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

• Type of Material: Article
• Authors: Arsénia J Massinga, Centro de Investigação em Saúde de Manhiça (CISM); Marcelino Garrine, Centro de Investigação em Saúde de Manhiça (CISM); Augusto Messa, Centro de Investigação em Saúde de Manhiça (CISM); Nélio A Nobela, Centro de Investigação em Saúde de Manhiça (CISM); Nadia Boisen, Statens Serum Institut; Sergio Massora, Centro de Investigação em Saúde de Manhiça (CISM); Anélsio Cossa, Centro de Investigação em Saúde de Manhiça (CISM); Rosauro Varo, University of Barcelona; António Sitoe, Centro de Investigação em Saúde de Manhiça (CISM); Juan Carlos Hurtado, University of Barcelona; Jaume Ordi, University of Barcelona; Hélio Mucavele, Centro de Investigação em Saúde de Manhiça (CISM); Tacilta Nhampossa, Centro de Investigação em Saúde de Manhiça (CISM); Robert Breiman, Emory University; Cynthia Whitney, Emory University; Dianna M Blau, Centers for Disease Control and Prevention, Atlanta; Quique Bassat, Centro de Investigação em Saúde de Manhiça (CISM); Inácio Mandomando, Centro de Investigação em Saúde de Manhiça (CISM)
• Language: English
• Date: 2021-06-05
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12879-021-06245-x
• Title of Journal or Parent Work: BMC INFECTIOUS DISEASES
• Volume: 21
• Issue: 1
• Start Page: 526
• End Page: 526
• Grant/Funding Information: CISM is supported by the Government of Mozambique and the Spanish Agency for International Development Cooperation (AECID). CHAMPS is funded by the Bill & Melinda Gates Foundation under the Grant OPP1126780 to Robert Breiman, subcontract SC00003286. ISGlobal receives support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018–000806-S), and support from the Generalitat de Catalunya through the CERCA Program.
• Keywords: EPIDEMIOLOGY; BLOOD-STREAM INFECTIONS; Hypervirulence; ESCHERICHIA-COLI STRAINS; CTX-M; Science & Technology; PNEUMONIAE STRAINS; SOUTH; SUSCEPTIBILITY; Life Sciences & Biomedicine; MORTALITY; SPATEs; Infectious Diseases; Bacteremia; Mozambique; CTX-M-15; Hypermucoviscosity; HIGH PREVALENCE; ESBL genes; SECRETED AUTOTRANSPORTER TOXIN
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

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. 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). 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.