1887

Journal of Medical Microbiology logo

Volume 72, Issue 6

Detection of multiple extensively-drug resistant hypervirulent clones from patients with ventilator-associated pneumonia in Egypt No Access

Graphical Abstract

Graphical Abstract

Emergence of XDR-hvKP as the predominant pathotype responsible for ventilator associated pneumonia in Assiut, Egypt.

Abstract

Hypervirulent- (hvKP) is an evolving pathotype that is more virulent than the classical- (cKP) and causes serious fatal illnesses.

Although there are few reports on hvKP isolated from Egyptian patients, the molecular characteristics and clonal relatedness of MDR-hvKP have not been adequately investigated.

To investigate the microbiological and genetic characteristics as well as the epidemiology of hvKP induced ventilator-associated pneumonia (VAP).

A retrospective study of 59 . inducing VAP was conducted at Assiut University Hospitals from November 2017 to January 2019. All were tested for resistance phenotype, capsular genotype (K1 and K2), virulence gene profile (), and the presence of resistance genes (likelike). Clonal relatedness was assessed by Pulsed field gel electrophoresis (PFGE).

HvKP accounted for 89.8 % (53/59) of isolates with ~95 % exhibiting extensively-drug resistant (XDR) phenotype. Hypermucoviscous phenotype was detected in 19 (35.8 %) hvKP and K2 capsular gene was identified in 18 (33.9 %) of hvKP. Regarding the virulence genotype of hvKP strains, was the most prevalent virulence gene (98.1%), while p and were detected in 75.4 and 52.8 % of hvKP strains, respectively. Resistance genes were highly prevalent in both cKP and hvKP with being more prevalent in hvKP (100 % vs 94.3 % for 50 % vs 62.2 % for like and 83.3 % vs 69.8 % for like, respectively). PFGE typing of 29 representative revealed 15 pulsotypes, with identical hvKP pulsotypes isolated from different ICUs at different times and several hvKP and cKP isolates belonged to the same pulsotype.

This study highlights the dominance and clonal spread of XDR-hvKP strains at Assiut University Hospital in Egypt. Physicians should be aware of the increased risk of hvKP induced-VAP and support further epidemiologic studies.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): cKP , clonal relatedness , hvKP and VAP
© 2023 The Authors
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001701
2023-06-07
2024-05-03
Loading full text...

Full text loading...

References

  1. Liu Y-C, Cheng D-L, Lin C-L. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med 1986; 146:1913–1916 [View Article] [PubMed]
     [Google Scholar]
  2. Gu D, Dong N, Zheng Z, Lin D, Huang M et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: A molecular epidemiological study. Lancet Infect Dis 2018; 18:37–46 [View Article] [PubMed]
     [Google Scholar]
  3. Zhao Y, Zhang X, Torres VVL, Liu H, Rocker A et al. An outbreak of carbapenem-Rresistant and hypervirulent Klebsiella pneumoniae in an intensive care unit of a major teaching hospital in Wenzhou, China. Front Public Health 2019; 7:229 [View Article] [PubMed]
     [Google Scholar]
  4. Tang M, Kong X, Hao J, Liu J. Epidemiological characteristics and formation mechanisms of multidrug-resistant hypervirulent Klebsiella pneumoniae. Front Microbiol 2020; 11:2774 [View Article]
     [Google Scholar]
  5. Bialek-Davenet S, Criscuolo A, Ailloud F, Passet V, Jones L et al. Genomic definition of hypervirulent and multidrug-resistant Klebsiella pneumoniae Clonal Groups. Emerg Infect Dis 2014; 20:1812–1820 [View Article]
     [Google Scholar]
  6. Liu C, Du P, Xiao N, Ji F, Russo TA et al. Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China. Virulence 2020; 11:1215–1224 [View Article] [PubMed]
     [Google Scholar]
  7. Li W, Sun G, Yu Y, Li N, Chen M et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2014; 58:225–232 [View Article] [PubMed]
     [Google Scholar]
  8. Lin Y-C, Lu M-C, Tang H-L, Liu H-C, Chen C-H et al. Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections: Comparative virulence analysis with hypermucoviscosity-negative strain. BMC Microbiol 2011; 11:1–8 [View Article] [PubMed]
     [Google Scholar]
  9. Russo TA, Olson R, Fang C-T, Stoesser N, Miller M et al. Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K. pneumoniae. J Clin Microbiol 2018; 56:e00776–00718 [View Article] [PubMed]
     [Google Scholar]
  10. Abdel-Rahim MH, El-Badawy O, Hadiya S, Daef EA, Suh S-J et al. Patterns of fluoroquinolone resistance in Enterobacteriaceae isolated from the Assiut University Hospitals, Egypt: A comparative study. Microb Drug Resist 2019; 25:509–519 [View Article] [PubMed]
     [Google Scholar]
  11. Hammad HA, Hadiya S, El-Feky M, Aly S. Co-occurrence of plasmid-mediated quinolone resistance and carbapenemases in Klebsiella Pneumoniae isolates in Assiut, Egypt. Egypt J Med Microbiol 2017; 26:1–7 [View Article]
     [Google Scholar]
  12. Mohamed ER, Aly SA, Halby HM, Ahmed SH, Zakaria AM et al. Epidemiological typing of multidrug-resistant Klebsiella pneumoniae, which causes paediatric ventilator-associated pneumonia in Egypt. J Med Microbiol 2017; 66:628–634 [View Article] [PubMed]
     [Google Scholar]
  13. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63:e61–e111 [View Article] [PubMed]
     [Google Scholar]
  14. Fang C-T, Chuang Y-P, Shun C-T, Chang S-C, Wang J-T. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004; 199:697–705 [View Article] [PubMed]
     [Google Scholar]
  15. Wayne P. Performance standards for antimicrobial susceptibility testing 29th ed CLSI supplement M100-S29. Clinical and Laboratory Standards Institute (CLSI) 2019
     [Google Scholar]
  16. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18:268–281 [View Article] [PubMed]
     [Google Scholar]
  17. Wu H, Li D, Zhou H, Sun Y, Guo L et al. Bacteremia and other body site infection caused by hypervirulent and classic Klebsiella pneumoniae. Microb Pathog 2017; 104:254–262 [View Article] [PubMed]
     [Google Scholar]
  18. Liu C, Guo J. Characteristics of ventilator-associated pneumonia due to hypervirulent Klebsiella pneumoniae genotype in genetic background for the elderly in two tertiary hospitals in China. Antimicrob Resist Infect Control 2018; 7:1–8 [View Article]
     [Google Scholar]
  19. Lee H-C, Chuang Y-C, Yu W-L, Lee N-Y, Chang C-M et al. Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: Association with invasive syndrome in patients with community-acquired bacteraemia. J Intern Med 2006; 259:606–614 [View Article]
     [Google Scholar]
  20. Zhang Y, Zhao C, Wang Q, Wang X, Chen H et al. High prevalence of hypervirulent Klebsiella pneumoniae infection in China: Geographic distribution, clinical characteristics, and antimicrobial resistance. Antimicrob Agents Chemother 2016; 60:6115–6120 [View Article]
     [Google Scholar]
  21. Abd-Elmonsef M, Khalil H, Selim A, Abd-Elsalam S, Elkhalawany W et al. Detection of hypervirulent Klebsiella pneumoniae in Tanta University Hospital, Egypt. BMRJ 2016; 17:1–10 [View Article]
     [Google Scholar]
  22. El-Mahdy R, El-Kannishy G, Salama H. Hypervirulent Klebsiella pneumoniae as a hospital-acquired pathogen in the intensive care unit in Mansoura, Egypt. Germs 2018; 8:140–146 [View Article] [PubMed]
     [Google Scholar]
  23. Yan Q, Zhou M, Zou M, Liu W -e. Hypervirulent Klebsiella pneumoniae induced ventilator-associated pneumonia in mechanically ventilated patients in China. Eur J Clin Microbiol Infect Dis 2016; 35:387–396 [View Article]
     [Google Scholar]
  24. Fang C-T, Lai S-Y, Yi W-C, Hsueh P-R, Liu K-L et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007; 45:284–293 [View Article] [PubMed]
     [Google Scholar]
  25. Shon AS, Bajwa RPS, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence 2013; 4:107–118 [View Article] [PubMed]
     [Google Scholar]
  26. Yao B, Xiao X, Wang F, Zhou L, Zhang X et al. Clinical and molecular characteristics of multi-clone carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in a tertiary hospital in Beijing, China. Int J Infect Dis 2015; 37:107–112 [View Article] [PubMed]
     [Google Scholar]
  27. Lev AI, Astashkin EI, Kislichkina AA, Solovieva EV, Kombarova TI et al. Comparative analysis of Klebsiella pneumoniae strains isolated in 2012-2016 that differ by antibiotic resistance genes and virulence genes profiles. Pathog Glob Health 2018; 112:142–151 [View Article] [PubMed]
     [Google Scholar]
  28. Mohammad Ali Tabrizi A, Badmasti F, Shahcheraghi F, Azizi O. Outbreak of hypervirulent Klebsiella pneumoniae harbouring blaVIM-2 among mechanically-ventilated drug-poisoning patients with high mortality rate in Iran. J Glob Antimicrob Resist 2018; 15:93–98 [View Article] [PubMed]
     [Google Scholar]
  29. Xu M, Fu Y, Fang Y, Xu H, Kong H et al. High prevalence of KPC-2-producing hypervirulent Klebsiella pneumoniae causing meningitis in Eastern China. Infect Drug Resist 2019; 12:641–653 [View Article] [PubMed]
     [Google Scholar]
  30. Alizade H, Jajarmi M, Aflatoonian MR, Kalantar-Neyestanaki D, Shoja S et al. Comparative prevalence of blaCTX-M-15 gene with virulence genes and serotypes in Klebsiella pneumoniae. Jundishapur J Microbiol 2018; 11:e61285 [View Article]
     [Google Scholar]
  31. Roulston KJ, Bharucha T, Turton JF, Hopkins KL, Mack DJF. A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK. JMM Case Rep 2018; 5:e005130 [View Article] [PubMed]
     [Google Scholar]
  32. Liu B-T, Su W-Q. Whole genome sequencing of NDM-1-producing serotype K1 ST23 hypervirulent Klebsiella pneumoniae in China. J Med Microbiol 2019; 68:866–873 [View Article] [PubMed]
     [Google Scholar]
  33. Rafat C, Messika J, Barnaud G, Dufour N, Magdoud F et al. Hypervirulent Klebsiella pneumoniae, a 5-year study in a French ICU. J Med Microbiol 2018; 67:1083–1089 [View Article] [PubMed]
     [Google Scholar]
  34. Chou A, Nuila RE, Franco LM, Stager CE, Atmar RL et al. Prevalence of hypervirulent Klebsiella pneumoniae-associated genes rmpA and magA in two tertiary hospitals in Houston, TX, USA. J Med Microbiol 2016; 65:1047–1048 [View Article] [PubMed]
     [Google Scholar]
  35. Yu W-L, Ko W-C, Cheng K-C, Lee H-C, Ke D-S et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis 2006; 42:1351–1358 [View Article] [PubMed]
     [Google Scholar]
  36. Catalán-Nájera JC, Garza-Ramos U, Barrios-Camacho H. Hypervirulence and hypermucoviscosity: Two different but complementary Klebsiella spp. phenotypes?. Virulence 2017; 8:1111–1123 [View Article] [PubMed]
     [Google Scholar]
  37. Harada S, Ishii Y, Saga T, Aoki K, Tateda K. Molecular epidemiology of Klebsiella pneumoniae K1 and K2 isolates in Japan. Diagn Microbiol Infect Dis 2018; 91:354–359 [View Article] [PubMed]
     [Google Scholar]
  38. Choby JE, Howard‐Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives. J Intern Med 2020; 287:283–300 [View Article]
     [Google Scholar]
  39. Conlan S, Park M, Deming C, Thomas PJ, Young AC et al. Plasmid dynamics in KPC-positive Klebsiella pneumoniae during long-term patient colonization. mBio 2016; 7:e00742–00716 [View Article] [PubMed]
     [Google Scholar]
  40. Tang H-L, Chiang M-K, Liou W-J, Chen Y-T, Peng H-L et al. Correlation between Klebsiella pneumoniae carrying pLVPK-derived loci and abscess formation. Eur J Clin Microbiol Infect Dis 2010; 29:689–698 [View Article]
     [Google Scholar]
  41. Russo TA, Olson R, Macdonald U, Metzger D, Maltese LM et al. Aerobactin mediates virulence and accounts for increased siderophore production under iron-limiting conditions by hypervirulent (hypermucoviscous) Klebsiella pneumoniae. Infect Immun 2014; 82:2356–2367 [View Article] [PubMed]
     [Google Scholar]
  42. Hsieh P-F, Lin T-L, Lee C-Z, Tsai S-F, Wang J-T. Serum-induced iron-acquisition systems and TonB contribute to virulence in Klebsiella pneumoniae causing primary pyogenic liver abscess. J Infect Dis 2008; 197:1717–1727 [View Article] [PubMed]
     [Google Scholar]
  43. Compain F, Babosan A, Brisse S, Genel N, Audo J et al. Multiplex PCR for detection of seven virulence factors and K1/K2 capsular serotypes of Klebsiella pneumoniae. J Clin Microbiol 2014; 52:4377–4380 [View Article] [PubMed]
     [Google Scholar]
  44. Poirel L, Revathi G, Bernabeu S, Nordmann P. Detection of NDM-1-Producing Klebsiella pneumoniae in Kenya. Antimicrob Agents Chemother 2011; 55:934–936 [View Article]
     [Google Scholar]
  45. Chia J-H, Chu C, Su L-H, Chiu C-H, Kuo A-J et al. Development of a multiplex PCR and SHV melting-curve mutation detection system for detection of some SHV and CTX-M beta-lactamases of Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae in Taiwan. J Clin Microbiol 2005; 43:4486–4491 [View Article] [PubMed]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001701
Loading
Detection of multiple extensively-drug resistant hypervirulent Klebsiella pneumoniae clones from patients with ventilator-associated pneumonia in Egypt
J. Med. Microbiol. 72, 001701 (2023); https://doi.org/10.1099/jmm.0.001701
/content/journal/jmm/10.1099/jmm.0.001701
/content/journal/jmm/10.1099/jmm.0.001701
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error