Klebsiella variicola is a human pathogen that has been misidentified as K. pneumoniae. This misidentification has led to a lack of understanding
of important clinical and biological aspects of this bacterial species. It is
responsible for serious and potentially fatal infections, with a prevalence of
multi-resistance to routine antibiotics. We present through three clinical
observations, the case of three newborns having been hospitalized in the
neonatal intensive care unit and whose evolution was complicated by the
occurrence of a nosocomial infection in front of which a blood culturewas done on blood agar, with a manual antibiogram on antibiotic disks, isolated the germ Klebsiella variicola. The management of the newborns was initially centered
on non-invasive ventilation with a bi-antibiotic therapy based on carbapenem
and amikacin for two newborns and switched to colymicin for the third case.
Newborn follow-up was based on assessment of general condition, clinical signs
of infection, as well as a biological control made of a blood count, a
c-reactive protein, a complete ionogram, and a blood culture, every four days
or if signs of clinical call. The evolution was favorable for two cases with
good clinical and biological improvement, and complicated by death due to
alveolar hemorrhage in the third case. Given the high pathogenicity of this
germ, and the frequency of misidentification, it is crucial to know the
clinical spectrum of Klebsiella variicola infections in neonatal intensive care units, in order to adapt the
References
[1]
Rodríguez-Medina, N., Barrios-Camacho, H., Duran-Bedolla, J. and Garza-Ramos, U. (2019) Klebsiella variicola: An Emerging Pathogen in Humans. Emerging Microbes & Infections, 8, 973-988. https://doi.org/10.1080/22221751.2019.1634981
[2]
Lin, L., Wei, C., Chen, M., et al. (2015) Complete Genome Sequence of Endophytic Nitrogen-Fixing Klebsiella variicola Strain DX120E. Standards in Genomic Sciences, 10, Article No. 22. https://doi.org/10.1186/s40793-015-0004-2
[3]
Piepenbrock, E., Higgins, P.G., Wille, J., Xanthopoulou, K., Zweigner, J., Jahn, P., Reuter, S., Skov, R., Eichhorn, J. and Seifert, H. (2020) Klebsiella variicola Causing Nosocomial Transmission among Neonates—An Emerging Pathogen? Journal of Medical Microbiology, 69, 396-401. https://doi.org/10.1099/jmm.0.001143
[4]
Martinez-Romero, E., Rodriguez-Medina, N., Beltrán-Rojel, M., et al. (2017) Genome Misclassification of Klebsiella variicola and Klebsiella quasipneumoniae Isolated from Plants, Animals and Humans. Salud Pública de México, 60, 56-62.
https://doi.org/10.21149/8149
[5]
Podschun, R. and Ullmann, U. (1998) Klebsiella Spp. as Nosocomial Pathogens: Epidemiology, Taxonomy, Typing Methods, and Pathogenicity Factors. Clinical Microbiology Reviews, 11, 589-603. https://doi.org/10.1128/CMR.11.4.589
[6]
Rao, K., Patel, A., Sun, Y., Vornhagen, J, Motyka, J., Collingwood, A., Teodorescu, A., Baang, J.H., Zhao, L.L., Kaye, K.S. and Bachmanb, M.A. (2021) Risk Factors for Klebsiella Infections among Hospitalized Patients with Preexisting Colonization. mSphere, 6, e00132-21. https://doi.org/10.1128/mSphere.00132-21
[7]
Magill, S.S., Edwards, J.R., Bamberg, W., Beldavs, Z.G., Dumyati, G., Kainer, M.A., et al. (2014) Multistate Point-Prevalence Survey of Health Care-Associated Infections. The New England Journal of Medicine, 370, 1198-1208.
https://doi.org/10.1056/NEJMoa1306801
[8]
Richards, M.J., Edwards, J.R., Culver, D.H. and Gaynes, R.P. (2000) Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States. Infection Control & Hospital Epidemiology, 21, 510-515.
https://doi.org/10.1086/501795
[9]
Maatallah, M., Vading, M., Kabir, M.H., et al. (2014) Klebsiella variicola Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to K. pneumoniae. PLOS ONE, 9, e113539.
https://doi.org/10.1371/journal.pone.0113539
[10]
Seki, M., Gotoh, K., Nakamura, S., et al. (2013) Fatal Sepsis Caused by an Unusual Klebsiella Species That Was Misidentified by an Automated Identification System. Journal of Medical Microbiology, 62, 801-803.
https://doi.org/10.1099/jmm.0.051334-0
[11]
Garza-Ramos, U., Barrios-Camacho, H., Moreno-Dominguez, S., et al. (2018) Phenotypic and Molecular Characterization of Klebsiella spp. Isolates Causing Community-Acquired Infections. New Microbes and New Infections, 23, 17-27.
https://doi.org/10.1016/j.nmni.2018.02.002
[12]
Long, S.W., Linson, S.E., Ojeda, S.M., et al. (2017) Whole-Genome Sequencing of Human Clinical Klebsiella pneumoniae Isolates Reveals Misidentification and Misunderstandings of Klebsiella pneumoniae, Klebsiella variicola, and Klebsiella quasipneumoniae. mSphere, 2, e00290-17.
https://doi.org/10.1128/mSphereDirect.00290-17
[13]
Paczosa, M.K. and Mecsas, J. (2016) Klebsiella pneumoniae: Going on the Offense with a Strong Defense. Microbiology and Molecular Biology Review, 80, 629-661.
https://doi.org/10.1128/MMBR.00078-15
[14]
Emonet, S., Shah, H.N., Cherkaoui, A. and Schrenzel, J. (2010) Application and Use of Various Mass Spectrometry Methods in Clinical Microbiology. Clinical Microbiology and Infection, 16, 1604-1613.
https://doi.org/10.1111/j.1469-0691.2010.03368.x
[15]
van Belkum, A., Welker, M., Pincus, D., Charrier, J.P. and Girard, V. (2017) Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry in Clinical Microbiology: What Are the Current Issues? Annals of Laboratory Medicine, 37, 475-483. https://doi.org/10.3343/alm.2017.37.6.475
[16]
Fontana, L., Bonura, E., Lyski, Z. and Messer, W. (2019) The Brief Case: Klebsiella variicola—Identifying the Misidentified. Journal of Clinical Microbiology, 57, e00826-18. https://doi.org/10.1128/JCM.00826-18
[17]
Garza-Ramos, U., Silva-Sanchez, J., Martinez-Romero, E., et al. (2015) Development of a Multiplex-PCR Probe System for the Proper Identification of Klebsiella variicola. BMC Microbiology, 15, Article No. 64.
https://doi.org/10.1186/s12866-015-0396-6
[18]
Potter, R.F., Lainhart, W., Twentyman, J., et al. (2018) Population Structure, Antibiotic Resistance, and Uropathogenicity of Klebsiella variicola. MBio, 9, e02481-18.
https://doi.org/10.1128/mBio.02481-18
[19]
Liu, L., Feng, Y., Tang, G., et al. (2018) Carbapenem-Resistant Isolates of the Klebsiella pneumoniae Complex in Western China: The common ST11 and the Surprising Hospital-Specific Types. Clinical Infectious Diseases, 67, S263-S265.
https://doi.org/10.1093/cid/ciy662
[20]
Lu, Y., Feng, Y., McNally, A. and Zong, Z.Y. (2018) Occurrence of Colistin-Resistant Hypervirulent Klebsiella variicola. Journal of Antimicrobial Chemotherapy, 73, 3001-3004. https://doi.org/10.1093/jac/dky301
[21]
Ramirez, M.S., Traglia, G.M., Lin, D.L., Tran, T. and Tolmasky, M.E. (2014) Plasmid-Mediated Antibiotic Resistance and Virulence in Gram-Negatives: The Klebsiella pneumoniae Paradigm. Microbiology Spectrum, 2, 1-15.
https://doi.org/10.1128/microbiolspec.PLAS-0016-2013
