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High Prevalence of Multidrug-Resistant Klebsiella pneumoniae Harboring Several Virulence and β-Lactamase Encoding Genes in a Brazilian Intensive Care Unit

机译：巴西重症监护病房中携带多种毒力和β-内酰胺酶编码基因的耐多药肺炎克雷伯菌的高流行

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Klebsiella pneumoniae is an important opportunistic pathogen that commonly causes nosocomial infections and contributes to substantial morbidity and mortality. We sought to investigate the antibiotic resistance profile, pathogenic potential and the clonal relationships between K. pneumoniae (n = 25) isolated from patients and sources at a tertiary care hospital’s intensive care units (ICUs) in the northern region of Brazil. Most of K. pneumoniae isolates (n = 21, 84%) were classified as multidrug resistant (MDR) with high-level resistance to β-lactams, aminoglycosides, quinolones, tigecycline, and colistin. All the 25 isolates presented extended-spectrum beta-lactamase-producing (ESBL), including carbapenemase producers, and carried the blaKPC (100%), blaTEM (100%), blaSHV variants (n = 24, 96%), blaOXA-1 group (n = 21, 84%) and blaCTX-M-1 group (n = 18, 72%) genes. The K2 serotype was found in 4% (n = 1) of the isolates, and the K1 was not detected. The virulence-associated genes found among the 25 isolates were mrkD (n = 24, 96%), fimH-1 (n = 22, 88%), entB (100%), iutA (n = 10, 40%), ybtS (n = 15, 60%). The genes related with efflux pumps and outer membrane porins found were AcrAB (100%), tolC (n = 24, 96%), mdtK (n = 22, 88%), OmpK35 (n = 15, 60%), and OmpK36 (n = 7, 28%). ERIC-PCR was employed to determine the clonal relationship between the different isolated strains. The obtained ERIC-PCR patterns revealed that the similarity between isolates was above 70%. To determine the sequence types (STs) a multilocus sequence typing (MLST) assay was used. The results indicated the presence of high-risk international clones among the isolates. In our study, the wide variety of MDR K. pneumoniae harboring β-lactams and virulence genes strongly suggest a necessity for the implementation of effective strategies to prevent and control the spread of antibiotic resistant infections.
机译：肺炎克雷伯菌是一种重要的机会性病原体，通常引起医院感染，并导致大量发病和死亡。我们试图调查在巴西北部地区一家三级护理医院的重症监护病房（ICU）分离自患者和来源的肺炎克雷伯氏菌（n = 25）的抗生素耐药性，致病性和克隆关系。大多数肺炎克雷伯菌分离株（n = 21，占84％）被归类为对β-内酰胺类，氨基糖苷类，喹诺酮类，替加环素和大肠粘菌素具有高水平耐药性的多药耐药性（MDR）。所有25个分离株均表现出产生广谱β-内酰胺酶的产物（ESBL），包括碳青霉烯酶的生产者，并带有blaKPC（100％），blaTEM（100％），blaSHV变体（n = 24、96％），blaOXA-1组（n = 21，84％）和blaCTX-M-1组（n = 18，72％）基因。在4％（n = 1）的分离物中发现了K2血清型，未检测到K1。在25个分离株中发现的毒力相关基因分别是mrkD（n = 24，96％）， fim H-1（ n = 22，88％）， ent B（100％）， iut A（ n = 10、40％）， ybt S（ n = 15、60％）。发现与外排泵和外膜孔蛋白有关的基因是 AcrAB （100％）， tol C（ n = 24、96％）， mdt K（ n = 22，88％）， Omp K35（ n = 15，60％），和 Omp K36（ n = 7、28％）。采用ERIC-PCR确定不同分离菌株之间的克隆关系。获得的ERIC-PCR图谱表明分离株之间的相似性高于70％。为了确定序列类型（ST），使用了多基因座序列类型（MLST）测定法。结果表明在分离物中存在高风险的国际克隆。在我们的研究中，MDR K种类繁多。带有β-内酰胺和毒力基因的肺炎强烈提示实施有效策略以预防和控制抗生素耐药性感染的必要性。

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