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Monitoring Multi-Drug Resistant Klebsiella pneumoniae in Kitagata Hot Spring, Southwestern Uganda: A Public Health
Kaltume Umar Hambali1, Emmanuel Eilu1, Sunil Kumar1
1Department of Medical Microbiology and Immunology, Kampala International University-Western Campus, Ishaka-Bushenyi, Uganda.
Background:
The concerning frequency of K. pneumoniae in various recreational settings, is noteworthy, especially regarding multi-drug resistant (MDR) strains. This superbug is linked to the rapid spread of plasmids carrying these resistance genes. The objective of this study was to evaluate the spatiotemporal prevalence of MDR-K. pneumoniae in the Kitagata hot spring, Southwestern Uganda.
Methods:
A laboratory-based descriptive longitudinal study was conducted between May and July 2023. During rainy and dry seasons, we collected eighty water samples in the morning and evening from the hot spring. The temperature at each point was measured prior to sample collection, and two samples were obtained at varying depths. 5 mL of each homogenized sample were pre-enriched in brain heart infusion broth, and subsequently in both blood and violet red bile agar. The Kirby-Bauer disk diffusion method was performed, followed by the detection of carbapenemase (CR) and extended-spectrum β-lactamase (ESBL) production. Polymerase chain reaction showed resistance genes viz. bla TEM, bla CTX-M and bla KPC. Data were analyzed using SPSS-20 to obtain chi-square tests and regression analysis.
Results:
K. pneumoniae accounted for 30.0% of isolates obtained from Kitagata hot springs, with all isolates classified as multi-drug resistant. All isolates were resistant to ampicillin, rifampicin, ceftazidime, and azithromycin (79.2%). Additionally, 95.8% of isolates harbored bla TEM gene alone and both bla TEM and bla CTX genes, followed by bla KPC alone (33.3%), with 25% harboring all three resistance genes. During the dry season, K. pneumoniae had a higher prevalence (35.0%) compared to the wet season (25.0%). The prevalence of MDR-K. pneumoniae significantly increased over the course of the study. The presence of the three studied resistance genes in the isolates showed a positive correlation with the second phase of sample collection and the dry season but exhibited a negative correlation with temperature, except for isolates harboring either bla TEM alone or bla TEM+KPC+CTX genes.
Conclusion:
Kitagata hot spring serves as a hotspot for continuous dissemination and acquisition of MDR-K. pneumoniae harboring resistance genes that encode for ESBL and CR production. The healthcare sector ought to implement an ongoing monitoring and surveillance system as well as robust antimicrobial resistance stewardship programs aimed at delivering health education to the community.
Insights
Multi-drug resistant Klebsiella pneumoniae, a concerning superbug, was prevalent in Kitagata hot springs, Uganda. All identified K. pneumoniae strains were multi-drug resistant, highlighting the urgent need for enhanced surveillance and stewardship programs.
Area of Science:
- Environmental microbiology
- Antimicrobial resistance
- Public health
Background:
- Klebsiella pneumoniae is frequently detected in recreational environments, with multi-drug resistant (MDR) strains posing a significant public health threat.
- The rapid spread of resistance genes via plasmids contributes to the prevalence of MDR strains.
- Recreational water bodies can act as reservoirs for pathogenic bacteria, including MDR K. pneumoniae.
Purpose of the Study:
- To investigate the spatiotemporal prevalence of MDR K. pneumoniae in the Kitagata hot spring, Southwestern Uganda.
- To identify specific antibiotic resistance genes present in K. pneumoniae isolates.
- To understand the correlation between environmental factors and the prevalence of MDR K. pneumoniae.
Main Methods:
- A descriptive longitudinal study was conducted from May to July 2023, collecting water samples during dry and wet seasons.
- Samples were enriched, and K. pneumoniae isolates were identified using standard microbiological techniques.
- Antibiotic susceptibility testing, carbapenemase (CR) and extended-spectrum β-lactamase (ESBL) production detection, and PCR for resistance genes (blaTEM, blaCTX-M, blaKPC) were performed.
Main Results:
- K. pneumoniae constituted 30.0% of isolates, with all identified strains exhibiting multi-drug resistance.
- All isolates were resistant to ampicillin, rifampicin, ceftazidime, and azithromycin. Resistance genes blaTEM, blaCTX-M, and blaKPC were detected in 95.8%, 95.8%, and 33.3% of isolates, respectively.
- MDR K. pneumoniae prevalence was higher during the dry season (35.0%) compared to the wet season (25.0%) and increased throughout the study period.
Conclusions:
- Kitagata hot spring acts as a reservoir for MDR K. pneumoniae harboring ESBL and CR genes, facilitating continuous dissemination.
- The prevalence of MDR K. pneumoniae is influenced by seasonal variations and environmental factors.
- Enhanced surveillance, antimicrobial stewardship, and community health education are crucial to mitigate the spread of MDR K. pneumoniae.
