Multiclonal spread of Klebsiella pneumoniae across hospitals in Khartoum, Sudan

Einas A Osman; Nagwa E El-Amin; Leena L Al-Hassan; Maowia Mukhtar

doi:10.1016/j.jgar.2020.12.004

Multiclonal spread of Klebsiella pneumoniae across hospitals in Khartoum, Sudan

J Glob Antimicrob Resist. 2021 Mar:24:241-245. doi: 10.1016/j.jgar.2020.12.004. Epub 2020 Dec 26.

Authors

Einas A Osman¹, Nagwa E El-Amin², Leena L Al-Hassan³, Maowia Mukhtar⁴

Affiliations

¹ Faculty of Medical Laboratories, Microbiology Department, Ibn Sina University, Algerief West, Khartoum, Sudan; Bioscience Research Institute, Ibn Sina University, Khartoum, Sudan.
² Department of Pathology, College of Medicine, Qassim University, Saudi Arabia.
³ Department of Global Health and Infection, Brighton and Sussex Medical School, BN1 9PX, UK. Electronic address: l.al-hassan@bsms.ac.uk.
⁴ Bioscience Research Institute, Ibn Sina University, Khartoum, Sudan; Institute of Endemic Diseases, University of Khartoum, Sudan.

PMID: 33373737
DOI: 10.1016/j.jgar.2020.12.004

Abstract

Objectives: Multidrug-resistant (MDR) Klebsiella pneumoniae is increasing worldwide with poorly characterised epidemiology in many parts of the world, particularly in Africa. This study aimed to investigate the molecular epidemiology of K. pneumoniae, to identify the diversity of sequence types (ST), and to detect carbapenem resistance genes in major regional hospitals in Khartoum, Sudan.

Methods: Klebsiella pneumoniae isolates (n = 117) were cultured from four hospitals in Khartoum, from April 2015 to October 2016. The isolates were characterised by sequencing of 16S-23S rDNA internal transcribed spacer (ITS) region. Molecular epidemiology was determined by multilocus sequence typing (MLST), and analysed by maximum likelihood phylogeny (PhyML). Antimicrobial susceptibility was determined by disk diffusion. Isolates phenotypically resistant to carbapenem were screened for carbapenemase genes: bla_NDM, bla_OXA48, bla_IMP, bla_VIM and bla_GES by PCR.

Results: ITS sequencing confirmed the 117 isolates as K. pneumoniae. MLST revealed 52 different STs grouped in four distinct clusters by PhyML. All isolates were MDR, and carbapenemase-producing K. pneumoniae (CP-KP) isolates accounted for 44/117 (37.6%) mostly harbouring bla_NDM (28/44) and bla_OXA-48 (7/44), with several isolates harbouring multiple genes.

Conclusion: MDR and CP-KP K. pneumoniae is widespread in Khartoum hospitals, with a diverse population of 52 STs clustering in four major lineages. There is an urgent need for systematic epidemiological studies of drug-resistant infections across all healthcare institutions in Sudan to inform local infection prevention and control strategies.

Keywords: Epidemiology; Klebsiella pneumoniae; MLST; Sudan.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / pharmacology
Drug Resistance, Multiple, Bacterial / genetics
Hospitals
Humans
Klebsiella Infections* / epidemiology
Klebsiella pneumoniae* / genetics
Microbial Sensitivity Tests
Multilocus Sequence Typing
Sudan / epidemiology

Substances

Anti-Bacterial Agents