Article Figures & Data
Figures
- FIG 1
Schematic representation of the hvKp virulence plasmid pLVPK (red circle, 219,385 bp) (83) and pVir-CR-HvKp4 (blue circle, 178,154 bp) (22). The locations of various virulence genes and/or biomarkers are marked.
- FIG 2
An image from an abdominal CT scan of a previously healthy 24-year-old Vietnamese man shows a primary liver abscess (red arrow) with metastatic spread to the spleen (black arrow). (Courtesy of Chiu-Bin Hsaio and Diana Pomakova; reprinted with permission from McGraw-Hill Education [353].)
- FIG 3
A previously healthy 33-year-old Chinese male presented with endophthalmitis. (Courtesy of Chiu-Bin Hsaio; reprinted with permission from McGraw-Hill Education [353].)
Tables
- TABLE 1
Demographic and clinical features that can assist in differentiating infection due to hypervirulent and classical K. pneumoniae strainsa
Parameter Finding for pathotype hvKp cKp Location for the development of infection More commonly the communityb More commonly a health care setting Host All ages; often otherwise healthy Older, with some form of compromise Ethnic background Often Asian, Pacific Islander, Hispanic No ethnic predilection Hepatic abscess Usually occurs in the absence of biliary disease Usually occurs in the presence of biliary disease Number of sites of infection Often multiple Usually single Unusual infectious syndromes for K. pneumoniae Endophthalmitis, meningitis,c brain abscess, necrotizing fasciitis, splenic abscess, epidural abscess None Copathogens at the site of infection Rare, usually monomicrobial Not uncommon, especially with abdominal, soft tissue, or urinary catheter infection ↵a These are general features; exceptions occur. Definitive diagnosis requires identification of specific biomarkers, but assays for these markers are not presently FDA approved or routinely performed by clinical microbiology laboratories.
↵b With the advent of XDR cKp strains acquiring the hvKp virulence plasmid and thereby the hypervirulent phenotype, an increasing number of hvKp infections are developing in the health care setting; to date, this has been primarily reported from China.
↵c hvKp meningitis occurs in patients with a competent meningeal barrier (as opposed to those with an incompetent meningeal barrier, e.g., neonates or those who have undergone neurosurgery or trauma).
- TABLE 2
Major knowledge gaps that exist for hypervirulent K. pneumoniae
Area of interest Knowledge gap Epidemiology Incidence of infection in various countries Prevalence of antimicrobial resistance Incidence of health care-associated infections Mechanism of acquisition Pathogenesis Mechanism of entry Delineation of hvKp-specific virulence genes and mechanism of action Mechanism of metastatic spread Factors responsible for tissue damage Carcinogenic potential Host susceptibility Ethnic/genetic predisposition Treatment Optimal approach for source control Treatment duration Management of endophthamitis, especially for XDR strains Role of adjunct therapy Infection control Is there a benefit for implementing infection control measures when a hospitalized patient is infected with an hvKp antimicrobial-sensitive strain on a ward or an ICU? Is there a benefit for implementing infection control measures when a hospitalized patient is infected with an hvKp antimicrobial-sensitive strain to protect selected patient groups (e.g., those of certain ethnic backgrounds, such as Asian, or immunocompromised hosts)? Is there a benefit of prophylaxis for close contacts? - TABLE 3
Estimated proportion of hvKpa organisms among K. pneumoniae infections in various geographic locales
Site Time frame Isolate source/characteristic No./total (%) of K. pneumoniae infections due to hvKpb Reference Australia 2001–2014 Urine 3/193 (1.6) 28 Australia 2001–2014 Mixed clinical (minus urine) 19/141 (13.5) 28 Canada (Alberta) 2001–2007 Community-acquired blood isolates 9/134 (6.7) 354 Canada (Quebec) 2009–2013 Blood isolates 1/110 (0.9) 17 China 2015 ST11, carbapenem resistant 11/387 (3) 22 China 2008–2012 Blood isolates 32/70 (46) 355 China 2014–2016 Carbapenem-resistant isolates 32/66 (48.5) 311 China 2014–2016 Carbapenem-sensitive isolates 31/45 (68.9) 311 India 2014–2015 Urine, respiratory, and blood isolates 3/370 (0.8) 356 India 2014–2015 Carbapenem-resistant blood isolates 6/86 (7) 357 Japan 2011–2012 Sputum and urine isolates 22/130 (16.9) 133 Nepal 2008–2012 Mixed clinical 1/131 (0.76) Spain (Barcelona) 2007–2013 Blood isolates 37/878 (4.2) 139 UK (Oxford) 2008–2011 Blood isolates 4/69 (5.8) 17 USA (Texas) 2009–2010 Clinical isolates 4/64 (6.3) 358 USA 2013 Carbapenem-resistant blood isolates 0/97 (0) 311 USA 2007–2013 Urine isolates 1/191 (0.5) 28 USA 1937–2014 Mixed clinical isolates (minus urine) 26/490 (5.3) 28 Vietnam 2003–2009 Mixed clinical isolates 16/41 (39) 28
