Hypervirulent Klebsiella pneumoniae as a hospital-acquired pathogen in the intensive care unit in Mansoura, Egypt

Abstract

Introduction Hypervirulent Klebsiella pneumoniae (hvKP) are variants of K. pneumoniae that come up worldwide. hvKP is known in community-acquired infections but little is known about its role in hospital-acquired (HA) infections. The aim of this study was to evaluate the frequency of hvKP among HA K. pneumoniae infections in the intensive care unit (ICU) and to compare virulence and antibiotic susceptibility between hvKP and classical K. pneumoniae (cKP). Methods String test, biofilm formation, serum bactericidal assay, capsular polysaccharide genes (K1, K2, K5, K20, K54, K57), virulence genes: rmpA, rmpA2, iucA, iroB and antimicrobial susceptibility were assessed in HA K. pneumoniae strains isolated from the ICU in Mansoura, Egypt. Results Probable hvKP represented 4 out of 65 (6.2%) K. pneumoniae. K1 and K2 genes were present in 2 and 1 isolate respectively in probable hvKP. rmpA genes were significantly associated with hvKP; at the same time biofilm production and serum resistance were not significantly associated with the hypervirulent group. There was no significant difference between hvKP and cKP strains in terms of resistance pattern. Conclusion hvKP in critically ill patients from the ICU may form a new threat especially in the presence of antibiotic resistance. Although the validity of the string test in detecting metastatic Klebsiella is questionable, it is a simple and easy test that can be done in any laboratory indicating the presence of this organism. Serotypes and genomic background may provide helpful and confirmatory tools to diagnose hvKP. Keywords hospital-acquired, hypervirulent, intensive care unit, Klebsiella pneumoniae. Introduction1 Klebsiella pneumoniae can cause both community-and hospital-acquired (HA) infections. 1 There are two different groups of Klebsiella pneumoniae: classical (cKP) and

Characterization of virulence genetic profile and resistance patterns of clinical Klebsiella pneumoniae isolates: Classic versus hypermucoviscous phenotypes

“…Formation of biofilm provides superior protection for Kp species against the host immune responses, the action of antibiotics and enhances its persistence [35].According to current results about 91.2% and 100% of cKp and hmvKp isolates were respectively potential biofilm producers but with no statistically significant difference. This finding was similar to the previous studies of El-Mahdy et al [37], Yan et al [27] and Cubero et al [24]. On the other hand, Fu et al [39] and Wu et al [40]documented that biofilm production was higher in hmvKp than cKp with a statistically significant difference.…”

“…In our study, 26.3% and 7.4% of cKp and hmvKp isolates were respectively AmpC producers with a statistically significant difference (p<0.05), a finding that matched with results of Abd-Elmonsef et al [36]. Higher rates were showed by El-Mahdy et al [37] in Egypt who reported 50% of hmvKp and 55.7% cKp isolates as AmpC positive isolates.…”

“…In accordance with previous reports [22,27,36], the current study proved that hmvKp were less resistant to most antimicrobials than cKp. There was also a significant difference between the resistance rates to all antibiotics for HAIs as compared to CAIs which came in agreement with EL-Mahdy et al [37] and Cubero et al [24] who noticed that antibiotic resistance was higher in hospital-acquired hmvKp infections. It might be caused by the increased exposure to antimicrobials in the hospital environments that promote the selection pressure for antimicrobial resistance.…”

Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKp) in a hospital from North China

“…The study found that 37.8% (87/230) isolates were hvKp, and the prevalence of hvKp varied among different cities, with the highest rate in Wuhan (73.9%) and the lowest in Zhejiang (8.3%) [18]. Based on being positive for either iucA, or iroB gene, a total of 65 K. pneumoniae isolated from 65 patients with hospital-acquired infections in the ICUs of Mansoura University Hospital in Egypt were subjected to hvKp identification, of which only four strains were identified as probable hvKp [19]. With magA and rmpA genes being amplified by end point PCR, only three (7.9 %) out of 38 K. pneumoniae isolates carried one or both hvKp-associated genes in Houston, TX, USA [20].…”

Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKp) in a hospital from North China

“…Meanwhile, the hvKp proportion of our study was significantly higher than those of foreign reports. Based on being positive for either iucA, or iroB gene, a total of 65 K. pneumoniae isolated from 65 patients with hospitalacquired infections in the ICUs of Mansoura University Hospital in Egypt were subjected to hvKp identification, of which only four strains were identified as probable hvKp[20]. With magA and rmpA…”