Diversity of clonal types of Klebsiella pneumoniae causing infections in intensive care neonatal patients in a large urban setting

Abstract

Background Klebsiella infections are reported from neonatal intensive care units (NICUs) worldwide, but data on their incidence and genetic diversity remain scarce. Objective We determined the incidence and genetic diversity of Klebsiella infections in NICU patients in Rio de Janeiro. Methods This was a prospective study including newborns admitted to NICU in three hospitals during April 2005-November 2006 and March 2008-February 2009. Klebsiella pneumoniae isolates were genotyped by multilocus sequence typing (MLST) and extended spectrum β-lactamases (ESBL) were characterized. Results Klebsiella infections occurred in 38 of 3984 patients (incidence rate, 9.5/1000 admissions); 14 (37%) of these 38 newborns died. Two clonal groups, CC45 and CC1041, caused 11 cases (42% of K. pneumoniae infection). Ten (32%) of the isolates causing infection produced ESBL, 9 of which (83%) carried bla CTX-M-15 , all belonging to clonal complex (CC) 45 and CC1041. Nine of these ESBL-producing isolates were confined to only one of the NICUs. Major conclusions The high incidence of Klebsiella infections in NICU in Rio de Janeiro appeared to be due to a combination of frequent sporadic infections caused by multiple K. pneumoniae genotypes and small outbreaks caused by dominant multidrugresistant clones.

The Glucosinolates: A Sulphur Glucoside Family of Mustard Anti-Tumour and Antimicrobial Phytochemicals of Potential Therapeutic Application

“…Klebsiella pneumoniae normally colonises the mouth, skin, and intestines. Illness predominantly affects middle-aged and older men with debilitating diseases but infants are increasingly now being reported with this organism in urinary tract and intestinal infections [74][75][76]. The emergence of multi-drug-resistant bacterial infections in hospitalized patients with underlying morbidity is of particular concern [77].…”

Current Stage in the Development of Klebsiella pneumoniae Vaccines

“…Hypervirulent strains are more prevalent in the community and affect individuals of all age groups, causing diseases in sites where the presence of K. pneumoniae is uncommon, such as endophthalmitis, meningitis, brain, epidural, and splenic abscess and necrotizing fasciitis, in addition to increased risk of other more common infections such as liver abscesses [8]. Of particular importance is the emergence of neonatal infections caused by K pneumoniae, which are associated with high mortality in developing countries around the world [9][10][11]. According to the Burden of Antibiotic Resistance in Neonates from Developing Societies (BARNARDS) network, K. pneumoniae is the main cause of neonatal sepsis in low-and middle-income countries, accounting for 10% of total sepsis deaths [12].…”

“…Plasmid-associated carbapenemases, including KPC, NDM, IMP, VIM, and OXA-48 enzymes, are disseminated worldwide and cause high rates of morbidity and mortality, varying from 32% to 65% [20,21]. KPC-producing K. pneumoniae is one of the first pathogens isolated from bloodstream infection in patients hospitalized in intensive care units (ICU), a long hospital stay associated with immunocompromised patients being the main risk factor to acquire this pathogen [10].…”