Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity.
Antibiotic resistant Klebsiella pneumoniae is a leading public health threat and gastrointestinal carriage is an established risk factor for subsequent infections during hospitalization. Our study contributes new knowledge of risk factors for gastrointestinal carriage and the genomic population stru...
Published in: | Gut Microbes |
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Main Authors: | , , , , , , , , , , |
Format: | Article in Journal/Newspaper |
Language: | English |
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Informa UK Limited
2021
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Online Access: | https://researchonline.lshtm.ac.uk/id/eprint/4661886/ https://researchonline.lshtm.ac.uk/id/eprint/4661886/1/Gastrointestinal%20carriage%20of%20Klebsiella%20pneumoniae%20in%20a%20general%20adult%20population%20a%20cross-sectional%20study%20of%20risk%20factors%20and.pdf |
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London School of Hygiene & Tropical Medicine: LSHTM Research Online |
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Antibiotic resistant Klebsiella pneumoniae is a leading public health threat and gastrointestinal carriage is an established risk factor for subsequent infections during hospitalization. Our study contributes new knowledge of risk factors for gastrointestinal carriage and the genomic population structure of K. pneumoniae colonizing humans in a representative sample of a general population in a community setting. Altogether, 2,975 participants (54% women) >40 y in the population-based Tromsø Study: Tromsø7, Norway (2015-2016) were included. Fecal samples were screened for K. pneumoniae, which were characterized using whole-genome sequencing. Risk factors for carriage were analyzed using multivariable logistic regression on data from questionnaires and the Norwegian Prescription Database. Prevalence of K. pneumoniae gastrointestinal carriage was 16.3% (95% CI 15.0-17.7, no gender difference). Risk factors associated with carriage included age ≥60 y, travel to Greece or Asia past 12 months (adjusted odds ratio 1.49, 95% CI 1.11-2.00), Crohn's disease/ulcerative colitis (2.26, 1.20-4.27), use of proton pump inhibitors (1.62, 1.18-2.22) and non-steroidal anti-inflammatory drugs past 6 months (1.38, 1.04-1.84), and antibiotic use the last month (1.73, 1.05-2.86). Prevalence was higher among those having used combinations of drug classes and decreased over time with respect to preceding antibiotic use. The K. pneumoniae population was diverse with 300 sequence types among 484 isolates distributed across four phylogroups. Only 5.2% of isolates harbored acquired resistance and 11.6% had virulence factors. Identification of risk factors for gastrointestinal carriage allows for identification of individuals that may have higher risk of extraintestinal infection during hospitalization. The findings that specific diseases and drugs used were associated with carriage show an impact of these possibly through modulating the human gut microbiota promoting colonization. The diverse population structure of carriage isolates reflects the ecologically adaptive capacity of the bacterium and challenges for vaccine prospects and the identification of reservoirs as a potential source for human colonization. |
format |
Article in Journal/Newspaper |
author |
Raffelsberger, Niclas Hetland, Marit Andrea Klokkhammer Svendsen, Kristian Småbrekke, Lars Löhr, Iren Høyland Andreassen, Lotte Leonore Eivindsdatter Brisse, Sylvain Holt, Kathryn E Sundsfjord, Arnfinn Samuelsen, Ørjan Gravningen, Kirsten |
spellingShingle |
Raffelsberger, Niclas Hetland, Marit Andrea Klokkhammer Svendsen, Kristian Småbrekke, Lars Löhr, Iren Høyland Andreassen, Lotte Leonore Eivindsdatter Brisse, Sylvain Holt, Kathryn E Sundsfjord, Arnfinn Samuelsen, Ørjan Gravningen, Kirsten Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
author_facet |
Raffelsberger, Niclas Hetland, Marit Andrea Klokkhammer Svendsen, Kristian Småbrekke, Lars Löhr, Iren Høyland Andreassen, Lotte Leonore Eivindsdatter Brisse, Sylvain Holt, Kathryn E Sundsfjord, Arnfinn Samuelsen, Ørjan Gravningen, Kirsten |
author_sort |
Raffelsberger, Niclas |
title |
Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
title_short |
Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
title_full |
Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
title_fullStr |
Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
title_full_unstemmed |
Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
title_sort |
gastrointestinal carriage of klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. |
publisher |
Informa UK Limited |
publishDate |
2021 |
url |
https://researchonline.lshtm.ac.uk/id/eprint/4661886/ https://researchonline.lshtm.ac.uk/id/eprint/4661886/1/Gastrointestinal%20carriage%20of%20Klebsiella%20pneumoniae%20in%20a%20general%20adult%20population%20a%20cross-sectional%20study%20of%20risk%20factors%20and.pdf |
geographic |
Norway Tromsø |
geographic_facet |
Norway Tromsø |
genre |
Tromsø |
genre_facet |
Tromsø |
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https://researchonline.lshtm.ac.uk/id/eprint/4661886/1/Gastrointestinal%20carriage%20of%20Klebsiella%20pneumoniae%20in%20a%20general%20adult%20population%20a%20cross-sectional%20study%20of%20risk%20factors%20and.pdf Raffelsberger, Niclas; Hetland, Marit Andrea Klokkhammer; Svendsen, Kristian; Småbrekke, Lars; Löhr, Iren Høyland; Andreassen, Lotte Leonore Eivindsdatter; Brisse, Sylvain; Holt, Kathryn E <https://researchonline.lshtm.ac.uk/view/creators/ipmbkhot.html>; Sundsfjord, Arnfinn; Samuelsen, Ørjan; +1 more. Gravningen, Kirsten; (2021) Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. Gut microbes, 13 (1). p. 1939599. ISSN 1949-0976 DOI: https://doi.org/10.1080/19490976.2021.1939599 <https://doi.org/10.1080/19490976.2021.1939599> |
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op_rightsnorm |
CC-BY |
op_doi |
https://doi.org/10.1080/19490976.2021.1939599 |
container_title |
Gut Microbes |
container_volume |
13 |
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1 |
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1766219873459896320 |
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ftlshtm:oai:researchonline.lshtm.ac.uk:4661886 2023-05-15T18:34:53+02:00 Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. Raffelsberger, Niclas Hetland, Marit Andrea Klokkhammer Svendsen, Kristian Småbrekke, Lars Löhr, Iren Høyland Andreassen, Lotte Leonore Eivindsdatter Brisse, Sylvain Holt, Kathryn E Sundsfjord, Arnfinn Samuelsen, Ørjan Gravningen, Kirsten 2021-06-28 text https://researchonline.lshtm.ac.uk/id/eprint/4661886/ https://researchonline.lshtm.ac.uk/id/eprint/4661886/1/Gastrointestinal%20carriage%20of%20Klebsiella%20pneumoniae%20in%20a%20general%20adult%20population%20a%20cross-sectional%20study%20of%20risk%20factors%20and.pdf en eng Informa UK Limited https://researchonline.lshtm.ac.uk/id/eprint/4661886/1/Gastrointestinal%20carriage%20of%20Klebsiella%20pneumoniae%20in%20a%20general%20adult%20population%20a%20cross-sectional%20study%20of%20risk%20factors%20and.pdf Raffelsberger, Niclas; Hetland, Marit Andrea Klokkhammer; Svendsen, Kristian; Småbrekke, Lars; Löhr, Iren Høyland; Andreassen, Lotte Leonore Eivindsdatter; Brisse, Sylvain; Holt, Kathryn E <https://researchonline.lshtm.ac.uk/view/creators/ipmbkhot.html>; Sundsfjord, Arnfinn; Samuelsen, Ørjan; +1 more. Gravningen, Kirsten; (2021) Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. Gut microbes, 13 (1). p. 1939599. ISSN 1949-0976 DOI: https://doi.org/10.1080/19490976.2021.1939599 <https://doi.org/10.1080/19490976.2021.1939599> cc_by CC-BY Article NonPeerReviewed 2021 ftlshtm https://doi.org/10.1080/19490976.2021.1939599 2022-03-03T07:35:27Z Antibiotic resistant Klebsiella pneumoniae is a leading public health threat and gastrointestinal carriage is an established risk factor for subsequent infections during hospitalization. Our study contributes new knowledge of risk factors for gastrointestinal carriage and the genomic population structure of K. pneumoniae colonizing humans in a representative sample of a general population in a community setting. Altogether, 2,975 participants (54% women) >40 y in the population-based Tromsø Study: Tromsø7, Norway (2015-2016) were included. Fecal samples were screened for K. pneumoniae, which were characterized using whole-genome sequencing. Risk factors for carriage were analyzed using multivariable logistic regression on data from questionnaires and the Norwegian Prescription Database. Prevalence of K. pneumoniae gastrointestinal carriage was 16.3% (95% CI 15.0-17.7, no gender difference). Risk factors associated with carriage included age ≥60 y, travel to Greece or Asia past 12 months (adjusted odds ratio 1.49, 95% CI 1.11-2.00), Crohn's disease/ulcerative colitis (2.26, 1.20-4.27), use of proton pump inhibitors (1.62, 1.18-2.22) and non-steroidal anti-inflammatory drugs past 6 months (1.38, 1.04-1.84), and antibiotic use the last month (1.73, 1.05-2.86). Prevalence was higher among those having used combinations of drug classes and decreased over time with respect to preceding antibiotic use. The K. pneumoniae population was diverse with 300 sequence types among 484 isolates distributed across four phylogroups. Only 5.2% of isolates harbored acquired resistance and 11.6% had virulence factors. Identification of risk factors for gastrointestinal carriage allows for identification of individuals that may have higher risk of extraintestinal infection during hospitalization. The findings that specific diseases and drugs used were associated with carriage show an impact of these possibly through modulating the human gut microbiota promoting colonization. The diverse population structure of carriage isolates reflects the ecologically adaptive capacity of the bacterium and challenges for vaccine prospects and the identification of reservoirs as a potential source for human colonization. Article in Journal/Newspaper Tromsø London School of Hygiene & Tropical Medicine: LSHTM Research Online Norway Tromsø Gut Microbes 13 1 |