High proportions of multidrug-resistant Klebsiella pneumoniae isolates in community-acquired infections, Brazil
Adriano de Souza Santos Monteiro, Márcio de Oliveira Silva, Vívian Santos Galvão, Adriele Pinheiro Bomfim, Lorena Galvão de Araújo, Camila Maria Piñeiro Silva, Maria Goreth Barberino, Edilane Lins Gouveia, Soraia Machado Cordeiro, Joice Neves Reis Pedreira
Abstract
Abstract Klebsiella pneumoniae is one of the leading causes of bloodstream (BSI) and urinary tract infections (UTI), but limited data is available regarding community-acquired (CA) infections. This study characterized the clinical aspects of CA-BSI and CA-UTI caused by K. pneumoniae and the molecular features of isolates, including their resistance profiles. Sixty-five isolates (CA-BSI, n = 24; CA-UTI, n = 41) underwent antimicrobial susceptibility testing, β-lactamase and virulence gene assessment, capsular genotyping, and molecular typing. Older age, male gender, and comorbidities, particularly kidney disease, were significantly associated with CA-BSI. The MDR and carbapenem resistance rates for K. pneumoniae from CA infections were 24.6% and 4.6%, respectively. CA-BSI isolates were more antibiotic-resistant and had a higher proportion of ESBL-producing (37.5% versus 9.8%) and MDR isolates (45.8% versus 12.2%) than CA-UTI. The bla CTX−M−like or bla KPC−like genes was found in all ESBL-producing isolates, while bla KPC−like and bla NDM−like were detected exclusively in CA-BSI strains. The isolates’ virulence profiles were similar between the groups, although one CA-BSI and two CA-UTI isolates presented hypervirulence biomarkers. A high clonal diversity was observed, with a majority of MDR (81.3%) (ST11, ST15, ST101, ST258, ST307, and ST6852) and hypervirulent (2/3) (ST23 and ST65) isolates being high-risk pandemic clones in humans. Our data highlight the high prevalence of MDR K. pneumoniae in CA infections in Brazil, with CA-BSI showing significant differences in resistance profiles compared to CA-UTI.