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dc.contributor.authorFostervold, Aasmund
dc.contributor.authorRaffelsberger, Niclas Peter
dc.contributor.authorHetland, Marit
dc.contributor.authorBakksjø, Ragna-Johanne
dc.contributor.authorBernhoff, Eva
dc.contributor.authorSamuelsen, Ørjan
dc.contributor.authorSundsfjord, Arnfinn Ståle
dc.contributor.authorAfset, Jan Egil
dc.contributor.authorBerntsen, Christopher Friis
dc.contributor.authorBævre-Jensen, Roar Magne
dc.contributor.authorEbbesen, Marit Helen
dc.contributor.authorGammelsrud, Karianne Wiger
dc.contributor.authorGuleng, Anja D.
dc.contributor.authorHandal, Nina
dc.contributor.authorJakovljev, Aleksandra
dc.contributor.authorJohal, Simreen Kaur
dc.contributor.authorMarvik, Åshild
dc.contributor.authorNatvik, Ane Kristine
dc.contributor.authorSandnes, Rolf-Arne
dc.contributor.authorTofteland, Ståle
dc.contributor.authorBjørnholt, Jørgen
dc.contributor.authorLöhr, Iren Høyland
dc.date.accessioned2024-09-16T07:07:28Z
dc.date.available2024-09-16T07:07:28Z
dc.date.issued2024-04-02
dc.description.abstractBackground: Klebsiella pneumoniae species complex (KpSC) bloodstream infections (BSIs) are associated with considerable morbidity and mortality, particularly in elderly and multimorbid patients. Multidrugresistant (MDR) strains have been associated with poorer outcome. However, the clinical impact of KpSC phylogenetic lineages on BSI outcome is unclear. <p> <p>Methods: In an 18-month nationwide Norwegian prospective study of KpSC BSI episodes in adults, we used whole-genome sequencing to describe the molecular epidemiology of KpSC, and multivariable Cox regression analysis including clinical data to determine adjusted hazard ratios (aHR) for death associated with specific genomic lineages. <p>Findings: We included 1078 BSI episodes and 1082 bacterial isolates from 1055 patients. The overall 30-day case-fatality rate (CFR) was 12.5%. Median patient age was 73.4, 61.7% of patients were male. Median Charlson comorbidity score was 3. Klebsiella pneumoniae sensu stricto (Kp) (79.3%, n = 858/1082) and K. variicola (15.7%, n = 170/1082) were the dominating phylogroups. Global MDR-associated Kp clonal groups (CGs) were prevalent (25.0%, n = 270/1082) but 78.9% (n = 213/270) were not MDR, and 53.7% (n = 145/270) were community acquired. The major findings were increased risk for death within 30 days in monomicrobial BSIs caused by K. variicola (CFR 16.9%, n = 21; aHR 1.86, CI 1.10–3.17, p = 0.02), and global MDRassociated Kp CGs (CFR 17.0%, n = 36; aHR 1.52, CI 0.98–2.38, p = 0.06) compared to Kp CGs not associated with MDR (CFR 10.1%, n = 46). <p>Conclusion: Bacterial traits, beyond antimicrobial resistance, have a major impact on the clinical outcome of KpSC BSIs. The global spread of MDR-associated Kp CGs is driven by other mechanisms than antibiotic selection alone. Further insights into virulence determinants, and their association with phylogenetic lineages are needed to better understand the epidemiology of KpSC infection and clinical outcome.en_US
dc.identifier.citationFostervold A, Raffelsberger NP, Hetland MAK, Bakksjø R, Bernhoff E, Samuelsen Ø, Sundsfjord A, Afset JE, Berntsen CF, Bævre-Jensen RM, Ebbesen MH, Gammelsrud K, Guleng, Handal N, Jakovljev A, Johal SK, Marvik Å, Natvik AK, Sandnes R, Tofteland S, Bjørnholt J, Löhr IH. Risk of death in Klebsiella pneumoniae bloodstream infections is associated with specific phylogenetic lineages. Journal of Infection. 2024;88(5)en_US
dc.identifier.cristinIDFRIDAID 2259983
dc.identifier.doi10.1016/j.jinf.2024.106155
dc.identifier.issn0163-4453
dc.identifier.issn1532-2742
dc.identifier.urihttps://hdl.handle.net/10037/34723
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.relation.journalJournal of Infection
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2024 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleRisk of death in Klebsiella pneumoniae bloodstream infections is associated with specific phylogenetic lineagesen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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