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Characterization of Phenotypic and Genotypic Traits of Klebsiella pneumoniae from Lung Cancer Patients with Respiratory Infection

Authors Ding L, Yang Z, Lu J, Ma L, Liu Y, Wu X, Yao W, Zhang X, Zhu K

Received 30 August 2019

Accepted for publication 17 December 2019

Published 29 January 2020 Volume 2020:13 Pages 237—245

DOI https://doi.org/10.2147/IDR.S229085

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony


Lingchi Ding, 1,* Zhiqiang Yang, 1, 2,* Junguo Lu, 1 Lichao Ma, 2 Ying Liu, 2 Xiaoyan Wu, 3 Weidong Yao, 1 Xiaodong Zhang, 1 Kui Zhu 2

1Oncology Department, Nantong Tumor Hospital, Nantong 226361, People’s Republic of China; 2Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Veterinary Medicine, China Agricultural University, Beijing 100193, People’s Republic of China; 3Clinical Laboratory, Nantong Tumor Hospital, Nantong 226361, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaodong Zhang; Weidong Yao Email 419317110@qq.com; yaowd126nt-org@163.com

Background: Klebsiella pneumoniae has been a leading healthcare-acquired infection (HAI) agent worldwide for decades. However, the epidemiological characteristics of K. pneumoniae in lung cancer patients with respiratory infection are unclear. Here, we characterized the frequency of K. pneumoniae in lung cancer patients with respiratory infection in a cancer hospital in China and determined the antibiotic resistance profile, virulence phenotype and clonal relationships among these K. pneumoniae strains.
Methods: The clinical data of lung cancer patients with respiratory infection from September 2017 to October 2018 were retrospectively evaluated. Microbiological methods, antimicrobial susceptibility tests, pulsed-field gel electrophoresis (PFGE), polymerase chain reaction (PCR) assays, Sanger sequencing and Galleria mellonella larvae infection model were used in this study.
Results: During the study period, a total of 47 lung cancer patients with respiratory infection caused by bacteria were identified, among 27 patients were identified as positive for K. pneumoniae and the positive rate was 57.45%. Among 37 nonduplicate K. pneumoniae strains from these 27 patients, 19 isolates (51.4%) were classified as multidrug resistant (MDR) with high-level resistance to, at least one agent in three or more antibiotic categories, including polymyxin B and tigecycline. Sixteen of the 37 strains (43.2%) were hypermucoviscous isolates. Extended spectrum β-lactamases-producing K. pneumoniae strains consisted of two dominant PFGE types. Furthermore, the assessment of virulence potential using a G. mellonella larvae infection model showed that K. pneumoniae isolated from these patients exhibited a high virulence level.
Conclusion: Our data showed that K. pneumoniae is the most critical cause of lung infection in patients with lung cancer in this hospital. The various drug resistance and virulence backgrounds of K. pneumoniae may make this clinical center a breeding ground for superbugs. It is paramount to enhance surveillance of K. pneumoniae strains and take control measures.

Keywords: K. pneumoniae, lung cancer, multidrug-resistant, virulence


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