AUTHOR=Khaertynov Khalit S. , Anokhin Vladimir A. , Rizvanov Albert A. , Davidyuk Yuriy N. , Semyenova Dina R. , Lubin Sergey A. , Skvortsova Natalia N. 

TITLE=Virulence Factors and Antibiotic Resistance of Klebsiella pneumoniae Strains Isolated From Neonates With Sepsis

JOURNAL=Frontiers in Medicine

VOLUME=5

YEAR=2018

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2018.00225

DOI=10.3389/fmed.2018.00225

ISSN=2296-858X

ABSTRACT=<p><bold>Introduction:</bold><italic>Klebsiella pneumoniae</italic> is one of the most important infectious agents in neonates. There are “classic” and hypervirulent strains of <italic>K. pneumoniae</italic>. The “classic” non-virulent strain of <italic>K. pneumoniae</italic>, producing extended-spectrum beta-lactamases (ESBLs), is associated with nosocomial infections. Hypervirulent <italic>K. pneumoniae</italic> strains are associated with invasive infections in previously healthy adult people, and most of them exhibit antimicrobial susceptibility. The role of virulent strains of <italic>K. pneumoniae</italic> (including hv-KP) in neonatal infections is unknown. The aim of the study was the assessment of the impact of virulence factors and antibiotic resistance of <italic>K. pneumoniae</italic> strains on clinical features and outcomes of neonatal infection.</p><p><bold>Materials and Methods:</bold> Two groups of infants were enrolled. The first group consisted of 10 neonates with sepsis caused by <italic>K. pneumoniae</italic>. The second group consisted of 10 neonates with urinary tract infection (UTI) caused by <italic>K. pneumoniae</italic>. We investigated the susceptibility of <italic>K. pneumoniae</italic> isolates to antibiotics, the ability of the microorganism to produce ESBL, and virulence factors, including the <italic>rmpA</italic> gene, aerobactin, and colibactin genes. In neonates with sepsis, we investigated <italic>K. pneumoniae</italic> isolates, which was taken from the blood, in neonates with UTI—from the urine.</p><p><bold>Results:</bold> In neonates with sepsis testing of <italic>K. pneumoniae</italic> isolates for ESBL production was positive in 60% of cases, in neonates with UTI—in 40% of cases. All blood and urine ESBL producing <italic>K. pneumoniae</italic> isolates were resistant to ampicillins, including protected ones, and third-generation cephalosporins. At the same time, these isolates were sensitive to meropenem, amikacin, and ciprofloxacin. The <italic>rmpA</italic> gene was detected in four blood, and three urine <italic>K. pneumoniae</italic> isolates. In neonates with sepsis <italic>rmpA</italic> gene in two cases was detected in ESBL-producing <italic>K. pneumoniae</italic> isolates. They were infants with meningitis, and both cases were fatal. In the group of infants with UTI, the <italic>rmpA</italic> gene was detected only in <italic>K. pneumoniae</italic> isolates not producing ESBL. Aerobactin and colibactin genes were detected in two neonates with sepsis and in three neonates with UTI. In all cases, aerobactin and colibactin genes were detected only in <italic>rmpA</italic>-positive <italic>K. pneumoniae</italic> isolates. Out of three fatal outcomes, two cases were caused by hv-KP producing ESBL.</p><p><bold>Conclusion:</bold> The prevalence of virulent strains of <italic>K. pneumoniae</italic> among neonates with sepsis and other neonatal infection is higher than we think. The most severe forms of neonatal sepsis with an unfavorable outcome in our study were due to virulent strains of <italic>K. pneumoniae</italic>.</p>