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Volume 48, Number 3, June 2015

Clinical and microbiological characteristics of peritoneal dialysis-related peritonitis caused by Klebsiella pneumoniae in southern Taiwan 


Wei-Hung Lin, Chin-Chung Tseng, An-Bang Wu, Deng-Chi Yang, Shian-Wen Cheng, Ming-Cheng Wang, Jiunn-Jong Wu


Received: April 28, 2013    Revised: July 12, 2013    Accepted: July 25, 2013   

 

Corresponding author:

Ming-Cheng Wang
Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Correspondence
Corresponding author. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, 70428 Tainan, Taiwan.

Jiuun-Jong Wu
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
Correspondence
Corresponding author. Department of Medical Laboratory Science and Biotechnology, Infectious Disease and Signaling Research Center, College of Medicine, National Cheng Kung University, Number 1 University Road, Tainan 70101, Taiwan. 



 

Background and purpose: 

Gram-negative peritonitis is a frequent and serious complication of peritoneal dialysis (PD). No previous reports have focused on Klebsiella pneumoniae infection. The aim of this study was to investigate the host and bacterial factors associated with K. pneumoniae PD-related peritonitis. 



 

Methods:

We retrospectively studied K. pneumoniae PD-peritonitis cases treated at a university hospital in southern Taiwan during 1990–2011, and analyzed the clinical features and outcomes and bacterial characteristics of serotypes, hypermucoviscosity (HV), and virulence-associated genes such as wabG, uge, and rmpA in K. pneumoniae PD-related peritonitis. Fifty-four isolates of K. pneumoniae-related community-acquired urinary tract infection (UTI) and 76 morphologically different nonpathogenic K. pneumoniae isolates from healthy adults were used as controls.
 



 

Results:

K. pneumoniae was the second most common monomicrobial pathogen causing Gram-negative PD-related peritonitis (n = 13, 2.7%), and the most common pathogen involved in polymicrobial peritonitis (16/43, 37.2%) and associated with high catheter removal rate (7/16, 43.8%). Compared with Escherichia coli peritonitis cases, patients with monomicrobial K. pneumoniae peritonitis also had insignificantly higher incidence of sepsis/bacteremia [n = 5 (38%), p = 0.11] and a higher mortality rate [n = 3 (23%), p = 0.36]. The prevalence of K1/K2 (n = 1, 7.7%) serotypes was low, but there was a higher prevalence of serotype K20 (n = 3, 23.1%) in K. pneumoniae isolates derived from monomicrobial PD-related peritonitis compared with control groups. HV phenotype (p < 0.001) and rmpA genotype (p = 0.007) were absent in the peritonitis group. 



 

Conclusion:

This is the first study focused on clinical and microbiological characteristics of K. pneumoniae PD-related peritonitis. K. pneumoniae was a common Gram-negative pathogen causing monomicrobial and polymicrobial PD-related peritonitis in southern Taiwan. The bacterial characteristics with low percentage of capsular serotype K1/K2, no significant HV, and absence of rmpA suggest a different pathogenesis in K. pneumoniae PD-related peritonitis compared with that in UTI and liver abscess. 



 

Key words:

Hypermucoviscosity, Klebsiella pneumoniae, Peritoneal dialysis, Peritonitis, Virulence factor