Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Mahmud, Zahid Hayat; Uddin, Salman Zahir; Moniruzzaman, Md.; Ali, Sobur; Hossain, Maqsud; Islam, Md. Tamzid; Costa, Dorin Teresa D.; Islam, Mohammad Rafiqul; Islam, Md. Shafiqul; Hassan, Md. Zakiul; Ong, Li-Ann; Moore, Catrin E.; Charles, Katrina; Mondal, Dinesh; Lopes, Bruno Silvester; Parveen, Shahana

doi:10.3390/ph15091116

Cited by 17 publications

(9 citation statements)

References 84 publications

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“…Nevertheless, the prevalence of this gene particularly in Pakistan (n=162/1,033, 15.7%) was in-line with a study from several hospitals in the same country 42 . blaKPC is not common in Africa or South Asia 7,30 , which this study also confirmed; however, blaKPC was detected from neonatal cots in Tanzania in 2021 17 and blaKPC K. pneumoniae was found on pillows and the floor in three hospitals in Bangladesh 43 .…”

Section: Discussionsupporting

confidence: 77%

Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

Nieto-Rosado,

Sands,

Portal

et al. 2023

Preprint

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Inanimate surfaces in hospital settings can harbour bacterial pathogens, which can disseminate and cause nosocomial infections, resulting in unacceptable mortality in low- and middle-income countries (LMICs). As part of the BARNARDS study, this hospital swabs study determined which hospital surfaces were colonised by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). PCR screening for the presence of extended-spectrum β-lactamases (blaCTX-M-15) and carbapenemases (blaNDM, blaOXA-48-like and blaKPC) showed higher prevalence of blaNDM, and blaOXA-48-like in Pakistan, Bangladesh, and Ethiopia, compared to other LMICs. Identification of GNB carrying ARGs by MALDI-TOF MS confirmed dominance of Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata, mostly found in sinks and water system. The isolates were further analysed by whole genome sequencing, and the presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis was determined. The same strain was identified from the same ward on multiple occasions suggesting clonal persistence, and ST15 K. pneumoniae was shown to be responsible for transmission events in Pakistan and identical to isolates causing neonatal sepsis over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.

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Section: Discussionsupporting

confidence: 77%

Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

Nieto-Rosado,

Sands,

Portal

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Nevertheless, the prevalence of this gene, particularly in Pakistan (n = 162/ 1033, 15.7%), was in line with a study from several hospitals in the same country 41 . bla KPC is not common in Africa or South Asia 7,26 , which this study also confirmed; however, bla KPC was detected from neonatal cots in Tanzania in 2021 17 and bla KPC K. pneumoniae was found on pillows and the floor in three hospitals in Bangladesh 42 .…”

Section: Discussionsupporting

confidence: 76%

Colonisation of hospital surfaces from low- and middle-income countries by extended spectrum β-lactamase- and carbapenemase-producing bacteria

Nieto-Rosado,

Sands,

Portal

et al. 2024

Nat Commun

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Hospital surfaces can harbour bacterial pathogens, which may disseminate and cause nosocomial infections, contributing towards mortality in low- and middle-income countries (LMICs). During the BARNARDS study, hospital surfaces from neonatal wards were sampled to assess the degree of environmental surface and patient care equipment colonisation by Gram-negative bacteria (GNB) carrying antibiotic resistance genes (ARGs). Here, we perform PCR screening for extended-spectrum β-lactamases (blaCTX-M-15) and carbapenemases (blaNDM, blaOXA-48-like and blaKPC), MALDI-TOF MS identification of GNB carrying ARGs, and further analysis by whole genome sequencing of bacterial isolates. We determine presence of consistently dominant clones and their relatedness to strains causing neonatal sepsis. Higher prevalence of carbapenemases is observed in Pakistan, Bangladesh, and Ethiopia, compared to other countries, and are mostly found in surfaces near the sink drain. Klebsiella pneumoniae, Enterobacter hormaechei, Acinetobacter baumannii, Serratia marcescens and Leclercia adecarboxylata are dominant; ST15 K. pneumoniae is identified from the same ward on multiple occasions suggesting clonal persistence within the same environment, and is found to be identical to isolates causing neonatal sepsis in Pakistan over similar time periods. Our data suggests persistence of dominant clones across multiple time points, highlighting the need for assessment of Infection Prevention and Control guidelines.

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“…In the group of 160 ICU patients treated for COVID-19, Klebsiella pneumoniae ESBL or NDM strains were observed. The Klebsiella species are among the top 10 pathogens causing nosocomial bacterial infections ( Mahmud et al., 2022 ). No Klebsiella pneumoniae infection carbapenemase- (KPC-), VIM-, or IMP-type cases was reported in the aforementioned period.…”

Section: Discussionmentioning

confidence: 99%

Infection with the multidrug-resistant Klebsiella pneumoniae New Delhi metallo-B-lactamase strain in patients with COVID-19: Nec Hercules contra plures?

Janc,

Słabisz,

Woźniak

et al. 2024

Front. Cell. Infect. Microbiol.

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BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, in patients treated for SARS-CoV-2 infection, infections with the Klebsiella pneumoniae bacteria producing New Delhi metallo-B-lactamase (NDM) carbapenemase in the USA, Brazil, Mexico, and Italy were observed, especially in intensive care units (ICUs). This study aimed to assess the impact of Klebsiella pneumoniae NDM infection and other bacterial infections on mortality in patients treated in ICUs due to COVID-19.MethodsThe 160 patients who qualified for the study were hospitalized in ICUs due to COVID-19. Three groups were distinguished: patients with COVID-19 infection only (N = 72), patients with COVID-19 infection and infection caused by Klebsiella pneumoniae NDM (N = 30), and patients with COVID-19 infection and infection of bacterial etiology other than Klebsiella pneumoniae NDM (N = 58). Mortality in the groups and chosen demographic data; biochemical parameters analyzed on days 1, 3, 5, and 7; comorbidities; and ICU scores were analyzed.ResultsBacterial infection, including with Klebsiella pneumoniae NDM type, did not elevate mortality rates. In the group of patients who survived the acute phase of COVID-19 the prolonged survival time was demonstrated: the median overall survival time was 13 days in the NDM bacterial infection group, 14 days in the other bacterial infection group, and 7 days in the COVID-19 only group. Comparing the COVID-19 with NDM infection and COVID-19 only groups, the adjusted model estimated a statistically significant hazard ratio of 0.28 (p = 0.002). Multivariate analysis revealed that age, APACHE II score, and CRP were predictors of mortality in all the patient groups.ConclusionIn patients treated for SARS-CoV-2 infection acquiring a bacterial infection due to prolonged hospitalization associated with the treatment of COVID-19 did not elevate mortality rates. The data suggests that in severe COVID-19 patients who survived beyond the first week of hospitalization, bacterial infections, particularly Klebsiella pneumoniae NDM, do not significantly impact mortality. Multivariate analysis revealed that age, APACHE II score, and CRP were predictors of mortality in all the patient groups.

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Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Cited by 17 publications

References 84 publications

Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

Colonisation of extended spectrum β-lactamase- and carbapenemase-producing bacteria on hospital surfaces from low-/middle-income countries

Colonisation of hospital surfaces from low- and middle-income countries by extended spectrum β-lactamase- and carbapenemase-producing bacteria

Infection with the multidrug-resistant Klebsiella pneumoniae New Delhi metallo-B-lactamase strain in patients with COVID-19: Nec Hercules contra plures?

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