Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt

Noha A Hassuna; Reem A AbdelAziz; Amira Zakaria; Mohammed Abdelhakeem

doi:10.3389/fmicb.2020.01375

Extensively-Drug Resistant Klebsiella pneumoniae Recovered From Neonatal Sepsis Cases From a Major NICU in Egypt

Front Microbiol. 2020 Jun 19:11:1375. doi: 10.3389/fmicb.2020.01375. eCollection 2020.

Authors

Noha A Hassuna¹, Reem A AbdelAziz², Amira Zakaria³, Mohammed Abdelhakeem⁴

Affiliations

¹ Department of Medical Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt.
² Department of Pediatrics, Faculty of Medicine, Minia University, Minia, Egypt.
³ Biotechnology Institute, Suez Canal University, Ismaïlia, Egypt.
⁴ Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt.

Abstract

Background: Neonatal sepsis is a nuisance to clinicians and medical microbiologists, particularly those cases caused by Klebsiella pneumoniae. Thus, we aimed at investigating the profile and mechanisms of antibiotic resistance and the clonal relationships between K. pneumoniae isolated from neonates at the largest tertiary care hospital's neonatal intensive care units (NICUs) in Minia, Egypt.

Methods: This study comprised 156 neonates diagnosed with culture-proven sepsis from February 2019 to September 2019, at a major NICU of Minia City. All K. pneumoniae isolates were collected and characterized by antimicrobial profile, resistance genotype, and pulsed-field gel electrophoresis typing.

Results: Twenty-four K. pneumoniae isolates (15.3%) were collected out of the 156 sepsis diagnosed neonates. These samples showed extensive drug resistance (XDR) to most of the tested antimicrobials, except fluoroquinolones. All the K. pneumoniae isolates possessed bla _VIM and bla _NDM carbapenemase genes, while bla _KPC gene was detected in 95.8%. Considering extended-spectrum β-lactamases genes, bla _CTX-M was found in all the isolates and bla _OXA-1 gene in 75% of them. The plasmid-mediated quinolone resistance gene qnrS, was predominantly found among our isolates in comparison to qnrB or qnrA. A moderate degree of clonal relatedness was observed between the isolates.

Conclusion: To the best of our knowledge, this the first report of an alarming occurrence of XDR among K. penumoniae isolates recovered from neonatal sepsis in Egypt. Our data necessitate proper antimicrobial stewardship as the choices will be very limited.

Keywords: Klebsiella pneumoniae; NICU = neonatal ICU; PFGE; XDR; sepsis.