Spontaneous and post-surgical/traumatic Klebsiella pneumoniae meningitis: two distinct clinic-microbiological entities

Guillaume Rollin (1) , Benjamin Rossi (2) , Sylvain Brisse (3) , Dominique Decré (4) , Véronique Leflon-Guibout (1) , Frédéric Bert (1) , Isabelle Hoffmann (5) , Jean-Winoc Decousser (6, 7) , Bruno Fantin (7, 1) , Agnès Lefort (1, 7)

1 Hôpital Beaujon [AP-HP]
2 Hôpital Robert Ballanger [Aulnay-sous-Bois]
3 Biodiversité et Epidémiologie des Bactéries pathogènes - Biodiversity and Epidemiology of Bacterial Pathogens
4 CIMI - Centre d'Immunologie et des Maladies Infectieuses
5 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
6 CHU Henri Mondor [Créteil]
7 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution

Objectives To analyze and compare the characteristics and outcome of spontaneous meningitis (SM) versus post-surgical/traumatic meningitis (PSTM) due to Klebsiella pneumoniae. Methods We conducted a retrospective, multicentric, cohort study of all K. pneumoniae meningitis cases managed between January 2007 and May 2018 in 7 university hospitals of Paris area. We further analyzed the microbiological characteristics of 16 available K. pneumoniae isolates, and sequenced the genome of 7 of them that were isolated from SM. Results Among 35 cases, 10 were SM, and 25 were PSTM. SM were more severe than PSTM with higher septic shock (p=0.004) and in-hospital mortality rates (p=0.004). In contrast, 5 patients from the PSTM group versus no patients from the SM group relapsed. All K. pneumoniae strains recovered from SM but none of those recovered from PSTM displayed hypervirulent phenotypic (positive string test) and genotypic (genes corresponding to capsular serotypes K1 or K2, virulence genes rmpA, iutA) characteristics (p<0.0001). PSTM tended to be more frequently polymicrobial (p=0.08) and caused by an extended-spectrum β-lactamase producing strain (p=0.08) than SM. Conclusions SM and PSTM are two entities differing both from a clinical and a microbiological standpoint. SM appears as a dreadful infection induced by hypervirulent K. pneumoniae strains.

Mots clés: hypervirulent Klebsiella pneumoniae; Meningitis; Spontaneous meningitis; Post-surgical/traumatic meningitis

Domaines: Médecine humaine et pathologie

Guillaume Rollin, Benjamin Rossi, Sylvain Brisse, Dominique Decré, Véronique Leflon-Guibout, et al.. Spontaneous and post-surgical/traumatic Klebsiella pneumoniae meningitis: two distinct clinic-microbiological entities. International Journal of Infectious Diseases, 2021, ⟨10.1016/j.ijid.2021.11.013⟩. ⟨hal-03428997⟩