Case report: A successfully treated case of community-acquired urinary tract infection due to Klebsiella aerogenes in Bangladesh

Abstract

Klebsiella aerogenes, a nosocomial pathogen, is increasingly associated with extensive drug resistance and virulence profiles. It is responsible for high morbidity and mortality. This report describes the first successfully treated case of community-acquired urinary tract infection (UTI) caused by Klebsiella aerogenes in an elderly housewife with Type-2 diabetes (T2D) from Dhaka, Bangladesh. The patient was empirically treated with intravenous ceftriaxone (500 mg/8 h). However, she did not respond to the treatment. The urine culture and sensitivity tests, coupled with bacterial whole-genome sequencing (WGS) and analysis, revealed the bacteria to be K. aerogenes which was extensively drug-resistant but was susceptible to carbapenems and polymyxins. Based on these findings, meropenem (500 mg/8 h) was administered to the patient, who then responded to the treatment and recovered successfully without having a relapse. This case raises awareness of the importance of diagnosis of not-so-common etiological agents, correct identification of the pathogens, and targeted antibiotic therapy. In conclusion, correctly identifying etiological agents of UTI using WGS approaches that are otherwise difficult to diagnose could help improve the identification of infectious agents and improve the management of infectious diseases.

Caracterización de infección del tracto urinario a partir de urocultivos positivos aislados de mujeres embarazadas de la ciudad de Machala año 2022

“…En base a lo anterior, es importante indicar que, la E. coli es el principal uropatógeno productor de BLEE con mayor dominancia, esto se debe a que presenta toxinas, fimbrias, pili y adhesinas que ayudan a su unión con el uroepitelio, las cuales dan protección a las bacterias en la eliminación de la orina y ayudan a la proliferación de bacterias e ingreso al tejido uroepitelial (27). Además, la especie Klebsiella aerógena ha sido considerada como una de las especies emergentes-predominantes para ser adquiridas en una comunidad, esto debido a sus factores de virulencia inherentes-emergentes, entre ellas su capsula, sideróforo, lipopolisacárido, fimbrias 1-3, creación de biopelículas y resistencia antimicrobiana (28). En referencia a lo anterior, el MSP del Ecuador ha señalado que los principales antibióticos resistentes a ITU en mujeres embarazadas, son fármacos como la amoxicilina y ampicilina (con o sin inhibidores de betalactamasas y sulfas), pues estos poseen valores de resistencia a nivel nacional que superan los recomendados a nivel global (31).…”

Recent Records on Bacterial Opportunistic Infections via the Dietary Route

“…The reports described in this review are summarized in Table S1 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], where the bacterial groups involved in the illnesses are reported in alphabetical order along where the type of ...…”

“…However, it was susceptible to carbapenems and polymyxins. After the 14th day of antibiotic administration, the patient recovered completely [ 15 ].…”

“…zooepidemicus perinatal bacteremia [44]; different infections in 37 patients [45] Breast milk Klebsiella pneumoniae bacteremia [14]; Serratia marcescens bacteremia [37]; Pantoea agglomerans neonatal late onset sepsis (LOS) [30] Chicken Arcobacter spp. pericarditis [6] Composite dishes Bacillus pumilus bacteremia [10]; S. agalactiae septic arthritis and bacteremia [40] Drinking water Enterococcus faecalis gastroenteritis [13]; K. aerogenes urinary tract infection (UTI) [15] Fermented pork S. suis bacteremia, endophthalmitis [48] Yogurt Lacticaseibacillus paracasei endocarditis, embolic cerebrovascular infarct [3], cholecystitis [16], septic shock [22]; Lactobacillus jensenii endocarditis [19]; Pediococcus acidilactici bacteremia [31];…”

In-depth analysis of Klebsiella aerogenes resistome, virulome and plasmidome worldwide

“…This species is a ubiquitous member of the Enterobacteriaceae family, and although it has always been considered an opportunistic pathogen, recently, interest in this organism has increased, mainly due to the emergence of multidrug-resistant and carbapenem-resistant strains 3 . This may be due to the acquisition of antibiotic resistance genes carried by mobile elements, such as plasmids and conjugative integrative elements, which have already been identified in K. aerogenes 4 – 6 . However, in this species, the main mechanisms of resistance to carbapenems are attributed to chromosomal overexpression of AmpC β-lactamase (e.g., bla DHA-1 and bla CMY-2 ) and mutations that affect membrane permeability 4 , 7 , 8 .…”