Molecular and clinical insights into extended-spectrum β-lactamase genes of Klebsiella pneumoniae isolated from neonatal sepsis in Ethiopia

Abstract

Background Klebsiella bacterial strains harboring Extended-Spectrum Beta-Lactamase (ESBL) enzymes are the primary culprits behind neonatal sepsis globally. These strains significantly impact clinical outcomes due to their multi-drug resistance patterns in local healthcare settings. In response to this spiraling threat, we studied the prevalence and clinical implications of ESBL-encoding genes in neonates hospitalized with confirmed sepsis. Methods A correlational study was conducted on 51 neonates diagnosed with sepsis caused by ESBL-positive Klebsiella pneumoniae at Jimma Medical Center spanning from May 2022 to July 2023. Antimicrobial resistance profiles of the bacterial isolates were determined using the Kirby-Bauer diffusion test, while multiplex polymerase chain reaction (mPCR) techniques were employed to identify resistance genes. The correlation between resistance genes and treatment outcomes was analyzed using the phi coefficient (φ) with a significance level below 0.05. The data management was executed through the utilization of WHONET and STATA software platforms. Results The sample consisted of 26 (50.9%) male and the remaining 25 (49.1%) female neonates, with diverse clinical characteristics. All 51 Klebsiella pneumoniae isolates were 100% resistant to trimethoprim/sulfamethoxazole and ceftriaxone, but showed varying resistance profiles ranging from 30.8% to meropenem to 94.2% to ceftazidime. Notably, all isolates demonstrated multidrug resistance, with 23% of cases showing resistance to seven different antimicrobial classes. The most prevalent resistance genes identified were bla CTX−M (96.1%), bla TEM (94.1%), and bla SHV (88.2%). The majority of isolates (94.1%) carried at least two resistance genes, such as bla TEM and bla CTX (94.1%), bla TEM and bla SHV (86.2%), and bla CTX and bla SHV (86.2%). Notably, 84.3% of the bacteria harbored the trio of bla TEM , bla CTX , and bla SHV resistance genes, and only the presence of bla SHV in monogenic (φ = 0.4, P = 0.01) or the trio of bla TEM , bla CTX , and bla SHV genes (φ = 0.3, P = 0.02) showed positive correlation with neonatal mortality. Conclusion We observed a significant prevalence of multidrug-resistant Klebsiella pneumoniae strains among neonates. Moreover, ESBL-resistance genes were widespread, with the blaSHV gene showing a correlation with increased neonatal mortality...