Community- and Hospital-Acquired Klebsiella pneumoniae Urinary Tract Infections in Portugal: Virulence and Antibiotic Resistance

Abstract

Klebsiella pneumoniae is a clinically relevant pathogen and a frequent cause of hospital-acquired (HA) and community-acquired (CA) urinary tract infections (UTI). The increased resistance of this pathogen is leading to limited therapeutic options. To investigate the epidemiology, virulence, and antibiotic resistance profile of K. pneumoniae in urinary tract infections, we conducted a multicenter retrospective study for a total of 81 isolates (50 CA-UTI and 31 HA-UTI) in Portugal. The detection and characterization of resistance and virulence determinants were performed by molecular methods (PCR, PCR-based replicon typing, and multilocus sequence typing (MLST)). Out of 50 CA-UTI isolates, six (12.0%) carried β-lactamase enzymes, namely blaTEM-156 (n = 2), blaTEM-24 (n = 1), blaSHV-11 (n = 1), blaSHV-33 (n = 1), and blaCTX-M-15 (n = 1). All HA-UTI were extended-spectrum β-lactamase (ESBL) producers and had a multidrug resistant profile as compared to the CA-UTI isolates, which were mainly resistant to ciprofloxacin, levofloxacin, tigecycline, and fosfomycin. In conclusion, in contrast to community-acquired isolates, there is an overlap between virulence and multidrug resistance for hospital-acquired UTI K. pneumoniae pathogens. The study is the first to report different virulence characteristics for hospital and community K. pneumoniae pathogens, despite the production of β-lactamase and even with the presence of CTX-M-15 ESBL, a successful international ST15 clone, which were identified in both settings. This highlights that a focus on genomic surveillance should remain a priority in the hospital environment.

Frequency and antimicrobial susceptibility pattern of hospital isolates of Escherichia coli and Klebsiella pneumoniae in urine samples

“…Our study has shown high resistance of E. coli and K. pneumoniae to fluoroquinolones what is similar to studies conducted in many countries [16][17][18][19].…”

“…K. pneumoniae was most sensitive to imipenem and meropenem (95,3%), while there was no resistance to colistin. A similar result was in South Korean study and Portugal where the resistance to ciprofloxacin was in a range from 41.3 -46.5% and resistance to trimethoprim-sulfamethoxazole was 38.6 -46.7% [16,17].…”

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

“…To date the majority of hypervirulent K. pneumoniae have remained susceptible to antimicrobials [38,46] (except ampicillin). However, the last few years have seen increasing reports of "convergent" K. pneumoniae that are both hypervirulent (defined as strains carrying the iuc aerobactin locus) and MDR ESBL/CP either due to acquisition of an MDR plasmid by a hypervirulent strain [47][48][49][50][51] or by acquisition of a virulence plasmid by an MDR strain [49,[52][53][54][55][56]. The majority of these reports represent sporadic isolations.…”

<p>Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant <em>Klebsiella pneumoniae</em> in Wenzhou, China from 2003 to 2016</p>

“…10 However, another sequence type, ST15, is emerging as a new global threat because it is hypervirulent in addition to being multi-drug resistant. 10,17 Hypervirulent isolates causing community-acquired infections were first reported in the 1980s in Taiwan. [18][19][20][21] They have been shown to be highly invasive, in that they usually cause severe life-threatening infections which are associated with high morbidity and mortality in both hospital and community.…”