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Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU
Nadezhda K Fursova1, Evgenii I Astashkin1, Olga N Ershova2
1Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory "Kvartal A", 142279 Obolensk, Russia.
Abstract:
The purpose of this study was the identification of genetic lineages and antimicrobial resistance (AMR) and virulence genes in Klebsiella pneumoniae isolates associated with severe infections in the neuro-ICU. Susceptibility to antimicrobials was determined using the Vitek-2 instrument. AMR and virulence genes, sequence types (STs), and capsular types were identified by PCR. Whole-genome sequencing was conducted on the Illumina MiSeq platform. It was shown that K. pneumoniae isolates of ST14K2, ST23K57, ST39K23, ST76K23, ST86K2, ST218K57, ST219KL125/114, ST268K20, and ST2674K47 caused severe systemic infections, including ST14K2, ST39K23, and ST268K20 that were associated with fatal incomes. Moreover, eight isolates of ST395K2 and ST307KL102/149/155 were associated with manifestations of vasculitis and microcirculation disorders. Another 12 K. pneumoniae isolates of ST395K2,KL39, ST307KL102/149/155, and ST147K14/64 were collected from patients without severe systemic infections. Major isolates (n = 38) were XDR and MDR. Beta-lactamase genes were identified: blaSHV (n = 41), blaCTX-M (n = 28), blaTEM (n = 21), blaOXA-48 (n = 21), blaNDM (n = 1), and blaKPC (n = 1). The prevalent virulence genes were wabG (n = 41), fimH (n = 41), allS (n = 41), and uge (n = 34), and rarer, detected only in the genomes of the isolates causing severe systemic infections-rmpA (n = 8), kfu (n = 6), iroN (n = 5), and iroD (n = 5) indicating high potential of the isolates for hypervirulence.
Insights
This study identified specific genetic lineages of Klebsiella pneumoniae causing severe neuro-ICU infections. Certain sequence types (STs) were linked to fatal outcomes and vasculitis, highlighting their hypervirulence and antimicrobial resistance.
Area of Science:
- Medical Microbiology
- Genomics
- Infectious Diseases
Background:
- Klebsiella pneumoniae is a significant cause of hospital-acquired infections.
- Severe infections in neuro-ICU patients require understanding of pathogen genetics and resistance.
- Antimicrobial resistance (AMR) and virulence factors are key determinants of K. pneumoniae pathogenicity.
Purpose of the Study:
- To identify genetic lineages of K. pneumoniae associated with severe neuro-ICU infections.
- To characterize antimicrobial resistance and virulence genes in these isolates.
- To correlate specific sequence types (STs) and capsular types with infection severity and outcomes.
Main Methods:
- Antimicrobial susceptibility testing using Vitek-2.
- Polymerase Chain Reaction (PCR) for AMR and virulence genes, sequence types (STs), and capsular types.
- Whole-genome sequencing (WGS) on the Illumina MiSeq platform.
Main Results:
- Specific STs (e.g., ST14K2, ST39K23, ST268K20) were linked to severe, fatal infections and vasculitis.
- Most isolates (n=38) were extensively drug-resistant (XDR) or multidrug-resistant (MDR).
- Prevalent AMR genes included blaSHV, blaCTX-M, blaTEM, and blaOXA-48. Rare hypervirulence genes (rmpA, kfu, iroN) were found in severe infection isolates.
Conclusions:
- Specific K. pneumoniae STs possess a high potential for hypervirulence and cause severe systemic infections in neuro-ICU settings.
- The presence of XDR/MDR strains with specific virulence factors poses a significant clinical challenge.
- Understanding these genetic determinants is crucial for developing targeted treatment and control strategies.
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