Clinical and microbiological characteristics of spontaneous and post-surgical/traumatic Klebsiella pneumoniae meningitis in the Paris region, France.
Introduction:  Klebsiella pneumoniae is recognized as a leading cause of meningitis in Asia, where severe cases due to hypervirulent isolates occurring in patients with few comorbidities have been extensively reported in recent years; data on K. pneumoniae meningitis in western-countries are scarce.Methods: We conducted a retrospective, multicentric, cohort study aimed at analyzing and comparing the characteristics and outcome of all K. pneumoniae meningitis cases managed between January 2007 and May 2018 in 7 university hospitals of Paris area, according to their mechanism: spontaneous meningitis (SM) versus post-surgical/traumatic meningitis (PSTM). We further analyzed the microbiological characteristics of 16 available K. pneumoniae isolates recovered from patients of our cohort and sequenced the genome of 7 of them isolated from SM.Results: Among 35 cases, 10 were SM and 25 were PSTM.  SM were more severe than PSTM with higher septic shock (p=0.004) and in-hospital mortality rates (p=0.004), and a tendency towards more distant bacterial localizations (p=0.06). In contrast, 5 patients from the PSTM group versus no patients from the SM group relapsed. PSTM tended to be more frequently polymicrobial (p=0.08) and due to an extended-spectrum ß-lactamase producing strain (p=0.08) than SM. All K. pneumoniae strains recovered from SM but none of those recovered from PSTM displayed hypervirulent phenotypic (positive string test) and genotypic (genes corresponding to capsular serotypes K1 or K2, virulence genes rmpA, iutA) characteristics (p<0.0001). Conclusion: SM and PSTM are two different entities that differ both from a clinical and from a microbiological standpoint. SM appears as a dreadful infection induced by hypervirulent K. pneumoniae strains emerging in France.