Extensively Drug-Resistant <i>Klebsiella pneumoniae</i> Associated with Complicated Urinary Tract Infection in Northern India
Parinitha Kaza, Basil Britto Xavier, Jaspreet Mahindroo, Nisha Singh, Stephen Baker, To Nguyen Thi Nguyen, Ravimohan S. Mavuduru, Balvinder Mohan, Neelam Taneja
Abstract
Klebsiella pneumoniae (Kp) associated with hospital acquired infections are extensively-drug resistant (XDR), making treatment problematic. Understanding the genetic epidemiology of XDR -Kp can determine their potential to be hypervirulent (hv) through the presence of siderophores. We characterized genomes of 18 colistin-resistant XDR-Kp isolated from 14 patients with complicated urinary tract infection in an Indian healthcare facility. 18 organisms comprised STs: ST14 (9/18), ST147 (5/18), ST231 (2/18), ST2096 (1/18), and ST25 (1/18). Many patients in one ward were infected with the same ST, indicating a common infection source. Some patients had recurrent infections with multiple STs that were circulating in that ward, providing evidence for hospital transmission. Beta lactamase genes (blaCTX-M-1, blaSHV, and blaampH) were present in all isolates. blaNDM-1 was present in isolates 15/18, blaOXA-1 was present in isolates 16/18, blaTEM-1D was present in 13/18 isolates, and blaOXA-48 was present in isolates 14,19 and 30. Disruption of mgrB with various IS elements was responsible for colistin resistance in 6 isolates. The most common K type among these isolates was K2 (10/18). One XDR convergent hv-Kp ST2096 was associated with prolonged hospitalisation (iuc+ybt+blaOXA-1+blaOXA-48).Convergent XDR-hv-Kp detected has outbreak potential, warranting effective antimicrobial stewardship and infection control.