Detection of multiple extensively-drug resistant hypervirulent Klebsiella pneumoniae clones from patients with ventilator-associated pneumonia in Egypt

Hadeel Elzeny; Wegdan Mohamed; Enas Daef; Omnia El-Badawy; Lamiaa Shaaban; Naglaa S Osman; Safy Hadiya; Sherine Aly

doi:10.1099/jmm.0.001701

Detection of multiple extensively-drug resistant hypervirulent Klebsiella pneumoniae clones from patients with ventilator-associated pneumonia in Egypt

J Med Microbiol. 2023 Jun;72(6). doi: 10.1099/jmm.0.001701.

Authors

Hadeel Elzeny¹, Wegdan Mohamed², Enas Daef², Omnia El-Badawy², Lamiaa Shaaban³, Naglaa S Osman⁴, Safy Hadiya¹, Sherine Aly²

Affiliations

¹ Assiut International Center of Nanomedicine, Al-Rajhy Hospital, Assiut, Egypt.
² Medical Microbiology and Immunology, Faculty of Medicine, Assiut University, Assiut, Egypt.
³ Chest Department, Assiut University Hospital, Assiut, Egypt.
⁴ Paediatric Allergy, Immunology and Rheumatology Department, Childrens Hospital, Assiut University Hospital, Assiut, Egypt.

PMID: 37288576
DOI: 10.1099/jmm.0.001701

Abstract

Introduction. Hypervirulent-K. pneumoniae (hvKP) is an evolving pathotype that is more virulent than the classical-K. pneumoniae (cKP) and causes serious fatal illnesses.Hypothesis/Gap Statement. 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.Aim. To investigate the microbiological and genetic characteristics as well as the epidemiology of hvKP induced ventilator-associated pneumonia (VAP).Methodology. A retrospective study of 59 K. pneumoniae inducing VAP was conducted at Assiut University Hospitals from November 2017 to January 2019. All K. pneumoniae were tested for resistance phenotype, capsular genotype (K1 and K2), virulence gene profile (c-rmpA, p-rmpA, iucA, kfu, iroB, iroN), and the presence of resistance genes (blaNDM-1, blaCTX-M-3-like, blaCTX-M-14-like). Clonal relatedness was assessed by Pulsed field gel electrophoresis (PFGE).Result. HvKP accounted for 89.8 % (53/59) of K. pneumoniae 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, iucA was the most prevalent virulence gene (98.1%), while p-rmpA and kfu were detected in 75.4 and 52.8 % of hvKP strains, respectively. Resistance genes were highly prevalent in both cKP and hvKP with blaCTX-M-3-like being more prevalent in hvKP (100 % vs 94.3 % for blaNDM-1, 50 % vs 62.2 % for blaCTX-M-3-like and 83.3 % vs 69.8 % for blaCTX-M-14 _-like, respectively). PFGE typing of 29 representative K. pneumoniae 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.Conclusion. 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.

Keywords: VAP; cKP; clonal relatedness; hvKP.

MeSH terms

Anti-Bacterial Agents / pharmacology
Clone Cells
Egypt / epidemiology
Humans
Klebsiella Infections* / epidemiology
Klebsiella Infections* / microbiology
Klebsiella pneumoniae
Pneumonia, Ventilator-Associated* / microbiology
Retrospective Studies

Substances

Anti-Bacterial Agents