Abstract
Urinary tract infections (UTIs) are common in clinics and hospitals and are associated with a high economic burden. Enterobacterium Klebsiella pneumoniae is a prevalent agent causing UTIs. A high prevalence of carbapenem-resistant K. pneumoniae (CRKP) has emerged recently and is continuing to increase. Seventeen urinary CRKP isolates collected at a teaching hospital in Taiwan from December 2016 to September 2017 were analyzed to elucidate their drug resistance mechanisms. Two-thirds of the isolates were obtained from outpatients. Antimicrobial susceptibility tests demonstrated multidrug resistance in all the isolates. Multilocus sequence typing analysis showed high diversity among the isolates. PCR analysis demonstrated the presence of carbapenemases in three isolates. All isolates carried at least one other extended-spectrum β-lactamase, including TEM, DHA, and CTX-M. Fifteen isolates contained mutations in one of the outer membrane porins that were assessed. The expression levels of the acrB and/or oqxB efflux pump genes, as determined by qRT-PCR, were upregulated in 11 isolates. Six isolates might have utilized other efflux pumps or antimicrobial resistance mechanisms. These analyses demonstrated a highly diverse population and the presence of complex resistance mechanisms in urinary isolates of K. pneumoniae.
Highlights
Urinary tract infections (UTIs) are common bacterial infections in individuals of all ages and are associated with a high economic burden [1]
carbapenem-resistant K. pneumoniae (CRKP) isolates from any kind of specimen have been routinely collected at Taipei Medical University Hospital (TMUH), a teaching hospital with 800 beds in Northern Taiwan, since December 2016
Seventeen CRKP isolates from urine were determined to be nonsusceptible to either meropenem or to both imipenem and cefmetazole
Summary
Urinary tract infections (UTIs) are common bacterial infections in individuals of all ages and are associated with a high economic burden [1]. UTIs are clinically classified as uncomplicated and complicated UTIs. Uncomplicated UTIs usually affect healthy individuals without any abnormality of urinary tract structures. Complicated UTIs are commonly associated with host defenses and the existence of drainage devices or catheters [2]. UTIs are usually not life-threatening and can be treated by antibiotics, the high frequency of UTIs and the tendency for UTI recurrence place heavy economic burdens in healthcare systems [3]. Bacterial pathogens are the major causative agents of UTIs. Uropathogenic
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