The Detection of Hypermucoviscous Carbapenem-Resistant Klebsiella pneumoniae from a Tertiary Teaching Hospital in Malaysia and Assessment of Hypermucoviscous as Marker of Hypervirulence

The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great concern, as carbapenems are the last-line therapy for multidrug-resistant Gram-negative bacteria infections. This study aims to report the epidemiology of CRKP in a teaching hospital in Malaysia based on the molecular genotypic and clinical characteristics of the isolates. Sixty-three CRKP strains were isolated from a tertiary teaching hospital from January 2016 until August 2017. Carbapenemase genes were detected in 55 isolates, with blaOXA-48 (63.5%) as the predominant carbapenemase gene, followed by blaNDM (36.5%). At least one porin loss was detected in nine isolates. Overall, 63 isolates were divided into 30 clusters at similarity of 80% with PFGE analysis. Statistical analysis showed that in-hospital mortality was significantly associated with the usage of central venous catheter, infection or colonization by CRKP, particularly NDM-producers. In comparison, survival analysis using Cox proportional hazards regression identified a higher hazard ratio for patients with a stoma and patients treated with imipenem but a lower hazard ratio for patients with NDM-producing CRKP. OXA-48 carbapenemase gene was the predominant carbapenemase gene in this study. As CRKP infection could lead to a high rate of in-hospital mortality, early detection of the isolates was important to reduce their dissemination.

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Virulence Factors and Molecular Epidemiology of Pyogenic Liver Abscess Causing Multidrug Resistant Klebsiella pneumoniae in Wenzhou, China

10.21203/rs.3.rs-42660/v1 ◽

2020 ◽

Author(s):

Zhongyong Wang ◽

Siqin Zhang ◽

Na Huang ◽

Shixing Liu ◽

Ye Xu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Molecular Epidemiology ◽

Liver Abscess ◽

Virulence Factors ◽

Virulence Genes ◽

Pyogenic Liver Abscess ◽

Multidrug Resistant ◽

Carbapenem Resistant ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

Abstract Background: To date, little is known about virulence characteristics of pyogenic liver abscess (PLA) causing multidrug resistant (MDR) Klebsiella pneumoniae (K. pneumoniae). It may be these strains are rare. The aim of this study was to analyze the virulence and molecular epidemiology of 12 MDR strains from 163 PLA cases in a tertiary teaching hospital from the perspective of clinical characteristics, virulence phenotypes and genotypes.Results: The virulence phenotypes of the twelve PLA-causing MDR K. pneumoniae were similar or even more obvious than those of sensitive hypervirulent Klebsiella pneumoniae control strains. These MDR strains were mainly non-K1/K2 serotypes and carried multiple virulence genes. Multilocus sequence typing (MLST) revealed the PLA-causing MDR strains had low clone correlation.Conclusions: This study was the first analysis on virulence factors of PLA-causing MDR strains. The virulent factors exhibited the coexistence of hypervirulence and multidrug resistance in PLA-causing MDR K. pneumoniae strains, and these MDR strains were mainly polyclonal spread and there was firstly found one ST11 carbapenem-resistant hypervirulent strain in PLA.

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