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      Virulence determinant and extended spectrum beta-lactamase production in Klebsiella pneumoniae isolated from a tertiary care hospital, South India

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          Abstract

          BACKGROUND:

          Klebsiella pneumoniae on these days show greater resistance towards newer generation cephalosporin. The present study made an effort to show the relevance between ESBL producing K. pneumoniae and virulence determinant in respect to serum resistance and K1, K2 antigens at a tertiary care hospital in South India.

          MATERIAL AND METHODS:

          A total of 520 consecutive, non-duplicate isolates of K. pneumoniae were recovered from various clinical specimens such as Urine (n = 360), sputum (n = 107), pus (n = 25), blood (n = 6) and other miscellaneous specimens (n=22) obtained from both out patients and in patients between June 2012 to July 2016 were included in the study.

          RESULTS:

          Polymerase Chain Reaction to detect bla genes in 62 isolates phenotypically identified as ESBL producers were successful in 58 (93.54%) isolates. Of the 13 ESBL producing hypermucoviscous Klebsiella pneumoniae (hvKP) strains, 6 of them were showing the amplicons for gene's coding for K1 antigens.

          CONCLUSION:

          The study provides further authentication of the global sporadic of bla CTX-M and the relevance between K antigens and serum resistance with ESBL production in our place. As there is no much study available, it also highlights the need for further study of their epidemiological surveillance.

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          Most cited references41

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          Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.

          Johann Pitout, Kevin B Laupland (2008)
          The medical community relies on clinical expertise and published guidelines to assist physicians with choices in empirical therapy for system-based infectious syndromes, such as community-acquired pneumonia and urinary-tract infections (UTIs). From the late 1990s, multidrug-resistant Enterobacteriaceae (mostly Escherichia coli) that produce extended-spectrum beta lactamases (ESBLs), such as the CTX-M enzymes, have emerged within the community setting as an important cause of UTIs. Recent reports have also described ESBL-producing E coli as a cause of bloodstream infections associated with these community-onset UTIs. The carbapenems are widely regarded as the drugs of choice for the treatment of severe infections caused by ESBL-producing Enterobacteriaceae, although comparative clinical trials are scarce. Thus, more rapid diagnostic testing of ESBL-producing bacteria and the possible modification of guidelines for community-onset bacteraemia associated with UTIs are required.
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            A Novel Virulence Gene in Klebsiella pneumoniae Strains Causing Primary Liver Abscess and Septic Metastatic Complications

            Chi-Tai Fang, Yi-Ping Chuang, Chia-Tung Shun … (2004)
            Primary Klebsiella pneumoniae liver abscess complicated with metastatic meningitis or endophthalmitis is a globally emerging infectious disease. Its pathogenic mechanism remains unclear. The bacterial virulence factors were explored by comparing clinical isolates. Differences in mucoviscosity were observed between strains that caused primary liver abscess (invasive) and those that did not (noninvasive). Hypermucoviscosity correlated with a high serum resistance and was more prevalent in invasive strains (52/53 vs. 9/52; P < 0.0001). Transposon mutagenesis identified candidate virulence genes. A novel 1.2-kb locus, magA, which encoded a 43-kD outer membrane protein, was significantly more prevalent in invasive strains (52/53 vs. 14/52; P < 0.0001). The wild-type strain produced a mucoviscous exopolysaccharide web, actively proliferated in nonimmune human serum, resisted phagocytosis, and caused liver microabscess and meningitis in mice. However, magA − mutants lost the exopolysaccharide web and became extremely serum sensitive, phagocytosis susceptible, and avirulent to mice. Virulence was restored by complementation using a magA-containing plasmid. We conclude that magA fits molecular Koch's postulates as a virulence gene. Thus, this locus can be used as a marker for the rapid diagnosis and for tracing the source of this emerging infectious disease.
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              CTX-M: changing the face of ESBLs in Europe.

              D M Livermore, R Canton, M Gniadkowski … (2006)
              Since around 2000 - earlier in Poland and Spain and later in France and the UK - dramatic shifts have occurred in the prevalence and types of extended-spectrum beta-lactamases (ESBLs) in Europe. Before this watershed, most producers were nosocomial isolates, often Klebsiella spp. or Enterobacter spp. from specialist care units, and had mutant TEM or SHV ESBLs. Subsequently, CTX-M ESBLs have become dominant, with much greater penetration into Escherichia coli, and with many infections in 'complicated community' patients, usually with underlying disease, recent antibiotic usage, or healthcare contact. The degree of clonality among producers varies with the country, as does the enzyme type produced, with group 9 (CTX-M-9 and -14) enzymes dominant in Spain and group 1 enzymes (particularly CTX-M-3 and -15) dominant elsewhere. Irrespective of the particular enzyme, most producers are multiresistant. These changing patterns present major therapeutic and infection control challenges, with the public health intervention points unclear.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Lab Physicians
                Journal ID (iso-abbrev): J Lab Physicians
                Journal ID (publisher-id): JLP
                Title: Journal of Laboratory Physicians
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0974-2727
                ISSN (Electronic): 0974-7826
                Publication date (Print): Apr-Jun 2018
                Volume: 10
                Issue: 2
                Pages: 155-161
                Affiliations
                [1] Department of Microbiology, KVG Medical College, SULLIA, Dakshina Kannada, Karnataka, India
                Author notes
                Address for correspondence: Mrs. Lathamani Kotekani, Research Scholar, Department of Microbiology, KVG Medical College, SULLIA, Dakshina Kannada, Karnataka, India. E-mail: lathamani2006@ 123456rediffmail.com
                Article
                Publisher ID: JLP-10-155
                DOI: 10.4103/JLP.JLP_30_17
                PMC ID: 5896181
                SO-VID: 877cadaf-031c-4136-aa58-f658a5591b79
                Copyright © Copyright: © 2018 Journal of Laboratory Physicians
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Date received : 13 February 2017
                Date accepted : 19 August 2017
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Clinical chemistry
                Keywords: blactx-m,blashv,blatem,extended spectrum beta-lactamase,klebsiella pneumoniae
                Data availability:
                ScienceOpen disciplines: Clinical chemistry
                Keywords: blactx-m, blashv, blatem, extended spectrum beta-lactamase, klebsiella pneumoniae

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