Klebsiella Species and Enterobacter cloacae Isolates Harboring bla _OXA-181 and bla _OXA-48 : Resistome, Fitness Cost, and Plasmid Stability

Abstract

The growing rate of antibiotic resistance is an important global health threat. This threat is exacerbated by the lack of safe and potent alternatives to carbapenems in addition to the slow developmental process of newer and effective antibiotics.

Genomic diversity and antimicrobial resistance in clinicalKlebsiella pneumoniaeisolates from tertiary hospitals in Southern Ghana

“…The disparity in sequence type distribution across various study sites reinforces the genetic diversity of these pathogens, with some sequence types being widespread while others are unique to specific locales. Previous studies corroborate our findings, with certain sequence types such as ST17 being recurrent in clinical settings and others being more geographically dispersed [18,19,23,24]. This genetic variability across regions emphasises the need for localised infection control strategies, which take into account the regional differences in sequence type prevalence and the potential for localised spread of specific clones.…”

“…Our data add to the mounting evidence of the bla CTX-M-15 ESBL genotype’s prevalence in healthcare and community settings in our setting [15, 16, 21, 23–25, 70–73]. The detection of carbapenem resistance genes, such as bla OXA-181 and bla NDM-1 , is particularly concerning and echoes findings from other regional studies [12, 21, 24]. The presence of these genes indicates the challenging reality of treating infections with limited antimicrobial options.…”

“…The diversity of the plasmids carrying these resistance genes reflects K. pneumoniae’s genomic plasticity and potential to act as a reservoir for antimicrobial resistance. IncFIB and IncX3 plasmids, in particular, have been implicated in the spread of resistance, underscoring the role of mobile genetic elements in resistance gene dissemination [6, 15, 23, 24].…”

“…Despite the paucity of comprehensive local molecular epidemiological data [15, 16, 21, 23, 24], the information available paints a grim picture of the extensive challenges posed by this pathogen’s persistent and complex AMR mechanisms. For example, one study observed a 41% prevalence of gut colonisation with ESBL-producing K. pneumoniae in 435 children under five in the Agogo municipality, pinpointing a community-wide reservoir of the bl a CTX-M-15 gene [15].…”

“…Moreover, the genomic complexity observed in the Komfo Anokye Teaching Hospital in Kumasi, Ghana, featuring diverse resistance genes on mobile plasmids, highlights the escalating threat of multidrug resistance in hospital-acquired infections [15, 23]. Notably, plasmids carrying replicons such as IncF, IncX3, and IncL have been implicated in disseminating critical resistance genes, such as bla CTX-M-15 , bla OXA-181 , and bla OXA-48 , without a fitness cost, in K. pneumoniae and K. quasipneumoniae isolates from Effia Nkwanta Hospital, Ghana, underscoring their potential for widespread transmission [24].…”