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      Skin and soft tissue infection suspiciously caused by Klebsiella pneumoniae in an aquaculture worker: A case report

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          Abstract

          Skin and soft tissue infections (SSTIs), which are mainly caused by Gram-positive cocci existing on the skin surface, are more common than those caused by Gram-negative bacteria; however, the role of Gram-negative bacteria as emerging pathogens in SSTIs cannot to be ignored. Klebsiella pneumoniae is an opportunistic pathogenic bacterium that mainly inhabits the respiratory and intestinal tracts of humans and animals, as well as the environment, including aquaculture farms. This bacterium can cause multiple infections in humans and animals. The present study reports the case of a SSTI which was suspected to be caused by Klebsiella pneumoniae in a 74-year-old farmer with venous thrombosis. The patient had exposed his four bare limbs to the farmed shrimps and shrimp pond routinely. Pustule and skin ulcers were observed on both the legs of the patient. After receiving anti-infection therapy, the SSTI was almost completely resolved on day 9 and the patient was then discharged.

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          Most cited references28

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          Colonization, Infection, and the Accessory Genome of Klebsiella pneumoniae

          Klebsiella pneumoniae is a Gram-negative pathogen that has a large accessory genome of plasmids and chromosomal gene loci. This accessory genome divides K. pneumoniae strains into opportunistic, hypervirulent, and multidrug-resistant groups and separates K. pneumoniae from two closely related species, Klebsiella variicola and Klebsiella quasipneumoniae. Some strains of K. pneumoniae act as opportunistic pathogens, infecting critically ill and immunocompromised patients. These K. pneumoniae are a common cause of health-care associated infections including pneumonia, urinary tract infections (UTIs), and bloodstream infections. K. variicola and K. quasipneumoniae are often clinically indistinguishable from opportunistic K. pneumoniae. Other strains of K. pneumoniae are hypervirulent, infecting healthy people in community settings and causing severe infections including pyogenic liver abscess, endophthalmitis, and meningitis. A third group of K. pneumoniae encode carbapenemases, making them highly antibiotic-resistant. These strains act as opportunists but are exceedingly difficult to treat. All of these groups of K. pneumoniae and related species can colonize the gastrointestinal tract, and the accessory genome may determine if a colonizing strain remains asymptomatic or progresses to cause disease. This review will explore the associations between colonization and infection with opportunistic, antibiotic-resistant, and hypervirulent K. pneumoniae strains and the role of the accessory genome in distinguishing these groups and related species. As K. pneumoniae infections become progressively more difficult to treat in the face of antibiotic resistance and hypervirulent strains, an increased understanding of the epidemiology and pathogenesis of these bacteria is vital.
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            Integrated aquaculture contributes to the transfer of mcr-1 between animals and humans via the aquaculture supply chain

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              Microbial Infection and Antibiotic Susceptibility of Diabetic Foot Ulcer in China: Literature Review

              Objective To investigate the microbial spectrum isolated from foot ulcers among diabetic patients in China, which was conducted to help clinicians choose optimal antibiotics empirically. Method The PubMed, MEDLINE, Web of Science, China Biology Medicine (CBM), China National Knowledge Infrastructure (CNKI), WanFang, and VIP databases were searched for studies published between 2015 to 2019, that report primary data on diabetic foot infection (DFI) and antibiotic susceptibility in China. Result A total of 63 articles about DFI and antibiotic susceptibility tests among diabetic patients in China were included. There were 11,483 patients with an average age of 60.2 ± 10.1 years and a mean course of 10.6 ± 5.0 years between 2010 and 2019, covering most geographical regions of China. The prevalence of Gram-positive (GP) bacteria (43.4%) was lower than that of Gram-negative (GN) (52.4%). The most prevalent pathogens isolated were Staphylococcus aureus (17.7%), Escherichia coli (10.9%), Pseudomonas aeruginosa (10.5%), Klebsiella pneumoniae (6.2%), Staphylococcus epidermidis (5.3%), Enterococcus faecalis (4.9%), and fungus (3.7%). The prevalence of polymicrobial infection was 22.8%. GP bacteria were sensitive to linezolid, vancomycin, and teicoplanin. More than 50% of GN bacteria were resistant to third-generation cephalosporins, while the resistance rates of piperacillin/tazobactam, amikacin, meropenem, and imipenem were relatively low. Among the 6017 strains of the isolated organisms, 20% had multi-drug resistance (MDR). Staphylococcus aureus (30.4%) was the most predominant MDR bacteria, followed by extended-spectrum β-lactamase (ESBL) (19.1%). Conclusion The microbial infection of foot ulcers among diabetic patients in China is diverse. The microbial spectrum is different in different geographic regions and Staphylococcus aureus is the predominant bacteria. Polymicrobial and MDR bacterial infections on the foot ulcers are common. This study could be valuable in guiding the empirical use of antibiotics for diabetic foot infections.
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                Author and article information

                Journal
                Med Int (Lond)
                Med Int (Lond)
                MI
                Medicine International
                D.A. Spandidos
                2754-3242
                2754-1304
                Jul-Aug 2024
                23 April 2024
                23 April 2024
                : 4
                : 4
                : 34
                Affiliations
                [1 ]Department of Clinical Pharmacy, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong 524033, P.R. China
                [2 ]Department of Rheumatology and Immunology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong 524033, P.R. China
                [3 ]Department of Hematology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong 524033, P.R. China
                [4 ]Department of Emergency Medicine, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong 524033, P.R. China
                [5 ]Department of Clinical Laboratory, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong 524033, P.R. China
                Author notes
                Correspondence to: Dr Yan Chen, Department of Rheumatology and Immunology, Central People's Hospital of Zhanjiang, 236 Yuanzhu Road, Zhanjiang, Guangdong 524033, P.R. China 460968949qq.com cyan0515@ 123456163.com

                Dr Na Li, Department of Clinical Pharmacy, Central People's Hospital of Zhanjiang, 236 Yuanzhu Road, Zhanjiang, Guangdong 524033, P.R. China 460968949@ 123456qq.com

                Article
                MI-4-4-00158
                10.3892/mi.2024.158
                11097137
                38756456
                4bf05d74-b95b-4232-8b73-70368e0f5836
                Copyright: © 2024 Xie et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ) and either DOI or URL of the article must be cited.

                History
                : 02 September 2023
                : 28 March 2024
                Funding
                Funding: No funding was received.
                Categories
                Case Report

                aquaculture,klebsiella pneumoniae,skin,soft tissue,infection

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