Minimal Spanning Tree of <i>K. pneumoniae</i> Isolates in Fecal Carriage in Children in Guinea-Bissau.

<p>Full legend: The tree maps the relatedness of <i>K. pneumoniae</i> isolates. Isolates ≥93% related in DiversiLab analysis are grouped in a pie where each slice represents one isolate in the cluster. Each cluster was assigned a Roman numeral. Red indicates resistance to gentamicin, ciprofloxacin and trimethoprim-sulfamethoxazole, which at the time of the study were all easily available antibiotics except cephalosporin to treat gram-negative bacterial infections in Guinea-Bissau. Green indicates susceptibility to at least one of the mentioned agents.</p

Study Population Characteristics and Risk Factors for Colonization with ESBL-Producing Bacteria.

1<p>Mid-upper arm circumference at time of enrolment examined on children ≥6 months of age.</p>2<p>Test for linear trend.</p>3<p>Child breastfed at time of enrolment.</p>4<p>Bedsharing with another child <5 years of age.</p>5<p>Number of children <5 years of age living in the same household.</p>6<p>Antibiotic treatment initiated prior to presentation at emergency ward.</p>7<p>Reported antibiotic usage during the month prior to study enrolment (excluding antibiotic usage for current disease).</p>8<p>Child hospitalized ≥1 day during the month prior to enrolment.</p

Carriage Prevalence of ESBL-Producing <i>E. coli</i> and <i>K. pneumoniae</i> According to Age.

<p>Full legend: The ESBL carriage prevalence did not vary depending on age. Absolute numbers are presented within bars.</p

Antimicrobial Non-Susceptibility of ESBL-Producing <i>E. coli</i> and <i>K. pneumoniae</i> in Guinea-Bissau¹.

1<p>Non-susceptibility of isolate was defined as intermediate (I) or resistant (R) to respective antibiotic agent.</p>2<p>Non-susceptibility of isolate to three or more categories of antimicrobial agents as proposed by Magiorakos et al. <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0051981#pone.0051981-Oteo1" target="_blank">[30]</a>.</p>3<p>Available antimicrobials for common infections caused by gram-negative bacteria in Guinea-Bissau at the time of the study were trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin and ceftriaxone.</p

Minimal Spanning Tree of <i>E. coli</i> Isolates in Fecal Carriage in Children in Guinea-Bissau.

<p>Full legend: The tree maps the relatedness of <i>E. coli</i> isolates. Isolates ≥95% related in DiversiLab analysis are grouped in a pie where each slice represents one isolate in the cluster. Each cluster was assigned a Roman numeral. Red indicates resistance to gentamicin, ciprofloxacin and trimethoprim-sulfamethoxazole, which at the time of the study were all easily available antibiotics except cephalosporin to treat gram-negative bacterial infections in Guinea-Bissau. Green indicates susceptibility to at least one of the mentioned agents.</p

Factors and their independent association with nasopharyngeal pneumococcal density.

<p>Regression analysis with bootstrapping in 47 patients with complete information about the included parameters.</p

<i>Klebsiella variicola</i> Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to <i>K. pneumoniae</i>

<div><p>Clinical isolates of <i>Klebsiella pneumoniae</i> are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by <i>Klebsiella pneumoniae.</i> Isolates from all adult patients with BSI caused by <i>K. pneumoniae</i> admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three <i>K. pneumoniae</i> phylogroups were represented: KpI (n = 96), KpII (corresponding to <i>K. quasipneumoniae</i>, n = 9) and KpIII (corresponding to <i>K. variicola</i>, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10–8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (<i>wcaG</i> n = 1 and <i>wcaG</i>/<i>allS</i> n = 1). In conclusion, the results indicate higher mortality among patients infected with isolates belonging to <i>K. variicola</i>. The increased mortality could not be related to any known virulence factors, including virulent capsular types or mucoid phenotype.</p></div

Flow chart of the study population with and without nasopharyngeal aspirate tested with PCR for pneumococcal DNA.

<p>Flow chart of the study population with and without nasopharyngeal aspirate tested with PCR for pneumococcal DNA.</p

Clinical and microbiological factors and their association with nasopharyngeal pneumococcal density.

<p>^a Solid tumor, blood malignancy, liver disease, renal disease, chronic obstructive pulmonary disease, heart disease, stroke, diabetes.</p><p>^b Serotypes 3, 6B, 11A, 12F, 19A, 19F, 23F, and 35B.</p><p>Univariate analysis on 57 patients if not otherwise stated.</p

Characteristics of patients with community-acquired pneumonia with pneumococcal DNA detected and not detected in nasopharyngeal (NP) aspirate.

<p>Data are presented as numbers (%), unless otherwise indicated.</p><p>^a<i>Streptococcus pneumoniae</i> detected by blood culture and/or culture of respiratory secretions and/or urinary antigen test.</p><p>^b Solid tumor, blood malignancy, liver disease, renal disease, chronic obstructive pulmonary disease, heart disease, stroke, diabetes.</p><p>Characteristics of patients with community-acquired pneumonia with pneumococcal DNA detected and not detected in nasopharyngeal (NP) aspirate.</p