1184. Resistance Patterns and Susceptibility Analysis of Klebsiella pneumoniae Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan

Abstract Background Klebsiella pneumoniae was the third most common species of multidrug-resistant (MDR) Gram-negative organism in military trauma patients injured in Iraq and Afghanistan (2009–2014). This study aims to characterize the antimicrobial susceptibility and resistance patterns of K. pneumoniae isolates in these patients. Methods All infecting K. pneumoniae isolates (IKpI) archived by the Trauma Infectious Disease Outcomes Study (TIDOS) and 96 colonizing isolates (CKpI) from groin swabs were included (6/09-12/14). All CKpI linked with IKpI were included; the remainder to total 50 MDR and 46 non-MDR CKpI were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems, and/or fluoroquinolones or production of an ESBL or KPC. Results Of 588 K. pneumoniae archived isolates, 237 isolates were included in the analysis (141 IKpI and 96 CKpI). IKpI sources were 40% wound, 22% respiratory, 20% blood, 9% urine, and 9% other. Antibiotic susceptibilities for IKpI were: cefazolin (CFZ) 20%, ceftriaxone 30%, levofloxacin 62%, piperacillin–tazobactam (PTZ) 41%, meropenem 96%, and amikacin 89%. MDR IKpI and CKpI were more likely to have had prior fluoroquinolone (82% vs. 18%, P < 0.01) or anti-pseudomonal penicillin (53% vs. 47%, P < 0.01) exposure. Seventeen patients had CKpI cultured at a median of 5 days (IQR 2–17) before a subsequent IKpI with 11 (65%) having MDR CKpI. All IKpI isolated after MDR CKpI were also MDR. Among IKpI recovered after non-MDR CKpI, new resistance was noted in 1 IKpI to gentamicin (200 days post-CKpI), 1 IKpI to ertapenem (7 days post-CKpI), two IKpI to CFZ (10 days and 17 days, respectively), and 1 IKpI to PTZ (19 days post-CKpI). Serial isolates of IKpI had similar MDR status (63% initial IKpI were MDR, whereas 76% of subsequent IKpI were MDR). Conclusion K. pneumoniae isolates in military trauma patients from Iraq and Afghanistan had challenging resistance patterns. Prior exposure to fluoroquinolones and anti-pseudomonal penicillins were associated with MDR K. pneumoniae isolation. MDR status of CKpI predicted subsequent IKpI MDR status. Disclosures All authors: No reported disclosures.

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Antifungal Resistance Patterns in Molds Isolated from Wounds of Combat-Related Trauma Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.018 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S78-S79 ◽

Cited By ~ 1

Author(s):

Nicholas Keaton ◽

Katrin Mende ◽

Miriam Beckius ◽

Aaron Farmer ◽

Julie Rizzo ◽

...

Keyword(s):

Fungal Infections ◽

Medical Center ◽

Trauma Patients ◽

Broth Microdilution ◽

Fusarium Spp ◽

Post Injury ◽

Disease Outcomes ◽

Military Trauma ◽

Resistance Patterns ◽

Outcomes Study

Abstract Background An outbreak of trauma-related invasive fungal infections (IFI) occurred in US service members injured in Afghanistan. Empiric treatment included voriconazole (VORI) and amphotericin (AMB) and aggressive surgical debridement. Antifungal susceptibilities (AS) and relation to outcomes are yet to be described. Methods Between 2009 and 2013, military trauma patients with initial unique and serial (>3 days after initial isolation) molds isolated from wounds and admitted to Brooke Army Medical Center as part of the Trauma Infectious Disease Outcomes Study were assessed. The AS to AMB, VORI, posaconazole (POSA), isavuconazole (ISA), itraconazole, and caspofungin were determined by broth microdilution with CLSI breakpoint interpretations for Aspergillus spp. and mucormycetes (MM). Results Included are 18 patients with 28 initial mold isolates with 72% of IFI diagnosed via histopathology. All patients were male with a median of eight operations. There was a median of 11 days post-injury to mold culture. Initial isolates were five Aspergillus spp., three MM, three Fusarium spp., and combinations of three Aspergillus and MM, two Aspergillus and Fusarium, one Aspergillus and Bipolaris, one MM and Fusarium. A. flavus (AFL) and A. fumigatus (AFU) were all susceptible to AMB and POSA and 25% of AFL were intermediate to VORI. Four A. terreus (AT) isolates had MICs to AMB of 0.25, 1, 2, and 4, and were susceptible to VORI. ISA MIC50 and 90 were one and two for Aspergillus spp. Fusarium spp. MICs were >16 for VORI, POSA, and ISA, with AMB MIC50/90 of two and three. Among MM isolates, 86% were susceptible to AMB and 29% to POSA, and ISA MIC50 and MIC90 were 8 and >16. Five patients had serial isolates. One with serial AFL and AFU received no antifungal therapy, one with AT was treated with VORI, AMB, and POSA, and one with AFL was treated with AMB with no new resistance. The patient with serial MM was treated with AMB and VORI and remained resistant to POSA, but susceptible to AMB. Serial A. elegans acquired new POSA and AMB resistance and ISA MIC increased from 4 to 16 after AMB and VORI exposure. Conclusion Antifungal exposure to AMB and VORI was not associated with new resistance within Aspergillus spp., but 50% of MM exposed to this combination developed POSA and AMB resistance. Despite resistance of Fusarium, it was not isolated on subsequent debridements. Disclosures All authors: No reported disclosures.

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Resistance patterns and clinical outcomes of Klebsiella pneumoniae and invasive Klebsiella variicola in trauma patients

PLoS ONE ◽

10.1371/journal.pone.0255636 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255636

Author(s):

John L. Kiley ◽

Katrin Mende ◽

Miriam L. Beckius ◽

Susan J. Kaiser ◽

M. Leigh Carson ◽

...

Keyword(s):

Bloodstream Infections ◽

Multidrug Resistant ◽

Trauma Patients ◽

Blast Injuries ◽

Chain Reaction ◽

Disease Outcomes ◽

String Test ◽

Resistance Patterns ◽

Outcomes Study ◽

Polymerase Chain

Recent reclassification of the Klebsiella genus to include Klebsiella variicola, and its association with bacteremia and mortality, has raised concerns. We examined Klebsiella spp. infections among battlefield trauma patients, including occurrence of invasive K. variicola disease. Klebsiella isolates collected from 51 wounded military personnel (2009–2014) through the Trauma Infectious Disease Outcomes Study were examined using polymerase chain reaction (PCR) and pulsed-field gel electrophoresis. K. variicola isolates were evaluated for hypermucoviscosity phenotype by the string test. Patients were severely injured, largely from blast injuries, and all received antibiotics prior to Klebsiella isolation. Multidrug-resistant Klebsiella isolates were identified in 23 (45%) patients; however, there were no significant differences when patients with and without multidrug-resistant Klebsiella were compared. A total of 237 isolates initially identified as K. pneumoniae were analyzed, with 141 clinical isolates associated with infections (remaining were colonizing isolates collected through surveillance groin swabs). Using PCR sequencing, 221 (93%) isolates were confirmed as K. pneumoniae, 10 (4%) were K. variicola, and 6 (3%) were K. quasipneumoniae. Five K. variicola isolates were associated with infections. Compared to K. pneumoniae, infecting K. variicola isolates were more likely to be from blood (4/5 versus 24/134, p = 0.04), and less likely to be multidrug-resistant (0/5 versus 99/134, p<0.01). No K. variicola isolates demonstrated the hypermucoviscosity phenotype. Although K. variicola isolates were frequently isolated from bloodstream infections, they were less likely to be multidrug-resistant. Further work is needed to facilitate diagnosis of K. variicola and clarify its clinical significance in larger prospective studies.

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502. Klebsiella variicola Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.571 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S243-S244

Author(s):

John L Kiley ◽

Katrin Mende ◽

Miriam Beckius ◽

Susan Kaiser ◽

M Leigh Carson ◽

...

Keyword(s):

Injury Severity ◽

Length Of Hospital Stay ◽

Patient Characteristics ◽

Invasive Disease ◽

Multidrug Resistant ◽

Trauma Patients ◽

Disease Outcomes ◽

Military Trauma ◽

Pcr Targeting ◽

Selection Of

Abstract Background Recent work has argued that genus Klebsiella is best divided into 3 clades: K. pneumoniae (Kp), K. quasipneumoniae (Kq), and K. variicola (Kv). Kv has drawn attention from reports of higher mortality and virulence. We evaluated a previously defined group of military trauma patients with Klebsiella infections for the presence of Kv, described clinical and isolate characteristics, and compared Kv and Kp groups. Methods All initial and serial (≥7 days from prior isolate) infecting Kp isolates (identified by clinical laboratories without the ability to speciate Kq and Kv) were collected from the Trauma Infectious Disease Outcomes Study (6/09–12/14). Additionally, a previously defined group of colonizing isolates linked to the infecting isolates and a selection of random colonizers were included from groin swabs. DNA extraction and PCR targeting Kv per published methods was performed. Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. Multidrug resistance was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of ESBL or KPC. Results Of 237 archived Kp isolates (from 122 patients), 10 (4%) were identified as Kv by PCR (from 8 [7%] patients). The Kv sources were 4 from blood (40%), 1 intra-abdominal (10%) and 5 from groin (50%). Six (3%) isolates were identified as Kq (4 from groin and 2 from respiratory specimens). The Kv and Kp patients were all males, with a median age of 25 (IQR 21–46) and 23 (IQR 21–28), length of hospital stay of 24 days (IQR: 5–106) and 53 days (IQR 36–74), and Injury Severity Score of 21 (IQR: 10–50) and 38 (IQR: 30–45), respectively. There were no deaths in the Kv group compared with 4 with Kp. Infecting Kv isolates were more likely to be from blood compared with Kp (80% vs. 17%, P = 0.04). No infecting Kv isolates were multidrug-resistant compared with 70% of infecting Kp isolates (P < 0.01). Conclusion Kv represented 4% of the previously identified Kp isolates in this population. Patient characteristics were similar in both groups. While Kv was less resistant than Kp, it was more likely to be associated with invasive disease in this group. Disclosures All authors: No reported disclosures.

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1198. Clinical Characteristics and Outcomes of Klebsiella pneumoniae Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1031 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S362-S363

Author(s):

John Kiley ◽

Katrin Mende ◽

Susan J Kaiser ◽

Leigh Carson ◽

Dan Z Lu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Injury Severity ◽

Common Species ◽

Multidrug Resistant ◽

Clinical Aspects ◽

Trauma Patients ◽

Combat Casualties ◽

Improvised Explosive ◽

Explosive Devices ◽

Time From Injury

Abstract Background Klebsiella pneumoniae infections present a challenge to the clinician due to increasing resistance. K. pneumoniae was the third most common species of multidrug-resistant (MDR) Gram-negative organism in trauma patients sustaining injuries in Iraq and Afghanistan from 2009 to 2014. This study aims to elucidate the epidemiology of these infections by characterizing clinical aspects, risk for MDR infections, and outcomes. Methods All initial and serial (≥7 days from prior isolate) infecting K. pneumoniae isolates were collected from the Trauma Infectious Disease Outcomes Study (TIDOS) (6/09-12/14). Antimicrobial susceptibilities were determined using the BD Phoenix Automated Microbiology System and CLSI criteria. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results Of 588 K. pneumoniae isolates in the TIDOS registry, 141 infecting isolates (98 initial) from 51 patients met inclusion criteria. Initial isolates were respiratory (31%), wound (25%), blood (20%), urine (10%), intra-abdominal (8%) and other (6%). All patients were male with a median age of 23 years (IQR 21–28). The majority of patients (82%) suffered blast injuries; of which, 88% were from improvised explosive devices. Patients had a median injury severity score (ISS) of 38 (IQR 30–45) and time from injury to first infecting K. pneumoniae isolate was 15 days (IQR 8–31). The median hospital stay was 49 days (IQR 28–70) and four patients died. All patients had received antibiotics prior to diagnosis. Twenty-three (46%) patients had initial isolates classified as MDR. There was no difference in age, ISS, or time from injury to first isolation among those who did and did not have initial MDR isolates. Sixteen patients had 64 serial isolates, of which 24 were wound, 20 respiratory, 14 blood and six urine. Three of these 16 patients died compared with 1 of 35 patients without serial isolates. Conclusion K. pneumoniae infections are common among combat casualties. Patients with K. pneumoniae infections were severely injured and almost half of initial infecting isolates were MDR, complicating treatment. Disclosures All authors: No reported disclosures.

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543. Biocide Resistance Genes in Klebsiella spp. Infections from Trauma Patients in Iraq and Afghanistan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.612 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S259-S259

Author(s):

John L Kiley ◽

Dana M Blyth ◽

Miriam Beckius ◽

Susan Kaiser ◽

...

Keyword(s):

Resistance Genes ◽

Efflux Pump ◽

Multidrug Resistant ◽

Trauma Patients ◽

Biocide Resistance ◽

Military Trauma ◽

High Incidence ◽

Integral Role ◽

Rising Incidence ◽

Klebsiella Spp

Abstract Background Biocides play an integral role in infection control. Paralleling concern about rising incidence of multidrug-resistant (MDR) organisms is a concern for resistance to biocides. In small studies, several genes involved in the production of efflux pump proteins have been identified as markers of biocide resistance in Klebsiella spp., namely cepA, qacA, qacE, qac∆E, and acrA. This study aimed to analyze the Klebsiella spp. isolates of a previously defined military trauma group with a high incidence of MDR organisms for the presence of these genes and their correlation with other resistance. Methods All infecting K. pneumoniae, K. variicola, and K. quasipneumoniae isolates archived by the Trauma Infectious Disease Outcomes Study (June 2009–December 2014) were selected. Additionally, all colonizing isolates linked with infecting isolates were included; the remainder to total 50 MDR and 46 non-MDR colonizing isolates were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. PCR according to published methods for cepA, qacA, qacE, qac∆E, and acrA was accomplished in duplicate. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results A total of 237 isolates (221 K. pneumoniae, 10 K. variicola, 6 K. quasipneumoniae) met inclusion criteria, of which 149 (63%) were MDR. All isolates had been exposed to antimicrobials prior to isolation. Of all isolates, 234 (98%) carried cepA: 218 (98%) K. pneumoniae carried cepA, 10 (100%) K. variicola carried cepA, and 6 (100%) of K. quasipneumoniae carried cepA. In addition, 148 (62%) isolates with cepA were MDR. One (10%) K. variicola isolate carried qacE along with cepA. This isolate was the only MDR K. variicola. None of the isolates carried qacA, qac∆E, or acrA. Conclusion We confirmed the near universal presence of the cepA biocide resistance gene in Klebsiella spp. isolated from trauma patients in Iraq and Afghanistan. In the largest evaluation of biocide resistance genes in Klebsiella spp. to our knowledge, the presence of qacA, qacE, qac∆E, and acrA was less common than has been reported elsewhere. Disclosures All authors: No reported disclosures.

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Complement Susceptibility in Relation to Genome Sequence of RecentKlebsiella pneumoniaeIsolates from Thai Hospitals

mSphere ◽

10.1128/msphere.00537-18 ◽

2018 ◽

Vol 3 (6) ◽

Cited By ~ 3

Author(s):

Jessica Loraine ◽

Eva Heinz ◽

Jessica De Sousa Almeida ◽

Oleksandr Milevskyy ◽

Supayang P. Voravuthikunchai ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Single Gene ◽

Multidrug Resistant ◽

Side Chains ◽

Content Type ◽

Genes Encoding ◽

Resistance Patterns ◽

Tertiary Hospitals ◽

Population Structures ◽

Antibiotic Resistance Patterns

ABSTRACTThe capacity to resist the bactericidal action of complement (C′) is a strong but poorly understood virulence trait inKlebsiellaspp. Killing requires activation of one or more C′ pathways, assembly of C5b-9 membrane attack complexes (MACs) on the surface of the outer membrane (OM), and penetration of MACs into the target bilayer. We interrogated whole-genome sequences of 164Klebsiellaisolates from three tertiary hospitals in Thailand for genes encoding surface-located macromolecules considered to play a role in determination of C′ resistance. Most isolates (154/164) were identified asKlebsiella pneumoniae, and the collection conformed to previously established population structures and antibiotic resistance patterns. The distribution of sequence types (STs) and capsular (K) types were also typical of global populations. The majority (64%) of isolates were resistant to C′, and the remainder were either rapidly or slowly killed. All isolates carried genes encoding capsular polysaccharides (K antigens), which have been strongly linked to C′ resistance. In contrast to previous reports, there were no differences in the amount of capsule produced by C′-resistant isolates compared to C′-susceptible isolates, nor was there any correlation between serum reactivity and the presence of hypermucoviscous capsules. Similarly, there were no correlations between the presence of genes specifying lipopolysaccharide O-side chains or major OM proteins. Some virulence factors were found more frequently in C′-resistant isolates but were considered to reflect clonal ST expansion. Thus, no single gene accounts for the C′ resistance of the isolates sequenced in this study.IMPORTANCEMultidrug-resistantKlebsiella pneumoniaeis responsible for an increasing proportion of nosocomial infections, and emerging hypervirulentK. pneumoniaeclones now cause severe community-acquired infections in otherwise healthy individuals. These bacteria are adept at circumventing immune defenses, and most survive and grow in serum; their capacity to avoid C′-mediated destruction is correlated with their invasive potential. Killing of Gram-negative bacteria occurs following activation of the C′ cascades and stable deposition of C5b-9 MACs onto the OM. ForKlebsiella, studies with mutants and conjugants have invoked capsules, lipopolysaccharide O-side chains, and OM proteins as determinants of C′ resistance, although the precise roles of the macromolecules are unclear. In this study, we sequenced 164Klebsiellaisolates with different C′ susceptibilities to identify genes involved in resistance. We conclude that no single OM constituent can account for resistance, which is likely to depend on biophysical properties of the target bilayer.

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Klebsiella pneumoniae in Germany: An overview on spatiotemporal distribution and resistance development in humans

German Journal of Microbiology - Special Issue: Existence Battle: Viruses vs. Creatures ◽

10.51585/gjm.2021.0004 ◽

2021 ◽

Vol 1 (1) ◽

pp. 16-25

Keyword(s):

Klebsiella Pneumoniae ◽

Antimicrobial Agents ◽

Multidrug Resistant ◽

Resistance Development ◽

Federal States ◽

Treatment Regimens ◽

The Past ◽

Resistance Patterns ◽

Chronological Sequence ◽

Rapid Dissemination

The emerging of multidrug-resistant Klebsiella pneumoniae (K. pneumoniae) is increasing worldwide. Rapid dissemination and increase of its incidence in Germany are observed and becoming a significant challenge for clinical laboratories and physicians. The current review highlights its chronological sequence of appearance and resistance development in humans in the past two decades in Germany. Emerging resistance problems of K. pneumoniae to the vast majority of available antimicrobial agents, including carbapenems and those of the ß-lactam group, were observed since the end of the last century and strains carrying diverse resistance patterns have emerged in most federal states of Germany. Still, several aspects of resistance development and pathogenesis are not fully understood. To date, hypervirulent K. pneumoniae (hvKp) isolates have been rarely isolated from German patients. The most frequent resistance genes identified are blaOXA-48, blaCTX-M-15, blaKPC-2, blaOXA-9, blaSHV-11, blaSHV-5 blaCTX-M-3, blaCTX-M-14, blaVIM-1 and the plasmid-encoded quinolone resistance (PMQR) gene. One Health genomic surveillance of K. pneumoniae strains from different reservoirs is required. This would help to understand in great detail the mechanisms leading to resistance development, spread and transmission, and developing alternative treatment regimens

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Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.714 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Barchitta ◽

A Maugeri ◽

C La Mastra ◽

MC La Rosa ◽

L Sessa ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

High Risk ◽

Klebsiella Pneumoniae ◽

Intensive Care Units ◽

Multidrug Resistant ◽

Trauma Patients ◽

Healthcare Associated Infections ◽

Global Threat ◽

Healthcare Associated

Abstract Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

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Virulence Factors, Antibiotic Resistance patterns, and Molecular Types of Clinical Isolates of Klebsiella Pneumoniae

10.21203/rs.3.rs-331542/v1 ◽

2021 ◽

Author(s):

Mitra Ahmadi ◽

Payam Behzadi ◽

Reza Ranjbar

Keyword(s):

Antibiotic Resistance ◽

Klebsiella Pneumoniae ◽

Molecular Typing ◽

Virulence Genes ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Aminoglycoside Resistance ◽

Wide Range ◽

Resistance Patterns ◽

Esbl Producers

Abstract Background Klebsiella pneumoniae is armed with a wide range of antibiotic resistance mechanisms which mostly challenges effective treatment. Due to this fact, the aims of the current study were to identify the clinical strains of K . pneumoniae as well as to determine their phenotypes and molecular characterization related to antimicrobial resistance and virulence genes. Methods In this investigation, specimens from a hospital and different laboratories located in Shahr-e-Qods, Tehran, Iran were collected during a period of nine-month (December 2018 to August 2019). The isolated strains of K. pneumoniae were then identified through standard microbial and biochemical assays. Additionally, disk diffusion, combined disk, modified Hodge test and PCR were performed for antibiotic resistance of the strains and virulence genes profiling, respectively. The molecular typing was accomplished by ERIC-PCR. Results Eighty-four isolates of K. pneumoniae were identified and subjected to the study. Fifty- two percent of the isolated strains of K. pneumoniae were detected as multidrug resistant (MDR) pathotypes with the highest resistance to ceftriaxone (65%) and the lowest resistance to colistin (23%). Twenty-seven (52%) out of 52 (100%) MDR pathotypes of isolated K. pneumoniae were identified as ESBL producers. According to Modified Hodge Test (MHT) results, out of 24 resistant strains of isolated K. pneumoniae to imipenem and meropenem, 15 pathotypes (62.5%) were detected as KPC producers. The gene of blaCTX (encoding carbapenemase) with 96% ranked first, while the blaKPC gene with the prevalence of 71% ranked second among ESBL producers. The aminoglycoside resistance gene of Aac6-Ib showed the highest frequency with the prevalence percentage of 90%. The virulence genes of mrkD (94%) and magA (11%) were the highest and lowest among isolates, respectively. According to ERIC-PCR results the isolated strains of K. pneumoniae were divided into four clusters in which the cluster 4 was predominant group. Conclusions The high prevalence of antibiotic resistance and virulence genes in conjunction with a significant relationship between the strains reveals a high pathogenic capacity of the isolated pathotypes of K. pneumoniae . These findings emphasize the choose of more effective antibiotic regimens for treatment of infections caused by K. pneumoniae. Keywords: Klebsiella pneumoniae , antibiotic resistance, ESBL, virulence genes, molecular typing.

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RAPD PCR Profile, Antibiotic Resistance, Prevalence of armA Gene, and Detection of KPC Enzyme in Klebsiella pneumoniae Isolates

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2018/6183162 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Arezoo Saadatian Farivar ◽

Jamileh Nowroozi ◽

Gita Eslami ◽

Azar Sabokbar

Keyword(s):

Klebsiella Pneumoniae ◽

Simultaneous Detection ◽

Multidrug Resistant ◽

Resistance Pattern ◽

Pcr Assay ◽

Rapd Pcr ◽

Antibiotic Susceptibility Test ◽

Genetic Patterns ◽

Resistance Patterns ◽

Important Challenge

The increasing prevalence of multidrug-resistant Klebsiella pneumoniae strains isolated from hospitals shows the limitation of recent antibiotics used for bacterial eradication. In this study, 81 K. pneumoniae isolates were collected from three hospitals in Tehran. Antibiotic susceptibility test showed the highest rates of resistance to cefotaxim (85.5%) and ceftazidime (78.3%), and the lowest rates of resistance were detected for colistin (16.9%), streptomycin (16.8%), and chloroamphenicol (21.7%). Eleven different resistance patterns were observed. Sixty-six out of 81 isolates (81.5%) were found to be multidrug resistant (MDR), and 35.8% of them belonged to A3 resistance pattern. 7.4% and 66.7% were KPC enzyme and armA gene positive, respectively. RAPD PCR assay of these bacteria showed 5 clusters, 16 single types, and 14 common types, and there was not any correlation between genetic patterns of the isolates and presence of resistance agents. Simultaneous detection of resistance-creating agents could be an important challenge for combination therapy of MDR K. pneumoniae-caused infections.

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