We report a case of pyogenic liver abscess caused by community-acquired Klebsiella quasipneumoniae subsp. quasipneumoniae. The infecting isolate had 2 prominent features of hypervirulent K. pneumoniae strains: the capsular polysaccharide synthesis region for K1 serotype and the integrative and conjugative element ICEKp1, which encodes the virulence factors yersiniabactin, salmochelin, and RmpA.

To provide data on severe bacteremic community-acquired infections due to Klebsiella pneumoniae in New Caledonia. All patients admitted with bacteremic community-acquired infections due to K. pneumoniae at the only tertiary medical center in New Caledonia, from 2008 to 2013, were included retrospectively in this study. Clinical and microbiological characteristics were analyzed, as well as risk factors for mortality. The characteristics of 119 patients were analyzed. The most common clinical presentation was urinary tract infection (40 cases, 33%), followed by pneumonia (28 cases, 23%), deep abscesses (15 cases, 13%), liver abscess (12 cases, 9%), meningitis in (five cases, 4%), and endophthalmitis (two cases, 1%). Multiple localizations were reported in 18 cases (15%) and isolated bacteremia was reported in 22 cases (18%). The overall mortality rate was 22% (26/119) and the mortality rate in the intensive care unit was 33% (14/42). Renal impairment, chronic liver disease, pneumonia, and isolated bacteremia were independent risk factors for mortality. K. pneumoniae is a dominant cause of severe community-acquired bacteremic infection in New Caledonia. Physicians should be aware of the poor prognosis of any patient with a bacteremic K. pneumoniae infection and should monitor patients presenting with risk factors closely.

Community-acquired bacterial meningitis due to Klebsiella pneumoniae has mainly been described in Southeast Asia and has a poor prognosis. Severe invasive infections caused by K. pneumoniae, including meningitis, are often due to hypervirulent strains (hvKP), which are characterized by capsular serotypes K1 and K2, a gene responsible for hypermucoviscosity, and the cluster for synthesis of the siderophore aerobactin. A 55 year old man with a history of essential hypertension, benign prostate hyperplasia, hyperlipidemia, obstructive sleep apnea, and chronic alcoholism was admitted for meningitis due to Klebsiella pneumoniae with a wild-type susceptibility profile. Its genomic features were consistent with a capsular K2 strain belonging to clonal group 86 (CG86) displaying the large virulence of Klebsiella plasmid (pLVPK) with heavy metal resistance gene clusters, aerobactin, rmpA. This is the first case of community-acquired meningitis caused by a hypervirulent strain of hvKP ever reported in the Caribbean.

Vaccination is among the most important areas of progress in the worldwide history of public health. However, a crescent wave of anti-vaccine groups has grown in Western countries, especially in It...

Three New Cases of Melioidosis, Guadeloupe, French West Indies

Objective: By the end of 2014, 23% of people living with HIV (PWHIV) who had had a scheduled appointment at our outpatient clinic had not attended. We implemented an SMS reminder service and assessed its impact on medical consultation-attendance rate. Methods: The intervention was directed at all PWHIV with a scheduled appointment between March and April 2015 at our infectious diseases department. Two days before the scheduled visit, an appointment reminder SMS was sent to every other patient at random. On the visit day, a questionnaire was used to determine patient perceptions regarding the SMS. Results: A total of 224 patients (126 males, 98 females, mean age 52 years, 94% taking antiretroviral therapy) were selected to take part in the study. The medical consultation-attendance rate was 76% in the SMS reminder read group (87 patients) and 72% in the SMS reminder not sent or not read group (137 patients, P=0.6). Among the 66 SMS reminder read patients who attended their consultation and answered the questionnaire, 51% reported that the SMS had contributed to their attendance. Conclusion: Sending an SMS reminder had no significant impact on clinic attendance rates. This may have been due in part to the sociocultural characteristics of our patients. Further research should investigate other tools to improve attendance rates.