Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China
Hypervirulent (hypermucoviscous) Klebsiella pneumoniae strains constitute an increasing proportion of the K. pneumoniae strains isolated from patients in China. Disturbingly, the frequency of antimicrobial-resistant strains identified among these isolates has increased in recent years. Background. ...
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| Veröffentlicht in: | Clinical infectious diseases 2014-01, Vol.58 (2), p.225-232 |
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| creator | Li, Wei Sun, Guizhen Yu, Yanhua Li, Ning Chen, Ming Jin, Ronghua Jiao, Yanmei Wu, Hao |
| description | Hypervirulent (hypermucoviscous) Klebsiella pneumoniae strains constitute an increasing proportion of the K. pneumoniae strains isolated from patients in China. Disturbingly, the frequency of antimicrobial-resistant strains identified among these isolates has increased in recent years.
Background.
New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates.
Results.
Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842–59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153–9.768]) and K2 (OR, 9.280 [95% CI, 0.987–87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397–39.572]), liver abscess (OR, 9.068 [95% CI, 1.747–47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100–6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623–30.033]), sputum isolation (OR, 0.312 [95% CI, .095–1.021]), and HIV infection ( |
| doi_str_mv | 10.1093/cid/cit675 |
| format | Article |
| fullrecord | <record><control><sourceid>jstor_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1524409671</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><jstor_id>26523451</jstor_id><oup_id>10.1093/cid/cit675</oup_id><sourcerecordid>26523451</sourcerecordid><originalsourceid>FETCH-LOGICAL-c532t-ac5d958c211a71f1db06cbb996bb9b7bd9f1bdf07dea2f715bc00b6e00d5ec333</originalsourceid><addsrcrecordid>eNqF0c1rFDEUAPAgiv3Qi3clUIS2MJpMksnkWJZqlxYKouchybzRLDPJmEwK-9-buqsLPeghHw9-vLy8h9AbSj5QothH6_qylkaKZ-iYCiarRij6vNyJaCvesvYInaS0IYTSloiX6KjmRClF1THarr2NoJPz3_G9tTlG8BZwGPCVX9zkbAzG6bH6AsmlRfsF32xniA8u5hFKdP47nLINDy7ZkNMFvh3BJAfjqPHsIU_BOw14ncKoF0jYebz64bx-hV4Mekzwen-eom-frr-ubqq7-8_r1dVdZQWrl0pb0SvR2ppSLelAe0Maa4xSTdmMNL0aqOkHInvQ9SCpMJYQ0wAhvQDLGDtF57u8cww_M6Slm0qlj-V5KPV2VNS8tKOR9P-UKyI5k1IVevaEbkKOvnykKMnbtuasKepyp0obU4owdHN0k47bjpLucXZdmV23m13B7_Yps5mg_0v_DKuA93ugk9XjELW3Lh1cS5WQvDm4kOd_P_h25zZpCfGQpxE144KyX_Rtusw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1474882436</pqid></control><display><type>article</type><title>Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China</title><source>Jstor Complete Legacy</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Li, Wei ; Sun, Guizhen ; Yu, Yanhua ; Li, Ning ; Chen, Ming ; Jin, Ronghua ; Jiao, Yanmei ; Wu, Hao</creator><creatorcontrib>Li, Wei ; Sun, Guizhen ; Yu, Yanhua ; Li, Ning ; Chen, Ming ; Jin, Ronghua ; Jiao, Yanmei ; Wu, Hao</creatorcontrib><description>Hypervirulent (hypermucoviscous) Klebsiella pneumoniae strains constitute an increasing proportion of the K. pneumoniae strains isolated from patients in China. Disturbingly, the frequency of antimicrobial-resistant strains identified among these isolates has increased in recent years.
Background.
New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates.
Results.
Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842–59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153–9.768]) and K2 (OR, 9.280 [95% CI, 0.987–87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397–39.572]), liver abscess (OR, 9.068 [95% CI, 1.747–47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100–6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623–30.033]), sputum isolation (OR, 0.312 [95% CI, .095–1.021]), and HIV infection (<0.001 [not applicable]). Multivariate analysis implicated rmpA (OR, 17.398 [95% CI, 4.224–71.668]) and community-acquired infection (OR, 6.844 [95% CI, 1.905–24.585]) as independent risk factors. The proportion of hvKP isolates increased from April to December 2010, January to September 2011, and October 2011 to June 2012 (to 25.5%, 26.7%, and 54.5%, respectively). Resistance to 14 of 19 tested antimicrobials was found to be significantly greater in cKP compared to hvKP. Importantly, resistance to all the tested antimicrobials, except carbapenems and amikacin, was observed in a proportion of hvKP strains, 17% (5/29) of which expressed extended-spectrum β-lactamase. Furthermore, antimicrobial resistance in hvKP strains increased over time.
Conclusions.
HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/cit675</identifier><identifier>PMID: 24099919</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Aged ; Anti-Bacterial Agents - pharmacology ; ARTICLES AND COMMENTARIES ; Bacteriology ; Biological and medical sciences ; China - epidemiology ; Communicable Diseases, Emerging - epidemiology ; Communicable Diseases, Emerging - microbiology ; Drug resistance ; Drug Resistance, Bacterial ; Female ; Gram-negative bacteria ; Human immunodeficiency virus ; Humans ; Incidence ; Infectious diseases ; Klebsiella Infections - epidemiology ; Klebsiella Infections - microbiology ; Klebsiella pneumoniae ; Klebsiella pneumoniae - drug effects ; Klebsiella pneumoniae - genetics ; Klebsiella pneumoniae - isolation & purification ; Klebsiella pneumoniae - pathogenicity ; Male ; Medical sciences ; Middle Aged ; Multivariate analysis ; Prevalence ; Retrospective Studies ; Virulence ; Virulence Factors - analysis ; Virulence Factors - genetics</subject><ispartof>Clinical infectious diseases, 2014-01, Vol.58 (2), p.225-232</ispartof><rights>The Author 2013</rights><rights>The Author 2013. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com . 2013</rights><rights>2015 INIST-CNRS</rights><rights>Copyright Oxford University Press, UK Jan 15, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-ac5d958c211a71f1db06cbb996bb9b7bd9f1bdf07dea2f715bc00b6e00d5ec333</citedby><cites>FETCH-LOGICAL-c532t-ac5d958c211a71f1db06cbb996bb9b7bd9f1bdf07dea2f715bc00b6e00d5ec333</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/26523451$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/26523451$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,1578,27903,27904,57995,58228</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28195746$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24099919$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Wei</creatorcontrib><creatorcontrib>Sun, Guizhen</creatorcontrib><creatorcontrib>Yu, Yanhua</creatorcontrib><creatorcontrib>Li, Ning</creatorcontrib><creatorcontrib>Chen, Ming</creatorcontrib><creatorcontrib>Jin, Ronghua</creatorcontrib><creatorcontrib>Jiao, Yanmei</creatorcontrib><creatorcontrib>Wu, Hao</creatorcontrib><title>Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Hypervirulent (hypermucoviscous) Klebsiella pneumoniae strains constitute an increasing proportion of the K. pneumoniae strains isolated from patients in China. Disturbingly, the frequency of antimicrobial-resistant strains identified among these isolates has increased in recent years.
Background.
New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates.
Results.
Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842–59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153–9.768]) and K2 (OR, 9.280 [95% CI, 0.987–87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397–39.572]), liver abscess (OR, 9.068 [95% CI, 1.747–47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100–6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623–30.033]), sputum isolation (OR, 0.312 [95% CI, .095–1.021]), and HIV infection (<0.001 [not applicable]). Multivariate analysis implicated rmpA (OR, 17.398 [95% CI, 4.224–71.668]) and community-acquired infection (OR, 6.844 [95% CI, 1.905–24.585]) as independent risk factors. The proportion of hvKP isolates increased from April to December 2010, January to September 2011, and October 2011 to June 2012 (to 25.5%, 26.7%, and 54.5%, respectively). Resistance to 14 of 19 tested antimicrobials was found to be significantly greater in cKP compared to hvKP. Importantly, resistance to all the tested antimicrobials, except carbapenems and amikacin, was observed in a proportion of hvKP strains, 17% (5/29) of which expressed extended-spectrum β-lactamase. Furthermore, antimicrobial resistance in hvKP strains increased over time.
Conclusions.
HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.</description><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - pharmacology</subject><subject>ARTICLES AND COMMENTARIES</subject><subject>Bacteriology</subject><subject>Biological and medical sciences</subject><subject>China - epidemiology</subject><subject>Communicable Diseases, Emerging - epidemiology</subject><subject>Communicable Diseases, Emerging - microbiology</subject><subject>Drug resistance</subject><subject>Drug Resistance, Bacterial</subject><subject>Female</subject><subject>Gram-negative bacteria</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Incidence</subject><subject>Infectious diseases</subject><subject>Klebsiella Infections - epidemiology</subject><subject>Klebsiella Infections - microbiology</subject><subject>Klebsiella pneumoniae</subject><subject>Klebsiella pneumoniae - drug effects</subject><subject>Klebsiella pneumoniae - genetics</subject><subject>Klebsiella pneumoniae - isolation & purification</subject><subject>Klebsiella pneumoniae - pathogenicity</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Virulence</subject><subject>Virulence Factors - analysis</subject><subject>Virulence Factors - genetics</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0c1rFDEUAPAgiv3Qi3clUIS2MJpMksnkWJZqlxYKouchybzRLDPJmEwK-9-buqsLPeghHw9-vLy8h9AbSj5QothH6_qylkaKZ-iYCiarRij6vNyJaCvesvYInaS0IYTSloiX6KjmRClF1THarr2NoJPz3_G9tTlG8BZwGPCVX9zkbAzG6bH6AsmlRfsF32xniA8u5hFKdP47nLINDy7ZkNMFvh3BJAfjqPHsIU_BOw14ncKoF0jYebz64bx-hV4Mekzwen-eom-frr-ubqq7-8_r1dVdZQWrl0pb0SvR2ppSLelAe0Maa4xSTdmMNL0aqOkHInvQ9SCpMJYQ0wAhvQDLGDtF57u8cww_M6Slm0qlj-V5KPV2VNS8tKOR9P-UKyI5k1IVevaEbkKOvnykKMnbtuasKepyp0obU4owdHN0k47bjpLucXZdmV23m13B7_Yps5mg_0v_DKuA93ugk9XjELW3Lh1cS5WQvDm4kOd_P_h25zZpCfGQpxE144KyX_Rtusw</recordid><startdate>20140115</startdate><enddate>20140115</enddate><creator>Li, Wei</creator><creator>Sun, Guizhen</creator><creator>Yu, Yanhua</creator><creator>Li, Ning</creator><creator>Chen, Ming</creator><creator>Jin, Ronghua</creator><creator>Jiao, Yanmei</creator><creator>Wu, Hao</creator><general>Oxford University Press</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20140115</creationdate><title>Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China</title><author>Li, Wei ; Sun, Guizhen ; Yu, Yanhua ; Li, Ning ; Chen, Ming ; Jin, Ronghua ; Jiao, Yanmei ; Wu, Hao</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-ac5d958c211a71f1db06cbb996bb9b7bd9f1bdf07dea2f715bc00b6e00d5ec333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - pharmacology</topic><topic>ARTICLES AND COMMENTARIES</topic><topic>Bacteriology</topic><topic>Biological and medical sciences</topic><topic>China - epidemiology</topic><topic>Communicable Diseases, Emerging - epidemiology</topic><topic>Communicable Diseases, Emerging - microbiology</topic><topic>Drug resistance</topic><topic>Drug Resistance, Bacterial</topic><topic>Female</topic><topic>Gram-negative bacteria</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Incidence</topic><topic>Infectious diseases</topic><topic>Klebsiella Infections - epidemiology</topic><topic>Klebsiella Infections - microbiology</topic><topic>Klebsiella pneumoniae</topic><topic>Klebsiella pneumoniae - drug effects</topic><topic>Klebsiella pneumoniae - genetics</topic><topic>Klebsiella pneumoniae - isolation & purification</topic><topic>Klebsiella pneumoniae - pathogenicity</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate analysis</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>Virulence</topic><topic>Virulence Factors - analysis</topic><topic>Virulence Factors - genetics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Wei</creatorcontrib><creatorcontrib>Sun, Guizhen</creatorcontrib><creatorcontrib>Yu, Yanhua</creatorcontrib><creatorcontrib>Li, Ning</creatorcontrib><creatorcontrib>Chen, Ming</creatorcontrib><creatorcontrib>Jin, Ronghua</creatorcontrib><creatorcontrib>Jiao, Yanmei</creatorcontrib><creatorcontrib>Wu, Hao</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Wei</au><au>Sun, Guizhen</au><au>Yu, Yanhua</au><au>Li, Ning</au><au>Chen, Ming</au><au>Jin, Ronghua</au><au>Jiao, Yanmei</au><au>Wu, Hao</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2014-01-15</date><risdate>2014</risdate><volume>58</volume><issue>2</issue><spage>225</spage><epage>232</epage><pages>225-232</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Hypervirulent (hypermucoviscous) Klebsiella pneumoniae strains constitute an increasing proportion of the K. pneumoniae strains isolated from patients in China. Disturbingly, the frequency of antimicrobial-resistant strains identified among these isolates has increased in recent years.
Background.
New hypervirulent variants of Klebsiella pneumoniae (hvKP) are emerging globally, most of which exhibit antimicrobial susceptibility.
Methods.
A retrospective study was conducted in 88 patients with cultures positive for K. pneumoniae hospitalized in the Beijing You'an Hospital from April 2010 to June 2012. The clinical and molecular data of the hvKP isolates (defined as string test positive) were compared with those of the classic K. pneumoniae (cKP) isolates.
Results.
Overall, 33.0% (29/88) of K. pneumoniae isolates were hvKP. Univariate analysis revealed the following risk factors for hvKP: virulence gene rmpA (odds ratio [OR], 16.92 [95% confidence interval {CI}, 4.842–59.145]), capsule antigens K1 (OR, 3.355 [95% CI, 1.153–9.768]) and K2 (OR, 9.280 [95% CI, 0.987–87.250]), alcoholic hepatitis (OR, 7.435 [95% CI, 1.397–39.572]), liver abscess (OR, 9.068 [95% CI, 1.747–47.061]), metastatic infection (OR, 2.752 [95% CI, 1.100–6.886]), community-acquired infection (OR, 10.432 [95% CI, 3.623–30.033]), sputum isolation (OR, 0.312 [95% CI, .095–1.021]), and HIV infection (<0.001 [not applicable]). Multivariate analysis implicated rmpA (OR, 17.398 [95% CI, 4.224–71.668]) and community-acquired infection (OR, 6.844 [95% CI, 1.905–24.585]) as independent risk factors. The proportion of hvKP isolates increased from April to December 2010, January to September 2011, and October 2011 to June 2012 (to 25.5%, 26.7%, and 54.5%, respectively). Resistance to 14 of 19 tested antimicrobials was found to be significantly greater in cKP compared to hvKP. Importantly, resistance to all the tested antimicrobials, except carbapenems and amikacin, was observed in a proportion of hvKP strains, 17% (5/29) of which expressed extended-spectrum β-lactamase. Furthermore, antimicrobial resistance in hvKP strains increased over time.
Conclusions.
HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>24099919</pmid><doi>10.1093/cid/cit675</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical infectious diseases, 2014-01, Vol.58 (2), p.225-232 |
| issn | 1058-4838 1537-6591 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1524409671 |
| source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Aged Anti-Bacterial Agents - pharmacology ARTICLES AND COMMENTARIES Bacteriology Biological and medical sciences China - epidemiology Communicable Diseases, Emerging - epidemiology Communicable Diseases, Emerging - microbiology Drug resistance Drug Resistance, Bacterial Female Gram-negative bacteria Human immunodeficiency virus Humans Incidence Infectious diseases Klebsiella Infections - epidemiology Klebsiella Infections - microbiology Klebsiella pneumoniae Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - genetics Klebsiella pneumoniae - isolation & purification Klebsiella pneumoniae - pathogenicity Male Medical sciences Middle Aged Multivariate analysis Prevalence Retrospective Studies Virulence Virulence Factors - analysis Virulence Factors - genetics |
| title | Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China |
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