reported as CRE, but susceptible to carbapenems in two central laboratories). Klebsiella pneumoniae carbapenemase (KPC)-producing clonal group 258 K. pneumoniae was the most common carbapenemase-producing Enterobacteriaceae. In 449 patients with CDC-defined CRE infections, DOOR outcomes were not significantly different in patients with carbapenemase-producing Enterobacteriaceae, non-carbapenemase-producing CRE, and unconfirmed CRE. At 30 days 107/449 (24%, 95% CI 20–28%) patients had died. INTERPRETATION: Among patients with CDC-defined CRE, similar outcomes were observed among three subgroups, including the novel unconfirmed CRE group. CDC-defined CRE represent diverse bacteria, whose spread may not respond to interventions directed to carbapenemase-producing Enterobacteriaceae. FUNDING: National Institutes of Health

Pancreaticoduodenectomy (PD) is a complex procedure with a morbidity rate of 40%-50%. We evaluated the incidence, associated factors, etiologic characteristics, and outcome of pyogenic liver abscess (PLA), a rare infectious complication of PD.We retrospectively assessed the data of patients who underwent PD (n = 326) between January 2012 and February 2017 at a single institution. Patients who developed PLA after PD were matched (1:3) for age, sex, and pathologic diagnosis with patients without PLA after PD. Patients who developed PLA without abdominal operation history (n = 77) were also reviewed in the same period.Eleven patients (3.4%) developed PLA after PD; diabetes (5/11, 45.5% versus 4/33, 12.1%; P = 0.031) increased the risk of PLA after PD. The preoperative and postoperative fasting blood glucose (FBG) was significantly higher in PLA+ group than PLA- group: preoperative FBG (median: 7.39 versus 4.49; P 0.01), postoperative FBG (median: 8.98 versus 5.68; P 0.01). The occurrence of multiple liver abscess was significantly higher in patients with PLA after PD than patients who developed PLA without abdominal operation history (7/11 versus 22/77; P = 0.036). Microbial pus culture was positive in eight patients with PLA after PD (n = 8/11) and in forty-one patients who developed PLA without abdominal operation history (n = 41/77). Klebsiella pneumoniae was the most commonly isolated microorganism in PLA patients with or without a history of PD (5/8, 62.5% versus 34/41, 82.9%; P = 0.333).Patients with diabetes (including impaired fasting plasma glucose) have a higher risk of developing PLA after PD. Multiple liver abscess was the most common type of PLA after PD; K pneumoniae should be covered when empirically treated patients with PLA.

In this study, the pure, pale white, powdery nature and pigment produced endophytic actinomycetes strains were isolated from marine Sea grasses sample. The isolated strains were endophytes as confirmed by surface sterilization and validation methods. The anti-bacterial efficacy materials of the crude compound were extracted by liquid–liquid extraction using various organic solvents. Anti-bacterial efficacy of the isolated actinomycetes strain RMN 10 was exhibited excellent anti-bacterial activity against K. pneumoniae at increasing concentration. In addition, the minimum inhibition concentration (MIC) of the crude actinomycetes compound has excellent anti-bacterial activity at 250 µg/mL concentration and this concentration was fixed as a MIC. Further, the structural and shape damages of actinomycetes crude compound treated K. pneumoniae cells were clearly identified in SEM images. All the invitro experiments were proved that the actinomycetes compound has excellent anti-bacterial activity against K. pneumoniae.

Klebsiella pneumoniae is among the most important pathogens found in hospitals. The emergence of multiple antibiotic resistant K. pneumoniae associated with its virulence factors is a worldwide concern and its early identification is crucial, especially for controlling the spread of emerging clones. This article reports a high prevalence of multiresistant K. pneumoniae in a university hospital in southern Brazil, harboring several virulence and β-lactamase encoding genes, including pandrug-resistant high-risk international clones belonging to the clonal group 258 (ST11, ST15, ST101, ST258, ST340 and ST874).

A total of 82 extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and 4 Klebsiella oxytoca isolates were collected in 2014 from four geographical areas in Bulgaria and their multilocus sequence type (MLST) and transferability of the ESBL encoding genes were investigated. The predominant type was CTX-M-15 (87%), followed by CTX-M-3 (9%), SHV-12 or SHV-2 (2%) and CTX-M-14 (1%). The CTX-M-15 producers belonged to ST15 (34.1%) and to a lesser extent to CC17 (ST16, ST17, ST336). The CTX-M-15 transconjugants showed a presence of R, A/C 2 and F replicons. The CTX-M-3 producers were assigned to ST29, ST70, ST432, ST542 and ST15 types and the transconjugants carried M 2 replicons. To the best of our knowledge, this is the first report that fully describes the MLST types among Bulgarian ESBL producing K. pneumoniae and the first report of the detection of IncR plasmid replicon type in our country.

Summary Background and aim NDM-1 gene ( bla NDM−1) -producing Klebsiella pneumoniae is allegedly perceived as one of the most dangerous multidrug-resistant bacteria causing infections in hospitals and clinic domains. In numerous Asian countries, sporadic studies have been conducted to investigate the prevalence of bla NDM−1 -producing K. pneumoniae. In the present study, we determine the precise prevalence of bla NDM−1 -producing K. pneumoniae in different parts of Asia indeed. Methods Several international databases including Medline, Embase, and Web of sciences were searched from March 2005 to Jan 2016 to discern studies addressed the prevalence of bla NDM−1 -producing K. pneumoniae in Asia. Comprehensive meta-analysis (V2.2, Biostat) software was used to interpret the data. Results Of the 595 records identified from the databases, 19 studies fulfilled the eligibility criteria ostensibly. The analyses manifested that the prevalence of bla NDM− -producing K. pneumoniae was 32.5% [95% confidence interval (95% CI) 22.6–44.3] in the analyzed Asian countries. Hence, the further stratified analyses indicated that the prevalence of bla NDM−1 -producing K. pneumoniae was higher in the probes, particularly after 2010. Conclusions The relatively high prevalence of bla NDM−1 -producing K. pneumoniae merits our analysis. Moreover, regular surveillance for hospital-associated infection, monitoring antibiotic sensitivity pattern, and formulation of definite antibiotic policies advocates viable roles for prevention and control of bla NDM−1 -producing K. pneumoniae .

The aim of this study was to determine whether the route of extended-spectrum β-lactamase (ESBL) transmission to hospitalized newborns was from their mothers during delivery. Neonatal intensive care unit (NICU) hospitalized newborns were sampled for ESBL presence by stool cultures on the first and fourth days of life. Mothers of ESBL-positive newborns were sampled for possible correlation detection. Bacteria isolates were molecularly identified and susceptibility tests for antibiotic agents were performed. Of the 225 newborns, 14 (6.2%) were ESBL positive, 10 (4.4%) were Escherichia coli positive, and 4 (1.7%) were Klebsiella pneumoniae positive. Among the 14 mothers of positive newborns, 13 (92.8%) were found ESBL positive and one mother of a newborn with E. coli carriage was found ESBL negative. Genes encoding for ESBL resistance were identified. Antibiotic sensitivity and resistance were tested. This study demonstrated that ESBL bacteria carrier neonates hospitalized in NICU may be a result of transmission from mother to baby during delivery.

1. Department of Genetics, Ecology and Evolution (GEE), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 2. Institute of Health Sciences, Federal University of Bahia, Salvador, BA, Brazil. 3. Department of Microbiology, Immunology and Parasitology, Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil. 4. Laboratory of Clinical Pathology, Hospital das Clinicas, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 5. Tiradentes University, Technology and Research Institute, Biomaterials Laboratory, Aracaju, Sergipe, Brazil. 6. Swedish University of Agricultural Sciences, Uppsala, Sweden. 7. Department of Computer Science, Virginia Commonwealth University, Richmond, Virginia, 23284, USA. 8. Institute of Integrative Omics and Applied Biotechnology (IIOAB), Nonakuri, Purba Medinipur, West Bengal 721137, India. 9. Molecular and Computational Biology of Fungi Laboratory, Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. 10. AQUACEN – National Reference Laboratory of Aquatic Animal Disease, Ministry of Agriculture, Livestock and Food Supply, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. 11. Institute of Veterinary Medicine, University of Gottingen, Burckhardtweg 2, Gottingen, Germany. 12. Goncalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.

Klebsiella pneumoniae is the most clinically relevant species of this genus, known to cause both community-acquired and nosocomial infections worldwide. In the past two decades, a distinct hypervirulent strain of K pneumoniae, characterised by its hypermucoviscous phenotype, has emerged as a clinically significant pathogen responsible for highly invasive infections. We present a case of osteomyelitis due to hypervirulent K pneumoniae reported in the USA. Genomic testing of the K pneumoniae isolate was performed due to the striking clinical presentation of the infection as well as the hypermucoid nature of the isolates, raising the suspicion for possible infection with the hypervirulent strain. Whole-genome sequencing and additional PCR testing demonstrated the isolate to be a K1 serotype, sequence type 23 strain expressing rmpA and rmpA2. Given the multiple reports of this pathogen causing invasive infections, clinicians should be aware of the possible presentation of metastatic and severe infection, including osteomyelitis, due to the hypervirulent strain of K pneumoniae not typical of classic K pneumoniae variants. In this Grand Round, we review the clinical features of hypervirulent K pneumoniae and its link to invasive infections, and discuss the need for improved awareness and identification of the pathogen.

Introduction Rapid diagnosis of bacterial infection is an important for patient management and appropriate therapy during the early phase of bacteria-induced disease. Among the existing techniques for identifying pathogens were less sensitive and time-consuming processes. PCR has the benefits of excellent sensitivity, resolution and reproducibility. Materials and methods A multiplex PCR assay was designed for simultaneous detection and diagnosis of C. perfringens , P. aeruginosa and K. pneumoniae in different clinical samples. A total of 46 clinical samples of patients suspected with the infections were obtained from Sri Venkateswara Institute of Medical Sciences, and used in the present study as test samples for detecting the pathogens. Results and conclusions Through this approach, the above pathogens were detected simultaneously with high specificity in pure cultures and from the blood and urine samples. The results were correlated with normal diagnostic process, and proved to be more sensitive and specific diagnostic technique in the simultaneous detection of C. perfringens , P. aeruginosa and K. pneumoniae.

We evaluated the susceptibility profile of a colonizing carbapenem-resistant enterobacteriaceae to predict its susceptibility when recovered from a clinical specimen. An overall agreement of 88.7% (517 out of 583; 95% confidence interval, 85.8%-91.0%) was observed for the combinations of 11 antibiotics with 53 pairs of Klebsiella pneumoniae carbapenemase-producing K pneumoniae (the only carbapenem-resistant enterobacteriaceae detected). Very major errors were observed mainly for aminoglycoside agents and colistin, limiting the predictability of the susceptibility profile for these clinical isolates.

We examined the results of surveillance of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae, which are pathogens known to cause nosocomial outbreaks, at a comprehensive cancer center in Japan over a 5-year period. We found that the admission prevalence and the incidence of ESBL-producing E coli increased during the study period, in contrast with ESBL-producing K pneumoniae, in which the parameters remained low throughout the study period.

BackgroundKlebsiella pneumoniae liver abscess (KLA) is an emerging infectious disease caused by the virulent K pneumoniae strains of capsular serotype K1 and commonly associated with diabetes mellitus. Recurrent KLA is rarely reported and the mechanism of recurrence is uncertain. In this study we evaluated both phagocytosis by neutrophils and serum killing ability of serum from recurrent K1 KLA patients compared to normal healthy subjects (NHS).MethodsThis prospective study included six cases of recurrent K1 KLA consisting of three male and three female patients with a mean age of 67.2 years (range, 56-88 years). The different serotypes of K pneumoniae were reacted with serum from patients with recurrent KLA and NHS. Subsequent phagocytosis by neutrophils was determined using flow cytometry and serum killing assays were performed.ResultsThe most common underlying disease in patients with recurrent KLA was diabetes mellitus, occurring in about 83.3% (5/6) of patients. The antibiogram of the strains associated with recurrent KLA remained uniquely resistant to ampicillin. The average percentage derived from the serum killing assays showed serotype K1 and K2 resistance to serum from NHS (1281% and 621%, respectively); however, serum susceptibly was observed in the serum of patients with recurrent K1 KLA (0.3% and 1.1%, respectively). A significant increase in neutrophil phagocytosis of serotype K1 was observed following opsonisation with serum from patients with recurrent KLA compared with serum from NHS (p = 0.008). No significant difference in the phagocytic rate of non-K1/K2 or K2 serotypes was observed between NHS and patients with recurrent KLA (p = 0.76 and p = 0.132, respectively).ConclusionThese preliminary results showed possible immunologic protection in patients with recurrent KLA due to increasing opsonization and serum killing.

Hypertension (HTN) is a most prevalent cardiovascular diseases. The potential role of disordered gut microbiome in cardiovascular diseases has been revealed, yet whether gut microbiota dysbiosis and which bacterial strain play a key role in inducing HTN remains unknown. We carried out comprehensive

We present a case of an 83-year-old woman with history of diabetes mellitus, which came to the emergency room with a hyperosmolar state and UTI symptoms, she was started on IV fluids and antibiotics, but the abdominal CT scan image showed gas within the bladder.

A distinctive form of community-acquired invasive Klebsiella pneumoniae infection has been well described in Southeast Asia for more than 2 decades. The clinical syndrome includes liver abscess, bacteremia, and metastatic infection. It has recently been linked to a virulent hypermucoviscous K pneumoniae phenotype and to a specific genotype. As of 2008, there were only 2 published cases of invasive infection caused by this strain of K pneumoniae in the United States. We report 4 recent cases presenting to a single public hospital emergency department in northern California, which may signal the emergence of this clinical syndrome in North America.

Department of Emergency Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC Division of Infectious Diseases, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC

Synthesis of the terminal disaccharide unit of a novel α-(1→2) linked heptoglycan of K. pneumoniae ssp. strain R20 from methyl α- d -mannopyranoside has been presented. Central to the strategy is the application of Sharpless asymmetric dihydroxylation to introduce a new center at C-6 position of mannopyranoside. The coupling of two heptoglycans ( 12 and 13 ) was accomplished by a Lewis acid catalyst.

Deep neck infections may be lethal if life-threatening complications occur, especially in immunocompromised hosts such as diabetic patients. This study was undertaken to better define the clinical features and prognosis of deep neck infections in the diabetic patients with special emphasis on the use of empirical antibiotics and the role and timing of surgical management.A retrospective analysis of 105 consecutive patients treated at a single institution during a 9-year period was conducted. Of these, 30 patients also presented with diabetes mellitus.Compared with the nondiabetic patients, the unique features of deep neck infections in diabetic patients were as follows: (1) older age, (2) tendency of unclear infection source, (3) tendency to involve multiple spaces, (4) required more aggressive surgical intervention, (5) prolonged hospitalization, and (6) higher complication rate. The differences were statistically significant (P.05). There were no significant differences in the complete blood count/ differential count positive findings and fever between the 2 groups (P.05). Bacterial cultures showed that Klebsilla pneumoniae was the most common causative pathogen in diabetic patients.In deep neck infection patients with diabetes mellitus, the clinical course is more severe and there is a poorer prognosis. Thus, in treating them, we should keep close observation, appropriately control the diabetes, detect the life-threatening complications early, perform aggressive surgical treatment if fluctuation or complication occurs, and take into account the preponderance of K pneumoniae when administering the empirical antibiotics.

Osteomyelitis of the pubic symphysis or pubic osteomyelitis is a rare entity that is encountered in certain groups of people such as athletes, intravenous drug users, patients with pelvic malignancy, and patients who have undergone surgical manipulations of the genitourinary system. The most frequent causative organism is Staphylococcus aureus. K pneumoniae is a common pathogen in diabetic patients, but pubic osteomyelitis due to K pneumoniae has not previously been described. We present a diabetic patient with pubic osteomyelitis caused by K pneumoniae without known predisposing factors.

The synthesis and microbiological activity of a series of 5-methyl-2-(p-substituted phenyl)benzoxazoles 7a–7g are described. The in vitro microbiological activity of these compounds was determined against some Gram-positive and Gram-negative bacteria and C albicans. The observed minimum inhibitory concentration (MIC) values of the derivatives were compared to some other 2,5-disubstituted benzoxazoles and clinically used drugs. The in vitro microbiological data showed that the derivatives 7a–7g exhibited a broad spectrum of antibacterial activity and 7a–c and 7g were significantly active against E coli and/or K pneumoniae at an MIC of 6.2 μg/ml.

We report on a Klebsiella pneumoniae clinical isolate coproducing bla DHA-1 , bla SHV-2a , qnrB4 , and aac(6′)-Ib-cr genes. Molecular analysis demonstrated the presence of this combination on the same large plasmid. Despite a negative result for extended-spectrum beta-lactamase (ESBL) by Vitek2® system (bioMerieux, Marcy-l'Etoile, France), an ESBL was detected by a double-disk test. Phenotypic techniques and molecular analysis are key approaches to determine coresistance.

P74 First report of a Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KP) in Toronto, Canada J. Xiong1 *, S. Hota2, B. Willey3, R. Melano4, D. Boyd5, N. Tijet4, M. Mulvey5, N. Prayitno3, T. Mazzulli3, S. Poutanen3. 1University of Toronto, Toronto, Canada, 2University Health Network, Toronto, Canada, 3Mount Sinai Hospital, Toronto, Canada, 4Ontario Agency for Health Protection and Promotion, Toronto, Canada, 5National Microbiology Laboratory, Winnipeg, Canada

The effect of Fosfomycin on K. pneumoniae ATCC 10031 was studied. The morphology on the electron microscopical level and the viability were markedly altered after application of 6 micrograms/ml and 60 micrograms/ml of Fosfomycin, respectively. These were chosen because they can be attained in man by oral or parenteral administration. Until 30 min after the administration of 6 micrograms/ml, and 10 min after administration of 60 micrograms/ml the turbidity increased in the same range as in the control. Thereafter the turbidity decreased but did not fall below its minimal values; after application of 6 micrograms/ml of Fosfomycin the OD remained at higher levels than after applying 60 micrograms/ml of Fosfomycin, at all corresponding times. The number of viable cells, after application of 6 micrograms/ml of Fosfomycin, was maximally reduced for 70% of the value at the time of administration. 60 micrograms/ml quickly impaired the ability of reproduction. Consequently, the CFU were reduced continuously, e.g. by 80% after 30 min and by more than 99% after 180 min. The finestructural alterations were characterized by loss of contrast and regular shape. The occurrence of protruded protoplasts and defects in the cell wall indicate the action of Fosfomycin on the bacterial envelope, preferably on the peptidoglycan layer.

Facial crush wounds in 200 albino rats were contaminated with soil containing K pneumoniae, Ps aeruginosa, Pr mirabilis and Staph aureus. The wounds in the control group were irrigated with water using a bulb syringe. In the experimental group the wounds were lavaged with a pulsating water jet. The results indicate that the pulsating jet lavage was much more effective in reducing the bacterial population and in the removal of necrotic tissue and foreign particles from the wounds than was irrigation with a bulb syringe. The amount and extent of the inflammatory reaction and abscess formation was found to be directly related to the amount of foreign material remaining in the wound. Early reduction of bacterial concentration in the wound by pulsating water jet lavage resulted in faster elimination of all bacteria and accelerated wound healing.