The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

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Lockdown is considered to be the best of policies around the world to fight the deadly virus of COVID-19 which decimated hundreds of people in the last six months. However, this is not a cost-free measure. Billions of dollars worth of economic activities halted hinging upon these measures imposed by the governments of the countries. For instance, IMF predicted that the GDP growth will decline by 4.9 percent in 2020. Global trade is also expected to plummet by 27 percent in the second quarter of the year. In addition, paucity of recreational activities severely affects the mental health of the people. While imposing lockdown, both the cost and benefit should be analyzed to understand the real benefit of these measures on human life. This study critically examines the impact of the lockdown measures on mental health, and the economy of Bangladesh along with the efficacy of the measures on containing the virus. We found that the negative impact on the economy and mental health surpasses the positive impact of curbing the pandemic. It also compares the efficacy of the measures in different countries to find out the pattern that resembles with Bangladesh. From all the data, we conclude that the cost of lockdown measures in the country is greater than the benefit it brings to Bangladesh.

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