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Development of risk factor-based scoring system for detection of hypervirulent Klebsiella pneumoniae bloodstream
Atsushi Togawa1,2, Michinobu Yoshimura1,3, Chiemi Tokushige4
1Department of Medical Oncology, Hematology, and Infectious Diseases, Fukuoka University Hospital, 7-45-1 Nanakuma, Jonan, Fukuoka, 8140180 Japan.
Background:
Hypervirulent Klebsiella pneumoniae (HVKp) infections have distinct clinical manifestations from classical K. pneumoniae infections. The hallmark of HVKp infections are liver abscess formation and metastatic infections. Due to the severe sequelae of these complications, method to identify patients at-risk of HVKp infections should be developed.
Results:
A retrospective cohort study of 222 patients with K. pneumoniae bloodstream infections (BSIs) was performed. Patient demographics, clinical manifestations, and bacterial characteristics were investigated. Ten cases of liver abscesses were identified. Characteristics such as community-onset BSIs, hypermucoviscosity phenotype, and capsular serotype K1 were identified as risk factors for HVKp infections. A scoring system was developed based on the risk factors. The area under the receiver operating characteristic curve for the scoring system was 0.90. A score of ≥ 2 points provided sensitivity and specificity of 0.70 and 0.94, respectively.
Conclusions:
Simple scoring system was developed for the diagnosis of HVKp infections. The system allows early identification of patients with K. pneumoniae BSIs in whom hypervirulent infections should be evaluated. Prospective evaluation is expected.
Insights
A new scoring system helps identify patients with hypervirulent Klebsiella pneumoniae (HVKp) infections, characterized by liver abscesses. This tool aids early detection of severe HVKp bloodstream infections (BSIs).
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Hypervirulent Klebsiella pneumoniae (HVKp) infections present distinct clinical features, including liver abscesses and metastatic spread, differing from classical K. pneumoniae.
- The severe outcomes of HVKp necessitate methods for early identification of at-risk patients.
Purpose of the Study:
- To develop a method for identifying patients at risk of hypervirulent Klebsiella pneumoniae infections.
Main Methods:
- A retrospective cohort study involving 222 patients with K. pneumoniae bloodstream infections (BSIs).
- Analysis of patient demographics, clinical symptoms, and bacterial characteristics.
- Development of a scoring system based on identified risk factors.
Main Results:
- Ten cases of liver abscesses were identified among the 222 patients.
- Community-onset BSIs, hypermucoviscosity phenotype, and serotype K1 were significant risk factors for HVKp.
- The developed scoring system demonstrated strong diagnostic performance (AUC=0.90), with a score of ≥2 yielding 70% sensitivity and 94% specificity.
Conclusions:
- A simple scoring system effectively aids in diagnosing HVKp infections.
- This system facilitates early identification of patients with K. pneumoniae BSIs who require evaluation for hypervirulent strains.
- Prospective validation of the scoring system is recommended.
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