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Epidemiological and Microbiome Associations Between Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus
Abigail Collingwood1, Freida Blostein2, Anna M Seekatz3
1Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA.
Background:
Prior colonization by Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) is associated with subsequent infection, particularly in intensive care unit (ICU) populations. Screening for VRE colonization, but not K. pneumoniae, is routinely performed in some health care systems. Identification of patient factors associated with K. pneumoniae colonization could enable infection prevention.
Methods:
ICU patients were screened for VRE and K. pneumoniae by rectal swab culture over 2 time periods: July-October 2014 (n = 1209) and January-May 2016 (n = 1243). Patient demographics, baseline laboratory data, comorbidities, and outcomes were analyzed. 16S rRNA gene-based analysis was performed on a subset of patients (n = 248) to identify microbiota characteristics associated with VRE and K. pneumoniae colonization.
Results:
K. pneumoniae colonization (17.3% of patients in the 2014 cohort, 7.3% in 2016) was significantly associated with VRE colonization in multivariable analysis (P = .03 in 2016; P = .08 in 2014). VRE colonization was associated with poor underlying health, whereas K. pneumoniae colonization was associated with advanced age. The most prevalent operational taxonomic units were Escherichia coli /Shigella spp., Klebsiella, and Enterococcus, consistent with high rates of detectable K. pneumoniae and VRE by culture. Microbial community structure in noncolonized patients was significantly different from those with VRE, K. pneumoniae, or both, attributable to differences in the relative abundance of Klebsiella and Enterococcus.
Conclusions:
K. pneumoniae co-colonizes with VRE and is a predominant taxon in ICU patients, but colonization was not associated with significant comorbidities. Screening for K. pneumoniae and VRE simultaneously could be an efficient approach for novel infection prevention strategies.
Insights
Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) co-colonize ICU patients. Simultaneous screening for both pathogens could improve infection prevention strategies.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Prior colonization with Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) is linked to subsequent infections in intensive care units (ICUs).
- Routine screening for VRE exists, but not for K. pneumoniae, limiting infection prevention efforts.
- Identifying factors associated with K. pneumoniae colonization can enhance preventative measures.
Purpose of the Study:
- To investigate the association between K. pneumoniae and VRE colonization in ICU patients.
- To identify patient factors and microbiota characteristics linked to K. pneumoniae and VRE colonization.
- To evaluate the potential for simultaneous screening of K. pneumoniae and VRE.
Main Methods:
- Rectal swab cultures were used to screen ICU patients for VRE and K. pneumoniae over two periods (2014 and 2016).
- Patient demographics, laboratory data, comorbidities, and outcomes were analyzed.
- 16S rRNA gene sequencing was performed on a subset of patients to analyze microbiota composition.
Main Results:
- K. pneumoniae colonization was significantly associated with VRE colonization (P=.03 in 2016).
- K. pneumoniae colonization was linked to advanced age, while VRE colonization was associated with poor health.
- Microbiota structure differed significantly between colonized and non-colonized patients, with notable differences in Klebsiella and Enterococcus abundance.
Conclusions:
- K. pneumoniae frequently co-colonizes with VRE in ICU patients and is a predominant gut taxon.
- Colonization with K. pneumoniae was not significantly associated with comorbidities.
- Simultaneous screening for K. pneumoniae and VRE may offer an efficient approach for infection prevention.
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