Infective endocarditis by Klebsiella species: a systematic review

Abstract

This study aimed to systematically analyze all cases of infective endocarditis (IE) by Klebsiella species in the literature. A systematic review of PubMed, Scopus and Cochrane library (through 27^th January 2021) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of IE by Klebsiella species was performed. In this review, a total of 66 studies were included, providing data for 67 patients. A prosthetic valve was present in 16.4%, while the most common causative pathogen was K. pneumoniae followed by K. oxytoca. The aortic valve was the most commonly infected intracardiac site, followed by the mitral valve. The diagnosis was based on transthoracic echocardiography in 46.2%, while the diagnosis was set at autopsy in 9.2% of included patients. Blood cultures were positive in 93.8%. Fever and sepsis were the most frequent clinical presentations, followed by embolic phenomena, paravalvular abscess, and heart failure. Cephalosporins, aminoglycosides, and carbapenems were the most frequently used antimicrobials. Surgical treatment along with antimicrobials was performed in 37.3% of included patients. Clinical cure was noted in 80.3%, while the overall mortality was 19.4%. Infection at the aortic valve was independently associated with mortality by IE. This systematic review gives a comprehensive description of IE by Klebsiella and provides information on epidemiology, clinical manifestations, therapeutic strategies and their outcomes.

Keywords:

• Endocarditis
• systematic review
• Klebsiella
• antimicrobial susceptibility

Conflict of interest

The authors declare no conflict of interest.

Authors’ contributions

PI conceived the idea; PI and EM collected the data; PI and SB analyzed the data; and PI, EM, SB and DPK led the writing.

Additional information

Notes on contributors

Petros Ioannou

Petros Ioannou MD, MSc, PhD is an Infectious Diseases fellow in the Internal Medicine Department of the University Hospital of Heraklion, Crete, Greece.

Eugenia Miliara

Eugenia Miliara MD is a research assistant in the Internal Medicine Department of the University Hospital of Heraklion, Crete, Greece.

Stella Baliou

Stella Baliou BSc, MSc, is a PhD student in the National Hellenic Reasearch Foundation, Athens, Greece.

Diamantis P. Kofteridis

Diamantis P. Kofteridis MD, PhD is an associate professor of Internal Medicine in the Faculty of Medicine in the University of Crete, and head of the COVID-19 Department and the Internal Medicine Department of the University Hospital of Heraklion, Crete, Greece.