Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Abstract

Background Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.

Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

“…The crisis of MDR bacterial infection was more frequently occurring in developing countries. K. pneumoniae , as the second most common nosocomial gram-negative bacterium, leads to significantly high all-cause mortality in worldwide [ 10 , 12 , 14 , 25 ]. Carbapenem, amikacin and tigecycline used to be effective and latest antibiotics for MDR- K. pneumoniae treatments, but recent researches revealed that drug-resistance rates of these three antibiotics were significantly increasing which may be associated with overuse during treatments [ 24 , 26 ].…”

Polyclonal Multidrug ESBL-Producing Klebsiella pneumoniae and Emergence of Susceptible Hypervirulent Klebsiella pneumoniae ST23 Isolates in Mozambique

“…Furthermore, the presence of MDR ESBL-producing Klebsiella isolates carrying rmpA and wzi -K1 genes associated with hypermucoviscosity has been previously documented at the Manhiça District Hospital [ 19 ], suggesting the need to monitor the spread of these potentially dangerous clones locally.…”

“…Mozambique is facing, as are many other countries, its share of challenges concerning Klebsiella infections. Reports of MDR ESBL-producing Kp have surfaced [ 13 , 14 , 15 , 16 , 17 , 18 ], and there have been documented cases of MDR ESBL-producing hv Kp isolates causing severe and fatal disease, particularly in vulnerable populations, like children [ 19 ].…”