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

Lathamani Kotekani; Subbannayya Kotigadde

doi:10.4103/JLP.JLP_30_17

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2018; 10(02): 155-161
DOI: 10.4103/JLP.JLP_30_17

Original Article

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

Lathamani Kotekani

Department of Microbiology, KVG Medical College, SULLIA, Dakshina Kannada, Karnataka, India

,

Subbannayya Kotigadde

Department of Microbiology, KVG Medical College, SULLIA, Dakshina Kannada, Karnataka, India

› Author Affiliations

Abstract

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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.

Key words

BlaCTX-M - bla_SHV - blaTEM - extended spectrum beta-lactamase - Klebsiella pneumoniae

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References

REFERENCES
1 Podschun R, Ullmann U. Klebsiella spp. As nosocomial pathogens: Epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998;11:589-603.
2 Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F. Blood stream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: Risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006;50:498-504.
3 Kothari S, Mishra V, Ranjan N, Singh A. Third generation cephalosporin-resistance in K. pneumoniae isolates: An emerging threat. Int J Basic Clin Pharmacol 2013;2:56-60.
4 Dever LA, Dermody TS. Mechanisms of bacterial resistance to antibiotics. Arch Intern Med 1991;151:886-95.
5 Ahmed OI, El Hady SA, Ahmed TM, Iman Z. Detection of blaSHV $ bla CTX-M genes in ESBL producing K. pneumoniae isolated from Egyptian patients with suspected nosocomial infections. Egypt J Med Hum Genet 2013;14:277-83.
6 Memariani M, Najar Peerayeh S, Zahraei Salehi T, Shokouhi Mostafavi SK. Occurrence of SHV, TEM and CTX-M β-lactamase genes among enteropathogenic Escherichia coli strains isolated from children with diarrhea. Jundishapur J Microbiol 2015;8:e15620.
7 Sadat SS, Goudarzi M, Fattaneh S. Relation between blaTEM, blaSHV and blaCTX- M genes and acute urinary tract infections. J Acute Dis 2016;5:71-6.
8 Wiskur BJ, Hunt JJ, Callegan MC. Hypermucoviscosity as a virulence factor in experimental Klebsiella pneumoniae endophthalmitis. Invest Ophthalmol Vis Sci 2008;49:4931-8.
9 Hughes C, Philips R, Roberts AP. Serum resistance among Escherechia coli strain causing UTI in relation to O type and the carriage of hemolysin, colicin and antibiotic resistance determinants. Infect Immun 1982;35:270-5.
10 Sharma S, Bhat GK, Shenoy S. Virulence factors and drug resistance in Escherechia coli isolated from extra intestinal infections. Indian J Med Microbiol 2007;25:369-73.
11 Sahly H, Aucken H, Benedí VJ, Forestier C, Fussing V, Hansen DS, et al. Increased serum resistance in Klebsiella pneumoniae strains producing extended-spectrum beta-lactamases. Antimicrob Agents Chemother 2004;48:3477-82.
12 Forbes BA, Sahm DF, Weissfeld SA. Bailey & Scott's Diagnostic Microbiology. 1^st ed. St. Louis: Mosby; 2002.
13 Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Twenty First Informational Supplement M100-S21. Wayne, PA, USA: CLSI; 2011.
14 Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867-78.
15 Bora A, Hazarika NK, Shukla SK, Prasad KN, Sarma JB, Ahmed G. Prevalence of bla TEM, bla SHV and bla CTX-M genes in clinical isolates of E. coli and Klebsiella pneumoniae from North East India. Indian J Pathol Microbiol 2014;57:249-54.
16 Varkey DR, Balaji V, Abraham J. Molecular characterisation of extended spectrum beta lactamase producing strains from blood sample. Int J Pharm Pharm Sci 2014;6:276-8.
17 Jemima SA, Verghese S. Multiplex PCR for bla(CTX-M) & bla(SHV) in the extended spectrum beta lactamase (ESBL) producing gram-negative isolates. Indian J Med Res 2008;128:313-7.
18 Woodford N, Fagan EJ, Ellington MJ. Multiplex PCR for rapid detection of genes encoding CTX-M extended-spectrum (beta)-lactamases. J Antimicrob Chemother 2006;57:154-5.
19 Sridhar Rao PN. Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamases in Escherichia coli and Klebsiella pneumoniae Isolated across Karnataka (Doctoral thesis). Sri Devaraj Urs Academy of Higher Education and Research. Tamaka, Kolar, Karnataka, Microbiology Department; 2015.
20 Sun Y, Wu H, Shen D. Clinical and molecular analysis of Klebsiella pneumoniae causing liver abscess in China. J Mol Microbiol Biotechnol 2016;26:245-51.
21 Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med 2004;199:697-705.
22 Ranjan KP, Ranjan N, Chakraborty A, Arora DR. An approach to uropathogenic Escherichia coli in urinary tract infections. J Lab Physicians 2010;2:70-3.
23 Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains expressing an extended-spectrum beta-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific Region. Clin Infect Dis 2001;32 Suppl 2:S94-103.
24 Shaikh S, Fatima J, Shakil S, Rizvi SM, Kamal MA. Antibiotic resistance and extended spectrum beta-lactamases: Types, epidemiology and treatment. Saudi J Biol Sci 2015;22:90-101.
25 Walsh TR, Toleman MA, Jones RN. Comment on: Occurrence, prevalence and genetic environment of CTX-M beta-lactamases in Enterobacteriaceae from Indian hospitals. J Antimicrob Chemother 2007;59:799-800.
26 Biswas SM, Mia MR, Ara N, Ibrahim M, Nasir TA, Yunus S. Comparison of three dimensional test and double disc synergy test for detection of extended spectrum-lactamase (ESBL) producing gram negative bacteria. Pulse 2013;6:12-619.
27 Krishnamurthy V, Vijayakumar GS, Sudeepa KM, Prashanth HV, Prakash R, Nagaraj ER. Phenotypic and genotypic methods for detection of ESBL producing E. coli and K. pneumoniae isolates from ventilator associated pneumonia. J Clin Dign Res 2013;7:1975-8.
28 Rawat D, Nair D. Extended-spectrum β-lactamases in gram negative bacteria. J Glob Infect Dis 2010;2:263-74.
29 Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: An emerging public-health concern. Lancet Infect Dis 2008;8:159-66.
30 Priyadharsini RI, Kavitha A, Rajan R, Mathavi S, Rajesh KR. Prevalence of bla (CTX M) extended spectrum beta lactamase gene in Enterobacteriaceae from critical care patients. J Lab Physicians 2011;3:80-3.
31 Kaur M, Aggarwal A. Occurrence of the CTX-M, SHV and the TEM genes among the extended spectrum β-lactamase producing isolates of Enterobacteriaceae in a tertiary care hospital of North India. J Clin Diagn Res 2013;7:642-5.
32 Roy S, Gaind R, Chellani H, Mohanty S, Datta S, Singh AK, et al. Neonatal septicaemia caused by diverse clones of Klebsiella pneumoniae & Escherichia coli harbouring blaCTX-M-15. Indian J Med Res 2013;137:791-9.
33 Rastogi V, Nirwan PS, Jain S, Kapil A. Nosocomial outbreak of septicaemia in neonatal Intensive Care Unit due to extended spectrum β-lactamase producing Klebsiella pneumoniae showing multiple mechanisms of drug resistance. Indian J Med Microbiol 2010;28:380-4.
34 Sharma J, Sharma M, Ray P. Detection of TEM & SHV genes in Escherichia coli & Klebsiella pneumoniae isolates in a tertiary care hospital from India. Indian J Med Res 2010;132:332-6.
35 Doi Y, Adams-Haduch JM, Shivannavar CT, Paterson DL, Gaddad SM. Faecal carriage of CTX-M-15-producing Klebsiella pneumoniae in patients with acute gastroenteritis. Indian J Med Res 2009;129:599-602.
36 Shakil S, Akram M, Ali SM, Khan AU. Acquisition of extended-spectrum beta-lactamase producing Escherichia coli strains in male and female infants admitted to a neonatal Intensive Care Unit: Molecular epidemiology and analysis of risk factors. J Med Microbiol 2010;59:948-54.
37 Chagas TP, Alves RM, Vallim DC, Seki LM, Campos LC, Asensi MD, et al. Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil. Braz J Infect Dis 2011;15:420-5.
38 Wang G, Huang T, Surendraiah PK, Wang K, Komal R, Zhuge J, et al. CTX-M β-lactamase-producing Klebsiella pneumoniae in suburban New York city, New York, USA. Emerg Infect Dis 2013;19:1803-10.
39 Mshana SE, Hain T, Domann E, Lyamuya EF, Chakraborty T, Imirzalioglu C, et al. Predominance of Klebsiella pneumoniae ST14 carrying CTX-M-15 causing neonatal sepsis in Tanzania. BMC Infect Dis 2013;13:466.
40 George EA, Sankar S, Jesudasan MV, Sudandiradoss C, Nandagopal B. Molecular characterization of CTX-M type extended spectrum beta lactamase producing E. coli isolated from humans and the environment. Indian J Med Microbiol 2015;33 Suppl: 73-9.
41 Edelstein M, Pimkin M, Palagin I, Edelstein I, Stratchounski L. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother 2003;47:3724-32.
42 Antón R, Coque TM. The CTX-M beta-lactamase pandemic. Curr Opin Microbiol 2006;9:466-75.
43 Livermore DM, Canton R, Gniadkowski M, Nordmann P, Rossolini GM, Arlet G, et al. CTX-M: Changing the face of ESBLs in Europe. J Antimicrob Chemother 2007;59:165-74.
44 Hoda H, Baha A. Molecular characterization of extended-spectrum beta lactamase producing Enterobacteriaceae in a Saudi Arabian tertiary hospital. J Infect Dev Ctries 2014;8:282-8.
45 Cabral AB, Melo Rde C, Maciel MA, Lopes AC. Multidrug resistance genes, including bla(KPC) and bla(CTX)-M-2, among Klebsiella pneumoniae isolated in Recife, Brazil. Rev Soc Bras Med Trop 2012;45:572-8.
46 Jenney AW, Clements A, Farn JL, Wijburg OL, McGlinchey A, Spelman DW, et al. Seroepidemiology of Klebsiella pneumoniae in an Australian tertiary hospital and its implications for vaccine development. J Clin Microbiol 2006;44:102-7.