Prevalence and genotypic–phenotypic association of highly resistant Klebsiella pneumoniae in community-acquired urinary tract infections

Abstract

Urinary tract infection (UTI) is a common infectious disease. To collect data on community-acquired UTI in Egyptians at 27 different cities in Egypt, including Cairo, to investigate the association between the phenotypic and genotypic characteristics of Klebsiella pneumoniae (K. Pneumoniae) as a highly virulent UTI pathogen. Collection of urine samples from different genders and ages. Isolation of bacteria by culturing samples on blood, MacConkey, and nutrient agar plates. Identification of Klebsiella spp based on cultural characteristics, Gram staining, and the DL microbial ID/AST automated system. Antimicrobial minimum inhibitory concentration (MIC) values of 100 K. pneumoniae isolates were determined using the DL microbial ID/AST automated system. Detection of Extended-Spectrum Beta-Lactamases (ESBL) producing K. pneumoniae strains using double disc synergy testing. Extraction of DNA from 49 K. pneumoniae isolates by an automated Zybio EXM 3000 extractor system. Detection of resistance and virulence genes using Polymerase Chain Reaction (PCR). Statistical analysis using SPSS version 23. For the first time, a high prevalence of Pan Drug-Resistant (PDR) isolates (32.6%), 57.1% as Carbapenem-Resistant K. pneumoniae (CRKP), and 81.6% as ESBL-producers. Significant positive relationship in PDR K. pneumoniae with bla-NDM, bla-OXA−48, and bla-KPC, as well as CRKP with bla-NDM (89%), bla− OXA−48 (32%), and bla-TEM (75%). rmpA exhibited a significant positive relationship with PDR and CRKP. A positive relationship was exhibited between bla− NDM and bla-OXA−48, mrkD and fim-H, and bla− CTXM and bla− TEM. The prevalence of PDR K. pneumoniae was higher than previously reported. It is possible that some highly resistant K. pneumoniae strains also have increased pathogenic potential due to the observed positive associations between resistance genes and virulence genes. This relationship should be considered in developing treatment plans to ensure effectiveness against resistance and sufficient to neutralize virulence with minimal complications, using aggressive or combination therapy in the early stages. Not applicable. UTIs are common and increasingly complicated by antibiotic-resistant pathogens. There is limited data on community-acquired K. pneumoniae UTIs in Egypt, particularly regarding resistance and virulence profiles. The study aimed to investigate the phenotypic and genotypic characteristics of K. pneumoniae from non-hospitalized Egyptian UTI patients and examine the association between resistance and virulence factors. The significant relationship among resistance and virulence genes in K. pneumoniae underlines the critical need for genetic and antimicrobial resistance surveillance and targeted treatment options for community-acquired UTIs in Egypt.