Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Zahid Hayat Mahmud; Salman Zahir Uddin; M. Moniruzzaman; Sobur Ali; Monir Hossain; Md Tamzid Islam; Dorin Teresa D. Costa; Mohammad Rafiqul Islam; Md Zakiul Hassan; Li Ann Ong; Catrin E. Moore; Katrina J. Charles; Dinesh Mondal; Bruno Silvester Lopes; Shahana Parveen

doi:10.3390/ph15091116

Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

Zahid Hayat Mahmud, Salman Zahir Uddin, M. Moniruzzaman, Sobur Ali, Monir Hossain, Md Tamzid Islam, Dorin Teresa D. Costa, Mohammad Rafiqul Islam, Md Zakiul Hassan, Li Ann Ong, Catrin E. Moore, Katrina J. Charles, Dinesh Mondal, Bruno Silvester Lopes, Shahana Parveen

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Abstract

The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was bla_CTX-M-1 (91%), followed by bla_TEM (76.1%), bla_SHV (68.7%), bla_OXA-1 (29.9%), bla_GES (14.9%), bla_CTX-M-9 (11.9%), and bla_CTX-M-2 (4.5%). The carbapenemase genes bla_KPC (55.2%), bla_IMP (28.4%), bla_VIM (14.9%), bla_NDM-1 (13.4%), and bla_OXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

Original language	English
Article number	1116
Number of pages	21
Journal	Pharmaceuticals
Volume	15
Issue number	9
DOIs	https://doi.org/10.3390/ph15091116
Publication status	Published - 7 Sept 2022

Bibliographical note

Funding Information:
This research protocol was funded by US Centers for Disease Control and Prevention (CDC), grant number CoAg#U01GH001207. icddr,b acknowledges with gratitude the commitment of US CDC to its research efforts. icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden, and the UK for providing unrestricted support.

Publisher Copyright:
© 2022 by the authors.

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Mahmud, Z. H., Uddin, S. Z., Moniruzzaman, M., Ali, S., Hossain, M., Islam, M. T., Costa, D. T. D., Islam, M. R., Hassan, M. Z., Ong, L. A., Moore, C. E., Charles, K. J., Mondal, D., Lopes, B. S., & Parveen, S. (2022). Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh. Pharmaceuticals, 15(9), Article 1116. https://doi.org/10.3390/ph15091116

@article{949a93d3b43f4407925ab671bcaf6472,

title = "Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh",

abstract = "The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was blaCTX-M-1 (91\%), followed by blaTEM (76.1\%), blaSHV (68.7\%), blaOXA-1 (29.9\%), blaGES (14.9\%), blaCTX-M-9 (11.9\%), and blaCTX-M-2 (4.5\%). The carbapenemase genes blaKPC (55.2\%), blaIMP (28.4\%), blaVIM (14.9\%), blaNDM-1 (13.4\%), and blaOXA-48 (10.4\%) and virulence-associated genes such as fimH (71.6\%), ugeF (58.2\%), wabG (56.7\%), ureA (47.8\%) and kfuBC (28.4\%) were also detected. About 96.2\% of the environmental and 100\% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.",

author = "Mahmud, \{Zahid Hayat\} and Uddin, \{Salman Zahir\} and M. Moniruzzaman and Sobur Ali and Monir Hossain and Islam, \{Md Tamzid\} and Costa, \{Dorin Teresa D.\} and Islam, \{Mohammad Rafiqul\} and Hassan, \{Md Zakiul\} and Ong, \{Li Ann\} and Moore, \{Catrin E.\} and Charles, \{Katrina J.\} and Dinesh Mondal and Lopes, \{Bruno Silvester\} and Shahana Parveen",

note = "Funding Information: This research protocol was funded by US Centers for Disease Control and Prevention (CDC), grant number CoAg\#U01GH001207. icddr,b acknowledges with gratitude the commitment of US CDC to its research efforts. icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden, and the UK for providing unrestricted support. Publisher Copyright: {\textcopyright} 2022 by the authors.",

year = "2022",

month = sep,

day = "7",

doi = "10.3390/ph15091116",

language = "English",

volume = "15",

journal = "Pharmaceuticals",

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Mahmud, ZH, Uddin, SZ, Moniruzzaman, M, Ali, S, Hossain, M, Islam, MT, Costa, DTD, Islam, MR, Hassan, MZ, Ong, LA, Moore, CE, Charles, KJ, Mondal, D, Lopes, BS & Parveen, S 2022, 'Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh', Pharmaceuticals, vol. 15, no. 9, 1116. https://doi.org/10.3390/ph15091116

TY - JOUR

T1 - Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae

T2 - An Emerging Concern to Public Health in Bangladesh

AU - Mahmud, Zahid Hayat

AU - Uddin, Salman Zahir

AU - Moniruzzaman, M.

AU - Ali, Sobur

AU - Hossain, Monir

AU - Islam, Md Tamzid

AU - Costa, Dorin Teresa D.

AU - Islam, Mohammad Rafiqul

AU - Hassan, Md Zakiul

AU - Ong, Li Ann

AU - Moore, Catrin E.

AU - Charles, Katrina J.

AU - Mondal, Dinesh

AU - Lopes, Bruno Silvester

AU - Parveen, Shahana

N1 - Funding Information: This research protocol was funded by US Centers for Disease Control and Prevention (CDC), grant number CoAg#U01GH001207. icddr,b acknowledges with gratitude the commitment of US CDC to its research efforts. icddr,b is also grateful to the Governments of Bangladesh, Canada, Sweden, and the UK for providing unrestricted support. Publisher Copyright: © 2022 by the authors.

PY - 2022/9/7

Y1 - 2022/9/7

N2 - The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

AB - The emergence of virulent extended spectrum β-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common β-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.

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DO - 10.3390/ph15091116

M3 - Article

C2 - 36145337

AN - SCOPUS:85138669641

SN - 1424-8247

VL - 15

JO - Pharmaceuticals

JF - Pharmaceuticals

IS - 9

M1 - 1116

ER -

Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh

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