BACKGROUND/AIMS: Klebsiella pneumoniae (K. pneumoniae) has been emerging as the leading cause of liver abscess although the most common pathogen was Escherichia coli in the past. Our study was to clarify the significance of K. pneumoniae as a pathogen of pyogenic liver abscess. METHODS: We reviewed 157 cases of pyogenic liver abscess treated at Yeungnam University Hospital from 1996 to 2001. They were classified into two groups: K. pneumoniae group and non-K. pneumoniae group. The clinical presentations, characteristics of liver abscess, laboratory findings and the results of bacteriological studies were compared. RESULTS: The K. pneumoniae group included 60 (60.6%) cases among 99 cases with positive culture. We found higher incidence of alcoholics (45.0%) or diabetes millitus (35.0%) in K. pnemoniae group. Cryptogenic cause (61.7%) was the most frequent portal entry in K. pneumoniae liver abscess. On the other hand, in non-K. pneumoniae group, the cause of portal entry was usually the secondary (23.1%) following biliary disease (61.5%). Statistically, there was no significant difference in age, sex, symptom, characteristics of abscess, laboratory findings except total bilirubin level between the two groups. CONCLUSIONS: Liver abscess caused by K. pneumoniae has emerged as an important infectious disease with new clinical significance. When clinicians see pyogenic liver abscess in patients with alcoholics or diabetes millitus, K. pneumoniae should be considered first as a cause of liver abscess.
Aged ; Female ; Humans ; Klebsiella Infections/*diagnosis ; *Klebsiella pneumoniae ; Liver Abscess/diagnosis/*microbiology ; Male ; Middle Aged

Carbapenems ; pharmacology ; Drug Resistance, Bacterial ; Humans ; Klebsiella Infections ; drug therapy ; microbiology ; Klebsiella pneumoniae ; drug effects

No abstract available.
Aged ; Female ; Humans ; Klebsiella Infections/*diagnosis/microbiology ; Klebsiella pneumoniae/*enzymology/isolation & purification ; Pneumonia/*diagnosis/microbiology ; Turkey ; beta-Lactamases/*metabolism

OBJECTIVETo investigate and take a case study on a Klebsiella pneumoniae outbreak in a newborn intensive care unit (NICU).

METHODSUsing epidemiological investigation method to cultivate bacilli and detect the homology.

RESULTSKlebsiella pneumonia was detected in 4 NICU patients. Based on environmental sample analyses, four Klebsiella pneumonia strains were identified and confirmed to be highly homologous. The outbreak was effectively controlled after the strict implementation of hand hygiene practice and environment disinfection.

CONCLUSIONKlebsiella pneumonia outbreak in NICU may be caused by the route of hand transmission.

Cross Infection ; epidemiology ; microbiology ; Disease Outbreaks ; Female ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Klebsiella Infections ; epidemiology ; microbiology ; Klebsiella pneumoniae ; genetics ; isolation & purification ; Male

INTRODUCTIONKlebsiella pneumoniae septic arthritis and osteomyelitis, albeit uncommon in adults, are important sites of disseminated infection. Many case reports have shown K. pneumoniae as a cause of nosocomial transmitted septic arthritis in neonates and children. We report a rare case of an elderly patient with K. pneumoniae genitourinary infection spreading to the liver and other extra hepatic sites like the prostate and peripheral joint.

CLINICAL PICTUREThe patient presented with a short history of general malaise, fever and urinary symptoms, associated with an acute monoarthritis of the ankle. On admission, he was in septic shock. Investigations suggested an infective cause, as evidenced by raised total white cell count and pyuria. K. pneumoniae was cultured from both urine and ankle synovial fluid. Imaging confirmed multiple liver and prostatic abscesses, as well as osteomyelitis of the foot bones adjacent to the ankle.

TREATMENTTreatment in this case included surgical drainage of the affected joint and surrounding soft tissue structures, in addition to a 6-week course of systemic antibiotics.

OUTCOMEThe patient had good clinical response following treatment. In addition, we noted a normalisation of his laboratory parameters and resolution of the intraabdominal and pelvic abscesses.

CONCLUSIONThis case emphasises the importance of timely and accurate diagnosis followed by appropriate treatment in disseminated K. pneumoniae infection to prevent significant morbidity and mortality.

Aged ; Ankle Joint ; microbiology ; surgery ; Anti-Bacterial Agents ; therapeutic use ; Arthritis, Infectious ; diagnosis ; microbiology ; therapy ; Combined Modality Therapy ; Drainage ; Foot Bones ; microbiology ; Humans ; Klebsiella Infections ; diagnosis ; therapy ; Klebsiella pneumoniae ; Liver Abscess ; microbiology ; Magnetic Resonance Imaging ; Male ; Osteomyelitis ; drug therapy ; epidemiology ; microbiology ; surgery ; Prostatic Diseases ; microbiology ; Synovial Fluid ; microbiology ; Tomography, X-Ray Computed ; Urinary Tract Infections ; drug therapy ; microbiology

BACKGROUND: This study was conducted to evaluate the risk factors for infection and clinical outcomes of bacteremic spontaneous bacterial peritonitis (SBP) due to ESBL-producing E. coli and K. pneumoniae, in patients with advanced liver cirrhosis. METHODS: The ESBL production was determined by NCCLS guidelines and/or double-disk synergy tests, on stored E. coli and K. pneumoniae blood isolates collected between 1998 and 2002. Of the patients with advanced liver cirrhosis, 15 case patients, with SBP due to ESBL-producers, were compared with 30 matched controls, with SBP due to non-ESBL-producers. RESULTS: There were no significant differences in age, sex, Child-Pugh scores, or APACHE II scores between the two groups. Significant factors associated with infection by ESBL-producing organisms, according to univariate analysis, were: ICU care, indwelling urinary catheter, central venous catheterization, an invasive procedure within the previous 72 hours, and prior use of antibiotics within the previous 30 days. When assessing the clinical response at 72 hours after the initial antimicrobial therapy, the treatment failure rate was significantly higher in the ESBL group (73.3% vs. 16.7%, p< 0.001). Also, overall 30-day mortality rates were 60% (9/15) in the ESBL groups and 23.3% (7/30) in the control group (p=0.015). CONCLUSION: Among patients with advanced liver cirrhosis, bacteremic SBP due to ESBL-producing E. coli and K. pneumoniae was associated with adverse outcomes, and significantly higher mortality.
Bacteremia/*complications/microbiology ; Case-Control Studies ; Escherichia coli Infections/*complications ; Female ; Humans ; Klebsiella Infections/*complications ; Korea ; Liver Cirrhosis/*complications ; Male ; Middle Aged ; Outcome Assessment (Health Care) ; Peritonitis/*microbiology

In recent years, there have been increasing reports of KPC-producing Klebsiella pneumoniae in Korea. The modified Hodge test can be used as a phenotypic screening test for class A carbapenamase (CAC)-producing clinical isolates; however, it does not distinguish between carbapenemase types. The confirmation of type of CAC is important to ensure optimal therapy and to prevent transmission. This study applied a novel multiplex PCR assay to detect and differentiate CAC genes in a single reaction. Four primer pairs were designed to amplify fragments encoding 4 CAC families (SME, IMI/NMC-A, KPC, and GES). The multiplex PCR detected all genes tested for 4 CAC families that could be differentiated by fragment size according to gene type. This multiplex PCR offers a simple and useful approach for detecting and distinguishing CAC genes in carbapenem-resistant strains that are metallo-beta-lactamase nonproducers.
Bacterial Proteins/*genetics/metabolism ; DNA Primers/metabolism ; Databases, Genetic ; Humans ; Klebsiella Infections/microbiology ; Klebsiella pneumoniae/genetics/isolation & purification/metabolism ; *Multiplex Polymerase Chain Reaction ; beta-Lactamases/*genetics/metabolism

BACKGROUND/AIMS: Despite the improvement of personal and social hygiene, pyogenic liver abscess is still a common disease. We compared the incidence, infection route, underlying disease and major complications between two different local hospitals. METHODS: We reviewed the clinical data of 100 patients with pyogenic liver abscess who were treated at Seoul and Guri Hanyang University Hospital from 1999 to 2003. RESULTS: There were 64 males and 36 females in the study group; they were aged from 19 to 94 years with a mean of 56.5 years. Every year 19 to 23 pyogenic liver abscess patients were admitted to both hospitals. The most common organism isolated was Klebsiella pneumoniae in both local hospitals. In the Seoul hospital, diabetes (40.9%) was most common associated condition. In the Guri hospital, biliary tract disease or a history of hepatobiliary surgery (54.2%) was the most common associated condition. Catheter drainage and/or percutaneous needle aspiration were established as the standard treatment modality. CONCLUSIONS: In both regional hospitals, the incidence of pyogenic liver abscess did not decrease and Klebsiella pneumoniae was the most common organism. Diabetes and biliary tract disease, including, previous hepatobiliary surgery, were the most identifiable underlying disease.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; Female ; Humans ; Klebsiella Infections/complications/diagnosis/therapy ; Klebsiella pneumoniae ; *Liver Abscess, Pyogenic/complications/microbiology/therapy ; Male ; Middle Aged

BACKGROUND/AIMS: Klebsiella pneumoniae is emerging as the leading cause for liver abscess although the most common pathogen was Escherichia coli in the past. Patients with diabetes mellitus are more likely to have a pyogenic liver abscess with gas forming infection; a gas forming pyogenic liver abscess carries a higher morbidity and mortality than the non-gas forming group. This study was conducted to clarify the clinical presentation and prognostic factors for pyogenic liver abscess in diabetic patients compared with non-diabetic patients. METHODS: Medical records of 140 cases of patients treated for pyogenic liver abscess from January 1995 through January 2004 were reviewed retrospectively in detail. RESULTS: Among 140 cases of pyogenic liver abscess, underlying diabetes was present in 26.4% (37/140). The clinical presentation between the two groups was not significantly different. The most common organism for the pyogenic abscess was K. pneumoniae in both groups. A gas forming liver abscess was discovered in only the diabetic liver abscess group, 6 of 37 patients (16%). CONCLUSIONS: K. pneumoniae was the most common organism cultured in both diabetic and non-diabetic liver abscess. Gas forming liver abscess was more common in diabetic patients than non-diabetic patients. Diabetic patients had more complications than non-diabetic patients.
Adult ; Aged ; *Diabetes Complications ; Female ; Humans ; Klebsiella Infections/complications ; Klebsiella pneumoniae ; Liver Abscess, Pyogenic/*complications/diagnosis/microbiology ; Male ; Middle Aged ; Prognosis

A 39-year-old woman visited the emergency room complaining of right eye pain and swelling over the preceding three days. The ophthalmologist's examination revealed orbital cellulitis and diabetic retinopathy in the right eye, although the patient had no prior diagnosis of diabetes. It was therefore suspected that she had diabetes and orbital cellulitis, and she was started on multiple antibiotic therapies initially. She then underwent computed tomography scans of the orbit and neck and magnetic resonance imaging of the brain. These studies showed an aggravated orbital cellulitis with abscess formation, associated with venous thrombophlebitis, thrombosis of the internal carotid artery, and mucosal thickening of maxillary sinus with multiple paranasal abscesses. Three days later, initial blood culture grew Klebsiella pneumoniae. She recovered after incision and drainage and antibiotic therapy for 37 days.
Adult ; Angiography ; Diabetes Mellitus, Type 2/*complications ; Diabetic Angiopathies/*complications/radiography ; Female ; Humans ; Klebsiella Infections/*complications/radiography ; *Klebsiella pneumoniae ; Orbital Cellulitis/*complications/microbiology/radiography ; Tomography, X-Ray Computed