Abstract
BackgroundKlebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children.MethodsAntimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR.ResultsKlebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75).ConclusionMultidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.
Highlights
Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality
We described and compared the molecular characterization, antimicrobial susceptibility of Klebsiella spp. isolates recovered from bloodstream infections and postmortem blood specimens collected in children under 5 years of age and we characterize the multi-drug resistant (MDR) associated Klebsiella spp. from admitted children with bloodstream infections who have died
Clinical isolates and study area We analyzed 111 Klebsiella spp. isolates recovered from bloodstream infection (n = 88) of children under 5 years old admitted at the Manhiça District Hospital (January 2001 and December 2019) and from postmortem blood specimens (n = 23) of deceased children under 5 years old enrolled in the ongoing Child Health and Mortality Prevention Surveillance (CHAMPS) project (December 2016 and December 2019) [23]
Summary
Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. A new K. pneumoniae, called hypervirulent (hvKp) is a global public health concern because of its invasiveness (e.g. causing pyogenic liver abscess, bacteremia, pneumonia), the capacity to form metastasis and for being more virulent than the classical K. pneumoniae (cKp), affecting healthy individuals in the community settings [5, 6]. Postmortem studies conducted in urban (Maputo city) and rural (Manhiça District) Mozambique to ascertain causes of death in stillbirths and young children using minimally invasive tissue sampling (MITS) approaches found Klebsiella spp. to be among the top pathogens assigned in the chain of events leading to death [14,15,16] The virulence genes of both cKp and hvKp includes: siderophores for the iron acquisition (e.g. enterobactin (ent), adhesins for adherence (eg. fimH, mrkD), invasins for invasion and escape of the immune system defence (eg. traT), and protectins (eg. magA responsible for the hypermucoviscous phenotype) [10,11,12,13].
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