Clinical and Microbiological Characteristics of Klebsiella pneumoniae Co-Infections in Pulmonary Tuberculosis: A Retrospective Study

Jun Liu; Yi Zhang; Jianpeng Cai; Lingyun Shao; Xiufeng Jiang; Xiaohong Yin; Xinguo Zhao; Sen Wang

doi:10.2147/IDR.S421587

Clinical and Microbiological Characteristics of Klebsiella pneumoniae Co-Infections in Pulmonary Tuberculosis: A Retrospective Study

Infect Drug Resist. 2023 Nov 8:16:7175-7185. doi: 10.2147/IDR.S421587. eCollection 2023.

Authors

Jun Liu^#¹, Yi Zhang^#², Jianpeng Cai^#², Lingyun Shao², Xiufeng Jiang³, Xiaohong Yin⁴, Xinguo Zhao⁴, Sen Wang^{2

5}

Affiliations

¹ Department of Laboratory medicine, Wuxi Fifth People's Hospital Affiliated to Nanjing Medical University, Wuxi, People's Republic of China.
² Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
³ Department of Respiratory and Critical Care Medicine, Wuxi Fifth People's Hospital Affiliated to Nanjing Medical University, Wuxi, People's Republic of China.
⁴ Department of Tuberculosis, Wuxi Fifth People's Hospital Affiliated to Nanjing Medical University, Wuxi, People's Republic of China.
⁵ Huashen Institute of Microbes and Infections, Shanghai, People's Republic of China.

^# Contributed equally.

Abstract

Background: Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens leading to pulmonary tuberculosis (PTB) co-infection, but the data of co-infections is scarce. This research aimed to study the clinical and microbiological characteristics of K. pneumoniae co-infections in pulmonary tuberculosis cases.

Methods: Clinical manifestations and examination results of PTB cases co-infected by K. pneumoniae were retrospectively collected from the medical record database of a tertiary teaching hospital in China between November 2019 and October 2021. The K. pneumoniae strains isolated from the patients were sent for whole-genome sequencing. Statistical analyses were conducted using Stata v.14.0.

Results: A total of 80 strains were collected from 76 PTB patients with K. pneumoniae co-infections (two strains were isolated from each of the four patients at different time points), including 37 primary and 39 retreated TB cases. Among these, 29 (36.3%) of the K. pneumoniae isolates were extended-spectrum β-lactamase (ESBL)-producing strains, and seven (8.8%) were determined as carbapenem-resistant Enterobacteriaceae (CRE) strains. We found that patients in the multidrug resistance (MDR)-group received more respiratory support than the non-MDR group (40.6% vs 18.2%, P= 0.031) and possessed higher elevated C-reactive protein (62.6% vs 41.8%, P=0.008) and lower haemoglobin (87.5% vs 47.7%, P=0.001). We found that 80.3% (61/76) patients had lung lesions and 57.8% (44/76) patients were immunocompromised within one month. The most common K. pneumoniae strain sequence type was ST23 (15%), followed by ST15 (12.5%) and ST273 (7.5%). Among the strains, 26.25% were classically hypervirulent K1/K2 K. pneumoniae, and all carried salmochelin and rmpA.

Conclusion: This study demonstrated the important clinical features, phenotypic and genomic characteristics of isolated strains of PTB patients with K. pneumoniae co-infection. These data suggested a special attention for multidrug resistant K. pneumoniae infections with more obvious inflammatory responses which calls for more respiratory support and timely clinical management.

Keywords: Klebsiella pneumoniae; co-infection; manifestation; multidrug resistant; tuberculosis.

Grants and funding

This work was supported by Shanghai Municipal Science and Technology Major Project (HS2021SHZX001), Shanghai Science and Technology Committee (20dz2210400, 20dz2260100), Major projects of Wuxi Municipal Health Commission (Z202111), and Wuxi Taihu Lake Talent Plan.