Extensively Drug-Resistant Klebsiella pneumoniae Associated with Complicated Urinary Tract Infection in Northern India

• Published in: Japanese Journal of Infectious Diseases Vol. 77; no. 1; pp. 7 - 15
• Main Authors: Kaza, Parinitha, Xavier, Basil Britto, Mahindroo, Jaspreet, Singh, Nisha, Baker, Stephen, Nguyen, To Nguyen Thi, Mavuduru, Ravimohan Suryanarayana, Mohan, Balvinder, Taneja, Neelam
• Format: Journal Article
• Language: English
• Published: Japan National Institute of Infectious Diseases 31.01.2024; Japan Science and Technology Agency
• Subjects: Anti-Bacterial Agents - pharmacology; antimicrobial resistance; Bacterial Proteins - genetics; Bacterial Proteins - pharmacology; beta-Lactamases - genetics; beta-Lactamases - pharmacology; Colistin; Colistin - pharmacology; complicated UTI; Convergence; Drug resistance; Epidemiology; extensively drug resistant Klebsiella pneumoniae; Genomes; Health care facilities; Hospitals; Humans; Insertion sequences; Klebsiella; Klebsiella Infections - epidemiology; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nosocomial infection; Nosocomial infections; Patients; Recurrent infection; Siderophores; Urinary tract; Urinary Tract Infections - epidemiology; β Lactamase; nosocomial infections; complicated UTI; extensively drug resistant Klebsiella pneumoniae; antimicrobial resistance; colistin
• ISSN: 1344-6304; 1884-2836; 1884-2836
• DOI: 10.7883/yoken.JJID.2023.009

Klebsiella pneumoniae (Kp), which is associated with hospital-acquired infections, is extensively drug-resistant (XDR), making treatment difficult. Understanding the genetic epidemiology of XDR-Kp can help determine its potential to be hypervirulent (hv) through the presence of siderophores. We characterized the genomes of 18 colistin-resistant XDR-Kp isolated from 14 patients with complicated tract infection at an Indian healthcare facility. The 18 organisms comprised the following sequence types (STs): ST14 (n = 9), ST147 (n = 5), ST231 (n = 2), ST2096 (n = 1), and ST25 (n = 1). Many patients in each ward were infected with the same ST, suggesting a common source of infection. Some patients had recurrent infections with multiple STs circulating in the ward, providing evidence of hospital transmission. β-lactamase genes (blaCTX-M-1, blaSHV, and blaampH) were present in all isolates. blaNDM-1 was present in 15 isolates, blaOXA-1 in 16 isolates, blaTEM-1D in 13 isolates, and blaOXA-48 in 3 isolates. Disruption of mgrB by various insertion sequences was responsible for colistin resistance in 6 isolates. The most common K-type among isolates was K2 (n = 10). One XDR convergent hvKp ST2096 mutation (iuc+ybt+blaOXA-1+blaOXA-48) was associated with prolonged hospitalization. Convergent XDR-hvKp has outbreak potential, warranting effective antimicrobial stewardship and infection control.