Ann Lab Med.  2020 Nov;40(6):481-487. 10.3343/alm.2020.40.6.481.

Clinical Features and Risk Factors Associated With 30-Day Mortality in Patients With Pneumonia Caused by Hypervirulent Klebsiella pneumoniae (hvKP)

• Hwang JH
• Handigund M
• Hwang JH
• Cho YG
• Kim DS
• Lee J

• KMID: 2507794
• DOI: http://doi.org/10.3343/alm.2020.40.6.481

Abstract

Background
Reports on metastatic or invasive infections by hypervirulent Klebsiella pneumoniae (hvKP) have increased recently. However, the effects of its virulence on clinical course and outcomes in pneumonia patients have rarely been addressed. We assessed and compared the clinical features of hvKp and classic K. pneumoniae (cKP) strains isolated from patients with pneumonia caused by K. pneumoniae. We also investigated the effects of virulence factors and the K. pneumoniae capsular serotypes K1 and K2 on mortality.
Methods
In this retrospective study, we enrolled 91 patients diagnosed as having pneumonia caused by K. pneumoniae and obtained their demographic and clinical data from medical records. We evaluated genes for K1 and K2, antimicrobial susceptibility, and the virulence genes rmpA, iutA, entB, ybtS, kfu, mrkD, and allS. Strains that possessed rmpA and iutA were defined as hvKP (N=39), while the remaining were classified as cKP (N=52). Odds ratio (OR) for the risk factors associated with 30-day mortality was calculated using the binary logistic regression model.
Results
The 30-day mortality in all patients was 23.1%; it was 17.9% (7/39) in the hvKP group and 26.9% (14/52) in the cKP group (P = 0.315). Bacteremia (OR = 38.1; 95% confidence interval [CI], 2.5–570.2), altered mental status (OR = 8.8; 95% CI, 1.7–45.0), and respiratory rate > 30 breaths/min (OR = 4.8; 95% CI, 1.2–20.0) were independent risk factors for 30-day mortality in all patients.
Conclusions
Our results suggest that hypervirulence determinants do not have a significant effect on 30-day mortality in patients with pneumonia caused by K. pneumoniae.

Keyword

Hypervirulence; Klebsiella pneumoniae; Pneumonia; Mortality

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