Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Zahid Hayat Mahmud; Salman Zahir Uddin; M Moniruzzaman; Sobur Ali; Monir Hossain; Md Tamzid Islam; Dorin Teresa D Costa; Mohammad Rafiqul Islam; Md Shafiqul Islam; Md Zakiul Hassan; Li-Ann Ong; Catrin E Moore; Katrina J Charles; Dinesh Mondal; Bruno Silvester Lopes; Shahana Parveen

doi:10.3390/ph15091116

Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Pharmaceuticals (Basel). 2022 Sep 7;15(9):1116. doi: 10.3390/ph15091116.

Authors

Zahid Hayat Mahmud¹, Salman Zahir Uddin¹, M Moniruzzaman¹, Sobur Ali^{1

2}, Monir Hossain¹, Md Tamzid Islam¹, Dorin Teresa D Costa¹, Mohammad Rafiqul Islam¹, Md Shafiqul Islam¹, Md Zakiul Hassan³, Li-Ann Ong⁴, Catrin E Moore⁵, Katrina J Charles⁴, Dinesh Mondal¹, Bruno Silvester Lopes^{6

7}, Shahana Parveen³

Affiliations

¹ Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh.
² Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA.
³ Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh.
⁴ School of Geography and the Environment, University of Oxford, Oxford OX1 2JD, UK.
⁵ Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK.
⁶ Department of Medical Microbiology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK.
⁷ National Horizons Centre, Teesside University, Darlington DL1 1HG, UK.

Abstract

The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was bla_CTX-M-1 (91%), followed by bla_TEM (76.1%), bla_SHV (68.7%), bla_OXA-1 (29.9%), bla_GES (14.9%), bla_CTX-M-9 (11.9%), and bla_CTX-M-2 (4.5%). The carbapenemase genes bla_KPC (55.2%), bla_IMP (28.4%), bla_VIM (14.9%), bla_NDM-1 (13.4%), and bla_OXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

Keywords: antibiotic resistance; biofilm; carbapenem-resistant Klebsiella pneumoniae (CRKP); extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP); healthcare facilities.

Abstract

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