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Open Access 01-12-2021 | Ampicillin | Research

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Authors: Arsénia J. Massinga, Marcelino Garrine, Augusto Messa Jr, Nélio A. Nobela, Nadia Boisen, Sergio Massora, Anélsio Cossa, Rosauro Varo, António Sitoe, Juan Carlos Hurtado, Jaume Ordi, Hélio Mucavele, Tacilta Nhampossa, Robert F. Breiman, Cynthia G. Whitney, Dianna M. Blau, Quique Bassat, Inácio Mandomando

Published in: BMC Infectious Diseases | Issue 1/2021

Abstract

Background

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. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children.

Methods

Antimicrobial 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.

Results

Klebsiella 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. bla_CTX-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).

Conclusion

Multidrug 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.

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Title: Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization
Authors: Arsénia J. Massinga
Marcelino Garrine
Augusto Messa Jr
Nélio A. Nobela
Nadia Boisen
Sergio Massora
Anélsio Cossa
Rosauro Varo
António Sitoe
Juan Carlos Hurtado
Jaume Ordi
Hélio Mucavele
Tacilta Nhampossa
Robert F. Breiman
Cynthia G. Whitney
Dianna M. Blau
Quique Bassat
Inácio Mandomando
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Ampicillin
Aminoglycoside
Ertapenem
Amoxicillin
Chloramphenicol
Ceftriaxone
Polymerase Chain Reaction
Aztreonam
Published in: BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI: https://doi.org/10.1186/s12879-021-06245-x

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