Fatal community-acquired bloodstream infection caused by Klebsiella variicola: A case report

Table 1 Liver and renal function results

Item	Result (1st)	Reference range
TBIL (μmol/L)	19.4	3.6-20.5
TP (μmol/L)	49.8	65-85
ALB (g/L)	31.4	40-55
ALT (U/L)	156	9-50
AST (U/L)	182	15-40
sCrea (μmol/L)	160	57-97
Urea (μmol/L)	12.40	3.1-8
GLU (mmol/L)	13.89	3.9-6.1
K+ (mmol/L)	3.22	3.5-5.5
UA (μmol/L)	591	210-420

Blood samples were collected on admission and liver and renal function parameters examined. Results were acquired about 2 h after sample collection. TBIL: Total bilirubin; ALB: Serum albumin; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GLU: Glutamate; sCrea: Serum creatinine; UA: Uric acid.

Table 2 Clotting function parameters tested after referral

Item	Result	Reference range
3P	Negative	Negative
D-D (μg/mL)	60.75↑	0-1
FDP (μg/mL)	128.5↑	0-5
PT (s)	18.3↑	9.2-12.2
INR	1.59↑	0.8-1.2
APTT (s)	67.6↑	21.1-36.5
TT (s)	23.4↑	14-21
FBG (g/L)	22.58	1.8-3.5

On admission, blood samples were sent for clotting assessment. Results were acquired 1 h after sample collection. FDP: Flexor digitorum profundus; PT: Prothrombin time; INR: International normalized ratio; APTT: Activated partial thromboplastin time; TT: Thromboplastin time; FBG: Fibrinogen.

Table 3 Inflammatory parameters

Item	Result	Reference range
WBC (× 109)	1.2	3.5-10
NEUT (× 109)	0.63	1.8-6.3
%NEUT	52.5	40-75
MONO (× 109)	0.05	0.1-0.6
%MONO	4.2	3-10
LYMBP (× 109)	0.39	1.1-3.2
%LYMBP	32.5	20-50
RBC (× 1012)	1.83	3.5-5.5
HGB (g/L)	52.0	114-163
%HCT	15.6	35-50
PLT (× 109)	10	125-350
CRP (mg/L)	230.33	0-5
PCT	> 100	0-0.046

On admission, blood samples were sent for routine examination including C-reactive protein and procalcitonin. Results were acquired 1 h after sample collection. WBC: White blood cells; NEUT: Neutrophils; MONO: Monocytes; LYMBP: Lymphocytes; RBC: Red blood cells; HGB: Hemoglobin; HCT: Hemocrit; PLT: Platelets; CRP: C-reactive protein; PCT: Procalcitonin.

Table 4 Results related to virus, mycobacteria, mycoplasma/chlamydia, and autoimmune disease

Item	Result	Reference
RSV-IGM	Negative	Negative
ADV-IGM	Negative	Negative
IFZA-IGM	Negative	Negative
IFZB-IGM	Negative	Negative
HPIVs-IGM	Negative	Negative
MP-IGM	Negative	Negative
CP-IGM	Negative	Negative
CBV-IGM	Negative	Negative
CAV-IGM	Negative	Negative
ECHO-IGM	Negative	Negative
LP-IGM	Negative	Negative
2019-nCoV	Negative	Negative
EB-DNA (copies/mL)	< 5E + 2	< 5E + 2
EB-DNA	Negative	Negative
CMVDNA DL (copies/mL)	< 5E + 2	< 5E + 2
CMV DNA DX	Negative	Negative
t1	Test method: Blotting
A-PR3	Negative	Negative
A-MP0	Negative	Negative
A-GBM	Negative	Negative
t2	Test method: Fluorescence
cANCA	Negative	Negative
pANCA	Negative	Negative

After admission, blood samples were sent for assessment of infection by virus, mycobacteria, and mycoplasma/chlamydia along with changes in autoimmune disease markers.

Table 5 Results of bacterial culture and drug sensitivity

Specimen	Blood
Equipment	Phoenix100
Items	Bacterial culture + antimicrobial susceptibility
Results	Klebsiella pneumoniae
Antibiotics	MIC	Result interpretation	Cutoff
Cefotaxime		S	S ≤ 1; R ≥ 4
Cotrimoxazole	≤ 20	S	S ≤ 2/38; R ≥ 4/76
Tigecycline	≤ 0.5	S
Levofloxacin	≤ 0.12	S	S ≤ 0.5; R ≥ 2
Amikacin	≤ 2	S	S ≤ 16; R ≥ 64
Imipenem	≤ 0.25	S	S ≤ 1; R ≥ 4
Er ertapenem	≤ 0.12	S	S ≤ 0.5; R ≥ 2
Cefepime	≤ 0.12	S	S ≤ 2; R ≥ 16
Ce foperazone/sulbactam	≤ 8	S	S ≤ 16; R≥ 64
Ceftriaxone	≤ 0.25	S	S ≤ 1; R ≥ 4
Ceftazidime	≤ 0.12	S	S ≤ 4; R ≥ 16
Cefoxitin	≤ 4	S	S ≤ 8; R ≥ 32
Cefuroxime axetil	4	S
Cefuroxime	4	S	S ≤ 4; R ≥ 32
Piperacillin/tatabatam	≤ 4	S	S ≤ 16/4; R ≥ 128/4
Amoxicillin/clavulanate	≤ 2	S	S ≤ 8/4; R ≥ 32/16
ESBL	Neg	-

A blood sample was collected and examined following the standards of bacterial culture. The results of bacterial growth and antimicrobial susceptibility were acquired 24 h later.

Table 6 PMseq-DNA Pro high throughput gene detection of blood sample

Type	Genus (number of sequences)		Species (number of sequences)
G	Klebsiella	68405	Klebsiella pneumoniae	243747
			Klebsiella variicola	543