Zaki Asmaa O Bakr And Maysaa E S
Clin Lab. 2019 Jan 1;65(1). doi: 10.7754/Clin.Lab.2018.180709.
Klebsiella pneumoniae (K. pneumoniae) is a common pathogen associated with hospital acquired infections. The presence of virulence genes and antibiotic resistance genes are known risk factors for the infection by this bacterial species.
The aims of the present study were to i) investigate the coexistence of capsular genes of K. pneumoniae (rmpA and wcaG) with integron genes in clinical isolates of K. pneumoniae by polymerase chain reaction (PCR) from hospital acquired infections and to ii) correlate the presence of these genes with extended spectrum β-lactamase (ESBLs) and carbapenem-resistant phenotypes. The study included K. pneumoniae isolates from 100 patients with hospital acquired sepsis from ICUs. The isolates were subjected to antibiotic susceptibility tests by the disc diffusion method, identification of extended spectrum beta-lactamase detection (ESBLs) and carbapenemase production by specific phenotypic methods. Determination of integrons genes and capsular genes were performed by polymerase chain reaction (PCR).
The most common detected virulence genes was wcaG (50%) followed by rmpA (10%). Intl1 was detected in 69% of the isolates, while intl2 and intl3 genes were not detected in any isolate. There was statistically significant association between rmpA and wcaG (p = 0.02), rmpA and intl1 (p = 0.02) and intl1 and wcaG (p = 0.0001). There was statistically significant association between wcaG, rmpA, and intl1 genes and ESBLs production as determined by double disc diffusion method (p = 0.008, p = 0.005, p = 0.05, respectively). On the other hand, only wcaG and intl1 genes had statistically significant association with carbapenemase production. The fatal outcome of the sepsis was significantly associated with the presence of wcaG, rmpA and intl1 genes (p = 0.0001, p = 0.001, p = 0.02 respectively).
The study highlights a correlation between wcaG and rmpA virulence genes of K. pneumoniae with integron 1 responsible for antibiotic resistance. There is also an association between phenotypic extended spectrum beta-lactamase and carbapenemase resistance and virulence genes because the genes may be coded on the same transferable genetic elements. There was a correlation between virulence genes and outcome of infection. There is a strict need for compliance of infection control guidelines.
肺炎克雷伯菌是与医院获得性感染相关的常见病原体。毒力基因和抗生素抗性基因的存在是该细菌物种感染的已知风险因素。
本研究的目的是：i）通过聚合酶链反应（PCR），调查医院获得性感染的肺炎克雷伯菌临床分离株中肺炎克雷伯菌荚膜基因（rmpA和wcaG）与整合子基因的共存情况；ii）将这些基因的存在与超广谱β-内酰胺酶（ESBLs）和耐碳青霉烯类表型相关联。该研究纳入了100例来自重症监护病房医院获得性败血症患者的肺炎克雷伯菌分离株。采用纸片扩散法对分离株进行药敏试验，通过特定表型方法鉴定超广谱β-内酰胺酶检测（ESBLs）和碳青霉烯酶产生情况。通过聚合酶链反应（PCR）测定整合子基因和荚膜基因。
检测到的最常见毒力基因是wcaG（50%），其次是rmpA（10%）。69%的分离株中检测到Intl1，而任何分离株中均未检测到intl2和intl3基因。rmpA与wcaG（p = 0.02）、rmpA与intl1（p = 0.02）以及intl1与wcaG（p = 0.0001）之间存在统计学显著关联。通过双纸片扩散法测定发现，wcaG、rmpA和intl1基因与ESBLs产生之间存在统计学显著关联（分别为p = 0.008、p = 0.005、p = 0.05）。另一方面，只有wcaG和intl1基因与碳青霉烯酶产生存在统计学显著关联。败血症的致命结局与wcaG、rmpA和intl1基因的存在显著相关（分别为p = 0.0001、p = 0.001、p = 0.02）。
该研究突出了肺炎克雷伯菌的wcaG和rmpA毒力基因与负责抗生素抗性的整合子1之间的相关性。超广谱β-内酰胺酶和耐碳青霉烯类表型与毒力基因之间也存在关联，因为这些基因可能编码在相同的可转移遗传元件上。毒力基因与感染结局之间存在相关性。严格需要遵守感染控制指南。
