Two Phenotypes of Klebsiella pneumoniae ST147 Outbreak from Neonatal Sepsis with a Slight Increase in Virulence

Neonatal sepsis is a leading cause of death among newborns and infants, especially in the developing world. The problem is compounded by the delays in pinpointing the causative agent of the infection. This is reflected in increasing mortality associated with these cases and the spread of multi-drug-resistant bacteria. In this work, we deployed bioinformatics and proteomics analyses to determine a promising target that could be used for the identification of a major neonatal sepsis causative agent, Klebsiella pneumoniae. A 19 amino acid peptide from a hypothetical outer membrane was found to be very specific to the species, well conserved among its strains, surface exposed, and expressed in conditions simulating infection. Antibodies against the selected peptide were conjugated to gold nanoparticles and incorporated into an immunochromatographic strip. The developed strip was able to detect as low as 105 CFU/mL of K. pneumoniae. Regarding specificity, it showed negative results with both Escherichia coli and Enterobacter cloacae. More importantly, in a pilot study using neonatal sepsis cases blood specimens, the developed strip selectively gave positive results within 20 min with those infected with K. pneumoniae without prior sample processing. However, it gave negative results in cases infected with other bacterial species.

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Extensively Drug-Resistant Hypervirulent Klebsiella pneumoniae From a Series of Neonatal Sepsis in a Tertiary Care Hospital, India

Frontiers in Medicine ◽

10.3389/fmed.2021.645955 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tuhina Banerjee ◽

Jayalaxmi Wangkheimayum ◽

Swati Sharma ◽

Ashok Kumar ◽

Amitabha Bhattacharjee

Keyword(s):

Klebsiella Pneumoniae ◽

Neonatal Sepsis ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Plasmid Profile ◽

Care Hospital ◽

Drug Resistant ◽

Maternal Complications ◽

Extensively Drug Resistant ◽

Recent Emergence

The recent emergence of multidrug-resistant (MDR) Klebsiella pneumoniae with hypervirulent traits causing severe infections and considerable mortality is a global cause for concern. The challenges posed by these hypermucoviscous strains of K. pneumoniae with regard to their optimal treatment, management, and control policies are yet to be answered. We studied a series of extensively drug-resistant (XDR) and hypervirulent K. pneumoniae ST5235 isolates with resistance to carbapenems and polymyxins causing neonatal sepsis in a tertiary care hospital in India. A total of 9 K. pneumoniae isolates from 9 cases of neonatal sepsis were studied with respect to their clinical relevance, antimicrobial susceptibility profile, presence of extended spectrum β lactamase (ESBL) production, and responsible genes, carbapenemases (classes A, B, and D), and aminoglycoside-resistant genes. Hypervirulence genes encoding hypermucoid nature, iron uptake, and siderophores were detected by multiplex PCR. The plasmid profile was studied by replicon typing. Isolates were typed by multilocus sequence typing (MLST) and enterobacterial repetitive intergenic consensus (ERIC) PCR to study the sequence types (STs) and clonal relation, respectively. The neonates in the studied cases had history of pre-maturity or low birth weight with maternal complications. All the cases were empirically treated with piperacillin–tazobactam and amikacin followed by imipenem/meropenem and vancomycin and polymyxin B as a last resort. However, all the neonates finally succumbed to the condition (100%). The studied isolates were XDR including resistance to polymyxins harboring multiple ESBL genes and carbapenemase genes (blaNDM and blaOXA−48). Hypervirulence genes were present in various combinations with rmpA/A2 genes present in all the isolates. IncFI plasmids were detected in these isolates. All belonged to ST5235. In ERIC PCR, 6 different clusters were seen. The study highlighted the emergence and burden of XDR hypervirulent isolates of K. pneumoniae causing neonatal sepsis in a tertiary care hospital.

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Changing Trends of Antimicrobial Resistance in Neonatal Sepsis: Experience from a Tertiary Care Hospital from West Bengal, India

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/49015.15136 ◽

2021 ◽

Author(s):

Manjula Dutta ◽

Piyali Mitra ◽

Shankha Subhra Nag ◽

Abhijit Dutta

Keyword(s):

Staphylococcus Aureus ◽

Klebsiella Pneumoniae ◽

Acinetobacter Baumannii ◽

Neonatal Sepsis ◽

West Bengal ◽

Tertiary Care ◽

World Health ◽

Klebsiella Pneumonia ◽

High Degree ◽

Very High

Introduction: Sepsis is the second leading cause of neonatal mortality in India. Emergence of highly resistant microorganisms as an aetiology of neonatal sepsis is a matter of serious concern. Aim: To study the prevailing aetiological agents in neonatal sepsis and their antimicrobial susceptibility pattern. Materials and Methods: A prospective observational study was performed in a tertiary care teaching hospital in neonatal care units in North Bengal Medical College and Hospital, West Bengal, India, over a period of two years from March 2017 to February 2019. All the neonates having clinical features suggestive of sepsis were subjected to blood culture using BacT/ALERT® PF Plus. Microbial identification and antibiotic susceptibility testing was done by VITEK-2 automated systems. Chi-square test was done using Epi info software version 7.1 and p-value <0.05 was considered significant. Results: Out of 403 neonates investigated for suspected sepsis, 156 (38.7%) were found to be culture positive. Klebsiella pneumoniae was the most common organism isolated (n=90, 57.7%) followed by Staphylococcus aureus (n=24, 15.4%) and Acinetobacter baumannii (n=10, 6.4%). Klebsiella pneumoniae showed a very high degree of resistance to ampicillin, amoxycillin- clavulenic acid (100% each), cefotaxime (93.4%), ceftazidime (92.3%), gentamycin (94.5%) and tobramycin (94.5%). High resistance of Staphylococcus aureus was seen against ampicillin (100%), cloxacillin (62.5%), amoxicillin-clavulenic acid (70.9%), and cefotaxime (79.2%). Few isolates of Klebsiella pneumonia (6.6%), Acinetobacter baumannii (60%) and Enterobacter cloacae (50%) were sensitive only to colistin and tigecycline. Conclusion: Most of the isolates showed very high degree of resistance against first line of antibiotics recommended by World Health Organisation (WHO) (ampicillin and gentamycin or amikacin) for empirical treatment of neonatal sepsis. Emergence of highly resistant organisms sensitive only to colistin and tigecycline should be considered as an eye opener. Strict adherence to sepsis prevention along with regular surveillance of organisms and their sensitivity patterns is the need of the hour to improve survival by contributing to antibiotic stewardship.

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