Clinical and microbiological characteristics and occurrence of Klebsiella pneumoniae infection in Japan

Mahoko Ikeda,1,2,* Miyuki Mizoguchi,1,* Yukie Oshida,3 Keita Tatsuno,1 Ryoichi Saito,4 Mitsuhiro Okazaki,5 Shu Okugawa,2 Kyoji Moriya1,2 1Department of Infection Control and Prevention, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan; 2Department of Infectious Diseases, The University of Tokyo Hospital, Hongo, Bunkyo-ku, Tokyo, Japan; 3Division of Infectious Diseases, Shizuoka Cancer Center, Simonagakubo, Nagaizumi-chou, Suntou-gun, Shizuoka, Japan; 4Department of Microbiology and Immunity, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Yushima, Bunkyo-ku, Tokyo, Japan; 5Department of Medical Technology, School of Health Sciences, Tokyo University of Technology, Kamata, Ota-ku, Tokyo, Japan *These authors contributed equally to this work Purpose: Klebsiella pneumoniae is a pathogen that causes pneumonia and urinary tract infection. Hypervirulent K. pneumoniae strains often show hypermucoviscosity, are of the K1 or K2 serotype, and harbor the rmpA and magA genes. However, the differences in the prevalence of K. pneumoniae with these hypervirulent characteristics between the infection and colonization status are not well understood. Therefore, in this study, we compared the clinical and microbiological characteristics of K. pneumoniae isolated from urine or sputum samples of cases of infection and colonization. Patients and methods: This retrospective study was conducted at a tertiary care teaching hospital in Tokyo, Japan. Patients whose sputum or urine tested positive for the presence of K. pneumoniae isolates were randomly included in the study. Clinical and microbiological data were collected from medical records. Results: Of the 130 cases investigated, 68 and 62 cases showed the presence of K. pneumoniae in the sputum and urine, respectively. There were 49 infection cases, including 21 in the sputum group and 28 in the urine group. The infections were not accompanied by liver abscess. Of the 130 K. pneumoniae isolates, 25 (19.2%) showed capsular serotype K1 or K2, whereas 33 (25.4%) showed hypermucoviscosity. The prevalence of virulence genes magA, allS, rmpA, mrkD, uge, kfu-BC, and wabG was 10% (all in K1), 13.1%, 16.9%, 85.4%, 79.2%, 36.9%, and 91.5%, respectively. In both the sputum and urine groups, there was no difference in the characteristics of patients with infection and those with colonization. Analysis of microbiological characteristics revealed that only rmpA was significantly more frequent in the infection cases than in the colonization/asymptomatic cases in both the sputum and urine groups. Conclusion: The rmpA-positive K. pneumoniae isolates were dominant in the infection cases compared with those in the colonization/asymptomatic cases, suggesting that rmpA may play a crucial role in the development of urinary tract infection and pneumonia. Keywords: Klebsiella pneumoniae, hypermucoviscosity, rmpA, capsular polysaccharide serotype, infection, colonization, pneumonia, urinary tract infection