004?005) but was Pan-RAS-IN-1 biological activity higher than that of the ESBL-KP blood isolates (2007?010,Table 2). The association of HV phenotype with rmpA and/or rmpA2 Overall, 96 of 226 KP isolates (2004?005) were HV-positive. Of these, only 6 (KP331, KP 347, KP350, KP476, KP 495, KP511) did not harbor rmpA and/or rmpA2, as demonstrated by the inability to amplify the corresponding gene sequences by PCR. Meanwhile 100 of 130 HV-negative isolates did not harbor rmpA and/or rmpA2 (p < 0.0001). Similarly, 37 of 166 ESBKKP blood isolates (2007?010) were HV-positive. jasp.12117 Of these, 10 did not harbor rmpA and/or rmpA2. Meanwhile 95 of 129 HVnegative isolates did not harbor rmpA and/or rmpA2 (p < 0.0001). The prevalence of HV phenotype among rmpA-positive KP isolates The HV prevalence of rmpA-positive KP isolates was significantly lower in the ESBL group than that in the non-ESBL group (33.3 vs. 91.9 . p < 0.0001,Table 3). Specifically, theResultsClinical isolates and microbiological characteristics All investigated bacterial strains were recovered from clinical specimens of the patients hospitalized in Chi Mei Medical Center in Tainan City in Taiwan. These human samples were obtained as part of routine care on clinical indication. A total of 226 nonrepetitive clinical isolates were collected from1 January 2004 to 31 December 2005. ESBL-KP was identified in 57 isolates (25.2 ) from various specimens, including sputum (n D 24), urine (n D 18), blood (n D 10), ascites (n D 2), bile (n D 1), pleural fluid (n D 1), and bronchoalveolar lavage fluid (n D 1). The remaining 169 non-ESBL KP isolates included sputum (n D 105), blood (n D 39), urine (n D 8), abscess pus (n D 6), wound (n D 3), central venous catheter (CVC) tip (n D 2), ascites (n D 3), bile (n D 1), pleural effusion (n D 1) and pericardial effusion (n D 1). Furthermore, 166 ESBL-KP blood isolates were collected from 1 January 2007 to 31 July, 2010 and 48 non-ESBL KP blood isolates collected in 2010 (randomly 4 isolates per month) were also used for comparison as external validation. The prevalence of HV phenotype among isolates The HV phenotype was significantly lower in ESBL-KP isolates than that in non-ESBL KP isolates (8.8 vs. 53.8 . p < 0.0001,Table 1). Specifically, the PM01183 site HV-positive sputum isolates were more common in non-ESBL than that in ESBL group (59 vs 4.2 ). However, the HV phenotype of urine isolates was significantly rarer than that of sputum and blood isolates within non-ESBL group. The HV phenotype of bloodwww.tandfonline.comVirulenceTable 1. Distribution of hypermucoviscosity journal.pone.0158910 (HV) phenotype between K. pneumoniae isolates with and without ESBLs Isolates (n) 2004 ?2005 (226) ESBL-KP (57) Sputum (24) Urine (18) Blood (10) Others a(5) Non-ESBL KP (169) Sputum (105) Blood (39) Urine (8) Abscess pus (6) Wound (3) CVCb tip (2) Othersc (6) 2007 – 2010 Blood ESBL-KP (166) HV-positive n D 96 5 (8.8 ) 1 (4.2 ) 1 (5.6 ) 3 (30.0 ) 0 91 (53.8 ) 62 (59.0 ) 22 (55 ) 1 (12.5 ) 4 (66.7 ) 0 0 2 (40 ) 37 (22.3 ) HV-negative n D 130 52 (91.2 ) 23 17 7 5 78 (46.2 ) 43 17 7 2 3 2 4 129 (77.7 ) p p for HV among 2004?005 isolates < 0.0001 (vs. non-ESBL KP) 0.385 (vs. non-sputum ESBL-KP) 1.000 (vs. non-urine ESBL-KP) 0.033* (vs. non-blood ESBL-KP)< 0.0001* (vs. sputum ESBL-KP) 0.171 (vs. blood ESBL-KP) 0.529 (vs. urine ESBL-KP) 0.048*(vs blood non-ESBL KP) 0.022*(vs sputum non-ESBL KP) 0.686 (vs. other non-ESBL KP)2010 Blood non-ESBL KP (48)25 (52.1 )23 (47.9 )2003?004 (from 2 medical centers)d Blood community-acquired KP (105).004?005) but was higher than that of the ESBL-KP blood isolates (2007?010,Table 2). The association of HV phenotype with rmpA and/or rmpA2 Overall, 96 of 226 KP isolates (2004?005) were HV-positive. Of these, only 6 (KP331, KP 347, KP350, KP476, KP 495, KP511) did not harbor rmpA and/or rmpA2, as demonstrated by the inability to amplify the corresponding gene sequences by PCR. Meanwhile 100 of 130 HV-negative isolates did not harbor rmpA and/or rmpA2 (p < 0.0001). Similarly, 37 of 166 ESBKKP blood isolates (2007?010) were HV-positive. jasp.12117 Of these, 10 did not harbor rmpA and/or rmpA2. Meanwhile 95 of 129 HVnegative isolates did not harbor rmpA and/or rmpA2 (p < 0.0001). The prevalence of HV phenotype among rmpA-positive KP isolates The HV prevalence of rmpA-positive KP isolates was significantly lower in the ESBL group than that in the non-ESBL group (33.3 vs. 91.9 . p < 0.0001,Table 3). Specifically, theResultsClinical isolates and microbiological characteristics All investigated bacterial strains were recovered from clinical specimens of the patients hospitalized in Chi Mei Medical Center in Tainan City in Taiwan. These human samples were obtained as part of routine care on clinical indication. A total of 226 nonrepetitive clinical isolates were collected from1 January 2004 to 31 December 2005. ESBL-KP was identified in 57 isolates (25.2 ) from various specimens, including sputum (n D 24), urine (n D 18), blood (n D 10), ascites (n D 2), bile (n D 1), pleural fluid (n D 1), and bronchoalveolar lavage fluid (n D 1). The remaining 169 non-ESBL KP isolates included sputum (n D 105), blood (n D 39), urine (n D 8), abscess pus (n D 6), wound (n D 3), central venous catheter (CVC) tip (n D 2), ascites (n D 3), bile (n D 1), pleural effusion (n D 1) and pericardial effusion (n D 1). Furthermore, 166 ESBL-KP blood isolates were collected from 1 January 2007 to 31 July, 2010 and 48 non-ESBL KP blood isolates collected in 2010 (randomly 4 isolates per month) were also used for comparison as external validation. The prevalence of HV phenotype among isolates The HV phenotype was significantly lower in ESBL-KP isolates than that in non-ESBL KP isolates (8.8 vs. 53.8 . p < 0.0001,Table 1). Specifically, the HV-positive sputum isolates were more common in non-ESBL than that in ESBL group (59 vs 4.2 ). However, the HV phenotype of urine isolates was significantly rarer than that of sputum and blood isolates within non-ESBL group. The HV phenotype of bloodwww.tandfonline.comVirulenceTable 1. Distribution of hypermucoviscosity journal.pone.0158910 (HV) phenotype between K. pneumoniae isolates with and without ESBLs Isolates (n) 2004 ?2005 (226) ESBL-KP (57) Sputum (24) Urine (18) Blood (10) Others a(5) Non-ESBL KP (169) Sputum (105) Blood (39) Urine (8) Abscess pus (6) Wound (3) CVCb tip (2) Othersc (6) 2007 – 2010 Blood ESBL-KP (166) HV-positive n D 96 5 (8.8 ) 1 (4.2 ) 1 (5.6 ) 3 (30.0 ) 0 91 (53.8 ) 62 (59.0 ) 22 (55 ) 1 (12.5 ) 4 (66.7 ) 0 0 2 (40 ) 37 (22.3 ) HV-negative n D 130 52 (91.2 ) 23 17 7 5 78 (46.2 ) 43 17 7 2 3 2 4 129 (77.7 ) p p for HV among 2004?005 isolates < 0.0001 (vs. non-ESBL KP) 0.385 (vs. non-sputum ESBL-KP) 1.000 (vs. non-urine ESBL-KP) 0.033* (vs. non-blood ESBL-KP)< 0.0001* (vs. sputum ESBL-KP) 0.171 (vs. blood ESBL-KP) 0.529 (vs. urine ESBL-KP) 0.048*(vs blood non-ESBL KP) 0.022*(vs sputum non-ESBL KP) 0.686 (vs. other non-ESBL KP)2010 Blood non-ESBL KP (48)25 (52.1 )23 (47.9 )2003?004 (from 2 medical centers)d Blood community-acquired KP (105).