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Article: Epidemiology of Klebsiella oxytoca-associated diarrhea detected by simmons citrate agar supplemented with inositol, tryptophan, and bile salts
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TitleEpidemiology of Klebsiella oxytoca-associated diarrhea detected by simmons citrate agar supplemented with inositol, tryptophan, and bile salts
 
AuthorsCheng, VCC1 2
Yam, WC1
Tsang, LL1
Yau, MCY1
Siu, GKH1
Wong, SCY1
Chan, JFW1
To, KKW1
Tse, H1
Hung, IFN1
Tai, JWM2
Ho, PL1
Yuen, KY1
 
Issue Date2012
 
PublisherAmerican Society for Microbiology.
 
CitationJournal Of Clinical Microbiology, 2012, v. 50 n. 5, p. 1571-1579 [How to Cite?]
DOI: http://dx.doi.org/10.1128/JCM.00163-12
 
AbstractWe studied the clinical and epidemiological characteristics of Klebsiella oxytoca-associated diarrhea in hospitalized patients in Hong Kong. Between 1 November 2009 and 30 April 2011, all inositol-fermenting colonies found on Simmons citrate agar supplemented with inositol, tryptophan, and bile salts (SCITB agar) used for the culturing of diarrheal stool samples were screened by a spot indole test for K. oxytoca. The overall sensitivity of SCITB agar plus the spot indole test (93.3%) for the detection of K. oxytoca in stool samples was superior to that of MacConkey agar (63.3%), while the specificities were 100% and 60.4%, respectively. The former achieved a 23-fold reduction in the workload and cost of subsequent standard biochemical identifications. Cytotoxin production and the clonality of K. oxytoca were determined by a cell culture cytotoxicity neutralization assay using HEp-2 cells and pulsed-field gel electrophoresis (PFGE), respectively. Of 5,581 stool samples from 3,537 patients, K. oxytoca was cultured from 117/5,581 (2.1%) stool samples from 104/3,537 (2.9%) patients. Seventy-six of 104 (73.1%) patients with K. oxytoca had no copathogens in their diarrheal stool samples. Twenty-four (31.6%) of 76 patients carried cytotoxin-producing strains, which were significantly associated with antibiotic therapy after hospital admission (50% versus 21.2%; P = 0.01). Health care-associated diarrhea was found in 44 (42%) of 104 patients with K. oxytoca, but there was no epidemiological linkage suggestive of a nosocomial outbreak, and PFGE showed a diverse pattern. None of the patients with cytotoxin-producing K. oxytoca developed antibiotic-associated hemorrhagic colitis, suggesting that K. oxytoca can cause a mild disease manifesting as uncomplicated antibiotic-associated diarrhea with winter seasonality. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
 
ISSN0095-1137
2013 Impact Factor: 4.232
 
DOIhttp://dx.doi.org/10.1128/JCM.00163-12
 
PubMed Central IDPMC3347154
 
ISI Accession Number IDWOS:000302900500012
Funding AgencyGrant Number
Food and Health Bureau of the Hong Kong Special Administrative Region Government
Funding Information:

The work was supported by the Research Fund for the Control of Infectious Diseases of the Food and Health Bureau of the Hong Kong Special Administrative Region Government.

 
ReferencesReferences in Scopus
 
DC FieldValue
dc.contributor.authorCheng, VCC
 
dc.contributor.authorYam, WC
 
dc.contributor.authorTsang, LL
 
dc.contributor.authorYau, MCY
 
dc.contributor.authorSiu, GKH
 
dc.contributor.authorWong, SCY
 
dc.contributor.authorChan, JFW
 
dc.contributor.authorTo, KKW
 
dc.contributor.authorTse, H
 
dc.contributor.authorHung, IFN
 
dc.contributor.authorTai, JWM
 
dc.contributor.authorHo, PL
 
dc.contributor.authorYuen, KY
 
dc.date.accessioned2012-08-08T08:52:18Z
 
dc.date.available2012-08-08T08:52:18Z
 
dc.date.issued2012
 
dc.description.abstractWe studied the clinical and epidemiological characteristics of Klebsiella oxytoca-associated diarrhea in hospitalized patients in Hong Kong. Between 1 November 2009 and 30 April 2011, all inositol-fermenting colonies found on Simmons citrate agar supplemented with inositol, tryptophan, and bile salts (SCITB agar) used for the culturing of diarrheal stool samples were screened by a spot indole test for K. oxytoca. The overall sensitivity of SCITB agar plus the spot indole test (93.3%) for the detection of K. oxytoca in stool samples was superior to that of MacConkey agar (63.3%), while the specificities were 100% and 60.4%, respectively. The former achieved a 23-fold reduction in the workload and cost of subsequent standard biochemical identifications. Cytotoxin production and the clonality of K. oxytoca were determined by a cell culture cytotoxicity neutralization assay using HEp-2 cells and pulsed-field gel electrophoresis (PFGE), respectively. Of 5,581 stool samples from 3,537 patients, K. oxytoca was cultured from 117/5,581 (2.1%) stool samples from 104/3,537 (2.9%) patients. Seventy-six of 104 (73.1%) patients with K. oxytoca had no copathogens in their diarrheal stool samples. Twenty-four (31.6%) of 76 patients carried cytotoxin-producing strains, which were significantly associated with antibiotic therapy after hospital admission (50% versus 21.2%; P = 0.01). Health care-associated diarrhea was found in 44 (42%) of 104 patients with K. oxytoca, but there was no epidemiological linkage suggestive of a nosocomial outbreak, and PFGE showed a diverse pattern. None of the patients with cytotoxin-producing K. oxytoca developed antibiotic-associated hemorrhagic colitis, suggesting that K. oxytoca can cause a mild disease manifesting as uncomplicated antibiotic-associated diarrhea with winter seasonality. Copyright © 2012, American Society for Microbiology. All Rights Reserved.
 
dc.description.naturelink_to_OA_fulltext
 
dc.identifier.citationJournal Of Clinical Microbiology, 2012, v. 50 n. 5, p. 1571-1579 [How to Cite?]
DOI: http://dx.doi.org/10.1128/JCM.00163-12
 
dc.identifier.citeulike10777749
 
dc.identifier.doihttp://dx.doi.org/10.1128/JCM.00163-12
 
dc.identifier.epage1579
 
dc.identifier.hkuros203196
 
dc.identifier.hkuros204615
 
dc.identifier.isiWOS:000302900500012
Funding AgencyGrant Number
Food and Health Bureau of the Hong Kong Special Administrative Region Government
Funding Information:

The work was supported by the Research Fund for the Control of Infectious Diseases of the Food and Health Bureau of the Hong Kong Special Administrative Region Government.

 
dc.identifier.issn0095-1137
2013 Impact Factor: 4.232
 
dc.identifier.issue5
 
dc.identifier.pmcidPMC3347154
 
dc.identifier.pmid22357507
 
dc.identifier.scopuseid_2-s2.0-84859992625
 
dc.identifier.spage1571
 
dc.identifier.urihttp://hdl.handle.net/10722/157691
 
dc.identifier.volume50
 
dc.languageeng
 
dc.publisherAmerican Society for Microbiology.
 
dc.publisher.placeUnited States
 
dc.relation.ispartofJournal of Clinical Microbiology
 
dc.relation.referencesReferences in Scopus
 
dc.rightsJournal of Clinical Microbiology. Copyright © American Society for Microbiology.
 
dc.rightsCopyright © American Society for Microbiology, [Journal of Clinical Microbiology, 2012, v. 50 n. 5, p. 1571-1579]
 
dc.subject.meshBacteriological Techniques - methods
 
dc.subject.meshCulture Media - chemistry
 
dc.subject.meshDiarrhea - epidemiology - microbiology
 
dc.subject.meshKlebsiella Infections - epidemiology - microbiology
 
dc.subject.meshKlebsiella oxytoca - classification - genetics - isolation and purification - pathogenicity
 
dc.titleEpidemiology of Klebsiella oxytoca-associated diarrhea detected by simmons citrate agar supplemented with inositol, tryptophan, and bile salts
 
dc.typeArticle
 
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Author Affiliations
  1. The University of Hong Kong
  2. Queen Mary Hospital Hong Kong