Journal
MICROBIAL DRUG RESISTANCE
Volume 27, Issue 10, Pages 1319-1327Publisher
MARY ANN LIEBERT, INC
DOI: 10.1089/mdr.2020.0096
Keywords
carbapenem-resistant Klebsiella pneumoniae; hypermucoviscous; serum bactericidal; virulence genes; hypervirulence; Malaysia
Funding
- International Society of Infectious Diseases [IF016-2015]
- Fundamental Research Grant Scheme [FP013-2018A]
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The study revealed a detection rate of 7.5% for hypermucoviscous carbapenem-resistant Klebsiella pneumoniae (hmCRKp) in a teaching hospital in Malaysia, with most infections being hospital-acquired or healthcare-associated. All hmCRKp isolates harbored carbapenemase genes and were multidrug resistant.
Background: Hypermucoviscous carbapenem-resistant Klebsiella pneumoniae (hmCRKp) is emerging globally and approaching the worst-case scenario in health care system. Aims: The main objective in this study was to determine the hypermucoviscous characteristics among the carbapenem-resistant K. pneumoniae (CRKp) isolated from a teaching hospital in Malaysia. The association of hypermucoviscous phenotype with the virulence traits and clinical presentations were also investigated. Methods: A retrospective study was conducted in University Malaya Medical Centre (UMMC). The presence of hypermucoviscous K. pneumoniae was identified among a collection of CRKp clinical isolates (first isolate per patient) from 2014 to 2015 using string test. Correlation between clinical and microbial characteristics of the hmCRKp was investigated. Results: A total of nine (7.5%) hmCRKp were detected among 120 CRKp isolates. Majority of the isolates were hospital acquired or health care-associated infections. None of the patients had typical pyogenic liver abscess. All of the hmCRKp isolates harbored carbapenemase genes and were multidrug resistant. K1/K serotype, peg-344, allS, and magA were not identified among hmCRKp isolates, whereas aerobactin siderophore receptor gene (iutA), iroB, rmpA, and rmpA2 were detected. Only three hmCRKp isolates were resistant to serum bactericidal. Conclusions: All the isolates presented inconclusive evidence for the interpretation of hypervirulence. Therefore, more study should be performed in the future to have a better understanding of the virulence mechanisms in correlation with the clinical and microbial determinants.
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