Analysis of the Correlation Between Antibiotic Resistance Patterns and Virulence Determinants in Pathogenic <i>Klebsiella pneumoniae</i> Isolates from Egypt

Abstract

Klebsiella pneumoniae is responsible for a plethora of infections involving multiple body systems. This study investigated K. pneumoniae clinical isolates for virulence-associated characters and antibiotic resistance. First, antibiotic sensitivity was determined for 40 K. pneumoniae clinical isolates. Some virulence and resistance-associated factors were studied phenotypically and genotypically. Multiple resistance profiles were observed (multidrug resistant [MDR; 42.5%], extensive drug resistant [XDR; 35%], and pandrug resistant [PDR; 5%]). Moreover, CTX-M-1 , TEM , qnrS , and qnrA genes were detected in 70%, 30%, 60%, and 30% of selected isolates, respectively, and 40% of tested isolates were extended-spectrum β-lactamases (ESBLs) producers. Interestingly, all ESBLs producers harbored class 1 integrase gene ( IntI1 ), while 60% of ESBLs producers harbored both CTX-M-1 and TEM . All tested isolates were capsulated while 87.5% were biofilm producers. Fimbriae were detected in 90% of tested isolates (all were biofilm producers and type 3 fimbriae adhesion gene [ mrkD ] positive). Sequence analysis of OXA-48 , qnrS , and IntI1 revealed 100% identity with published sequences, while sequencing of qnrA , OmpK-35 , and iron regulatory protein gene ( irp2 ) showed minor variations in the form of one or few single-nucleotide polymorphism. Altogether, the current study revealed that all MDR, XDR, and PDR K. pneumoniae isolates were multivirulent and all harbored 3–5 virulence genes and 2–9 antimicrobial resistance genes and exhibited 8 and 10 different virulence and antimicrobial resistance profiles, respectively. In this study, we also report a positive correlation between some virulence genes and antimicrobial resistance genes among K. pneumoniae tested isolates.