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Molecular characterization of ESBLs in clinical isolates of Escherichia coli and Klebsiella spp from a tertiary care hospital of South Eastern Assam was done by detection of blaTEM, blaSHV, blaCTX-M, blaOXA-2, blaOXA-10, blaPER, blaVEB and blaGES by Multiplex PCR. One hundred isolates yielded 44 bands of ESBL genes. CTX-M was most frequently isolated gene (36/44). Two isolates carried a combination of 2 genes CTX-M and OXA-2. Apart from CTX-M, the study isolates were also found to harbour TEM(n ​= ​3), OXA-2 (n ​= ​6) OXA-10 (n ​= ​1),GES(n ​= ​2) genes.

The multi-drug resistance of Gram-negative rods is one of the most important issues of present medicine. In recent years, more and more strains resistant to the majority or to all possible therapeutic options have been isolated—especially Klebsiella spp. and Pseudomonas spp. representatives. It is very important to detect strains with these phenotypes as quickly and reliably as possible. The aim of the study was to evaluate the usefulness of eazyplex® SuperBug CRE test (Amplex Diagnostics) for the detection of the most important beta-lactam resistance genes. eazyplex® SuperBug CRE test is based on the loop-mediated isothermal amplification (LAMP) method, and detects genes for the following beta-lactamases: KPC, NDM-1, VIM, OXA-48, CTX-M1, CTX-M9 and OXA-181. The study involved 87 strains. For all of the positive strains in the LAMP method, additional PCR were performed to increase the spectrum of ESBLs detected by the genes encoding for enzymes belonging to TEM and SHV families. The results obtained by the tested method and standard PCR were consistent for all Klebsiella spp. strains. The discrepancy between the evaluated test and PCR results was observed for one P. aeruginosa strain. The eazyplex® SuperBug CRE test can be used for quick detection of the most important beta-lactam resistance mechanisms amongst Gram-negative rods.

To mention the role of ticks in transmission of Klebsiella spp. and Staphylococcus aureus, sixty seven engorged adult females of the type which called hard ticks (Rhipicephalus spp.) were collected from cattle and sheep randomly from diverse regions of Baghdad city through the period November 2015 till March 2016. Blood swabs from ticks were subjected to the culture media to determine the percentages of Klebsiella spp. and Staphylococcus aureus. Results showed that out of 67 samples, 13 (14.40%) samples were positive for Klebsiella spp., 16 (23.88%) samples were positive for Staphylococcus aureus and 8 samples were positive for both bacteria. This study revealed that hard ticks (Rhipicephalus spp.) is a good source for bacterial infection by Klebsiella spp. and Staphylococcus aureus .

Klebsiella spp community-acquired meningitis caused by hypervirulent strains is well described as part of a distinct syndrome consisting of liver abscess and multiple septic metastatic lesions (Klebsiella pneumoniae invasive syndrome) occurring usually in diabetic, alcoholic, elderly or cancer patients, in Taiwan and other South-East Asian countries. In Western countries, these infections are very rare in natives and usually occur in patients of Asian origin. We report three cases of Filipino-origin patients, residents of Greece, with community-acquired invasive Klebsiella meningitis, who were treated in our ICU over a 10-year period. Learning points Community-acquired Klebsiella spp meningitis has a very bad prognosis.A physician must suspect an invasive Klebsiella infection in patients of Asian origin, even though they are residents of Western countries and have not visited their homeland recently.

Increases in hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia rates in England were observed between August 2020 and February 2021 to the highest levels recorded since the start of mandatory surveillance in April 2017. Cases were extracted from England's mandatory surveillance database for key Gram-negative bloodstream infections. Incidence rates for hospital-onset bacteraemia cases increased from 8.9 (N=255) to 14.9 (N=394) per 100,000 bed-days for Klebsiella spp. [incidence rate ratio (IRR) 1.7, P

This study evaluates whether the rapid fosfomycin resistance (fosfomycin NP) method can be used for detecting fosfomycin resistance in routine laboratory work. Results from the disk diffusion and rapid fosfomycin NP methods were compared with the reference agar dilution method for Escherichia coli and Klebsiella spp. strains isolated from urinary tract infections. The study included 57 E. coli and 48 Klebsiella spp. isolates from urinary tract infections. The reference agar dilution and disk diffusion methods were performed in accordance with EUCAST recommendations, and the results were evaluated according to EUCAST V.10.0. The method developed by Nordmann et al. was used for rapid detection of fosfomycin resistance (Nordmann, P., Poirel, L., Mueller, L., 2019. Rapid Detection of Fosfomycin Resistance in Escherichia coli. J Clin Microbiol. 57(1), e01531-18. doi:https://doi.org/10.1128/JCM.01531-18). The acceptable categorical agreement (CA ≥ 90%) and the rates of major error (ME

Sixty four local isolated of Klebsiella spp. have been isolated from environment samples (soil and water).These isolates were identified and diagnosis according to phenotype and biochemical tests. These isolateswere subjected to primary and secondary screening, to select the isolate with the highest laccase activity.Fifteen isolates chosen from primary screening for screening their enzyme activity in secondary screening.It has been found the Klebsiella(K7) has the highest productivity of the enzyme (12 Unit/ml).Klebsiella(K7)isolate was diagnosis by Vitak 2 system, it was identified asK. pneumonia. The laccase purified wascharacterization, the experiments showed that: The molecular weight of laccase was 120KD and the optimumpH for the purified laccase activity was 4.5 and forstability was 6.5. the optimum temperature for enzymeactivity was 40oC,the enzyme showed that laccase lost 22, 23 and 20% of its initial activity at 20, 25 and35°C, respectively.

Background Klebsiella spp. are opportunistic pathogens which can cause severe infections, are often multi-drug resistant and are a common cause of hospital-acquired infections. Multiple new Klebsiella species have recently been described, yet their clinical impact and antibiotic resistance profiles are largely unknown. We aimed to explore Klebsiella group- and species-specific clinical impact, antimicrobial resistance (AMR) and virulence. Methods We analysed whole-genome sequence data of a diverse selection of Klebsiella spp. isolates and identified resistance and virulence factors. Using the genomes of 3594 Klebsiella isolates, we predicted the masses of 56 ribosomal subunit proteins and identified species-specific marker masses. We then re-analysed over 22,000 Matrix-Assisted Laser Desorption Ionization - Time Of Flight (MALDI-TOF) mass spectra routinely acquired at eight healthcare institutions in four countries looking for these species-specific markers. Analyses of clinical and microbiological endpoints from a subset of 957 patients with infections from Klebsiella species were performed using generalized linear mixed-effects models. Results Our comparative genomic analysis shows group- and species-specific trends in accessory genome composition. With the identified species-specific marker masses, eight Klebsiella species can be distinguished using MALDI-TOF MS. We identified K. pneumoniae (71.2%; n = 12,523), K. quasipneumoniae (3.3%; n = 575), K. variicola (9.8%; n = 1717), “K. quasivariicola” (0.3%; n = 52), K. oxytoca (8.2%; n = 1445), K. michiganensis (4.8%; n = 836), K. grimontii (2.4%; n = 425) and K. huaxensis (0.1%; n = 12). Isolates belonging to the K. oxytoca group, which includes the species K. oxytoca, K. michiganensis and K. grimontii, were less often resistant to 4th-generation cephalosporins than isolates of the K. pneumoniae group, which includes the species K. pneumoniae, K. quasipneumoniae, K. variicola and “K. quasivariicola” (odds ratio = 0.17, p < 0.001, 95% confidence interval [0.09,0.28]). Within the K. pneumoniae group, isolates identified as K. pneumoniae were more often resistant to 4th-generation cephalosporins than K. variicola isolates (odds ratio = 2.61, p = 0.003, 95% confidence interval [1.38,5.06]). K. oxytoca group isolates were found to be more likely associated with invasive infection to primary sterile sites than K. pneumoniae group isolates (odds ratio = 2.39, p = 0.0044, 95% confidence interval [1.05,5.53]). Conclusions Currently misdiagnosed Klebsiella spp. can be distinguished using a ribosomal marker-based approach for MALDI-TOF MS. Klebsiella groups and species differed in AMR profiles, and in their association with invasive infection, highlighting the importance for species identification to enable effective treatment options.

Introduction: Infections caused by Carbapenemase-producing Enterobacterales (CPE) are an important public health issue. Intravenous fosfomycin can be considered as an alternative for the treatment of serious infections caused by CPE. In this study, in vitro activity of fosfomycin was investigated among CPE isolates. Methodology: Overall, 158 clinically relevant isolates obtained from 18 hospitals of 13 cities in Turkey with predetermined carbapenemase types were evaluated in the study, including Escherichia coli (n = 19) and Klebsiella spp. (n = 139). In vitro activity of fosfomycin was determined with agar dilution method. Among Klebsiella spp., 104 harbored blaOXA-48, 15 isolates carried both blaOXA-48 and blaNDM; three had both blaOXA-48 and blaVIM and nine isolates had blaNDM alone. Four isolates carried only blaVIM and two isolates harbored blaIMP alone. One isolate co-harbored blaVIM and blaNDM. Among E. coli isolates, blaOXA-48 and blaNDM were carried by 18 and one isolates, respectively. Results: Resistance to fosfomycin was detected in 43.7% of the isolates. Among Klebsiella spp. and E. coli, these rates were 46.8% and 21.1%, respectively. In Klebsiella spp. resistance to fosfomycin was 49.5% in blaOXA-48 carriers; 26.7% in isolates co-harbouring blaOXA-48 and blaNDM and 66.7% in blaNDM carriers. In E. coli, fosfomycin resistance was detected among 16.7% of the blaOXA-48 carriers. Conclusions: High level of fosfomycin resistance in these isolates may be attributable to the fact that these isolates are multidrug resistant. The genetic background of resistance should also be investigated in order to understand the co-occurrence and transfer of resistance among the CPE.

A computational method has been developed to distinguish the Klebsiella species serotypes to aid in outbreak surveillance. A reliability score (estimated based on the accuracy of a specific K-type prediction against the dataset of 141 distinct K-types) average (ARS) that reflects the specificity between the Klebsiella species capsular polysaccharide biosynthesis and surface expression proteins, and their K-types has been established. ARS indicates the following order of potency in accurate serotyping: Wzx (ARS = 98.5%),Wzy (ARS = 97.5%),WbaP (ARS = 97.2%),Wzc (ARS = 96.4%),Wzb (ARS = 94.3%),WcaJ (ARS = 93.8%),Wza (ARS = 79.9%) and Wzi (ARS = 37.1%). Thus, Wzx, Wzy and WbaP can give more reliable K-typing compared with other proteins. A fragment-based approach has further increased the Wzi ARS from 37.1% to 80.8%. The efficacy of these 8 proteins in accurate K-typing has been confirmed by a rigorous testing and the method has been automated as K-PAM (www.iith.ac.in/K-PAM/). Testing also indicates that the use of multiple genes/proteins helps in reducing the K-type multiplicity, distinguishing the K-types that have identical K-locus (like KN3 and K35) and identifying the ancestral serotypes of Klebsiella spp. K-PAM has the facilities to O-type using Wzm (ARS = 85.7%) and Wzt (ARS = 85.7%) and identifies the hypervirulent Klebsiella species by the use of rmpA, rmpA2, iucA, iroB and peg-344 marker genes. Yet another highlight of the server is the repository of the modeled 11 O- and 79 K- antigen 3D structures.

In the present study, we have investigated prevalence and diversity of ESBL genes among Klebsiella isolates obtained from highly polluted stretch of river Yamuna, India. Phenotypic screenings of 116 Klebsiella isolates revealed ~30% were positive for ESBL production. Antibiotic profiling showed multidrug resistance phenotype among 90% isolates. Prevalence of blaTEM, blaSHV and blaCTX-M genes were found to be 57, 54 and 48% respectively. Furthermore, we identified eight variants of blaSHV (SHV-1, SHV-11, SHV-27, SHV-28, SHV-38, SHV-61, SHV-144, SHV-148), three each of blaTEM (TEM-1, TEM-116, TEM-206) and blaCTX-M (CTX-M-15, CTX-M-55, CTX-M-188) among Klebsiella spp. Co-occurrence of blaTEM, blaSHV and blaCTX-M (any two or all three) was observed among 45% Klebsiella isolates. Occurrence of blaCTX-M-188 and blaTEM-206 in environmental isolates of K. pneumoniae has not been reported earlier. Identification of blaTEM-206, blaSHV-27 and blaSHV-144 from Klebsiella spp. and blaTEM-116 from K. quasipneumoniae and K. variicola is the first report from India.

Objective. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas. Methods. The descriptive retrospective epidemiological study of Acinetobacter spp. and Klebsiella pneumoniae cases in children's departments of health care was performed in Kemerovo regions (2012-2017). Results. A total of 129,430 patient treatment outcomes were studied, in 1380 K. pneumoniae and 201 Acinetobacter spp. were isolated. The incidence of Acinetobacter spp. in adults, 3.2 times higher than in children. The risk of Klebsiella ssp. infection was in 13 times higher than Acinetobacter spp. infection. Conclusions. We revealed decreasing trend in colonization Klebsiella spp. and Acinetobacter spp. incidence. Patients who were treated by intensive care medical technologies were under at the highest risk of infections, especially in case of invasive and noninvasive respiratory constant positive airway pressure support by combination

Carbapenem-resistant Enterobacteriaceae (CRE) are among the most difficult to treat emerging multidrug-resistant organisms. Major limitations exist in surveillance needed to address CRE, particularly in areas with inadequate resources. We utilised optimised strategies to search for data on carbapenem susceptibility of Klebsiella spp. and Escherichia coli from the World Health Organization (WHO) Africa Region. Core data elements were extracted for meta-analysis and mapping. Despite sparse data in existing reviews, 180 documents including 314 reports on susceptibility of E. coli and/or Klebsiella were located, providing information on 31 (66%) of 47 nations. Carbapenem-resistant E. coli or Klebsiella were identified in 22 (71%) of these 31 countries. Crude resistance proportions were estimated for nations with100 representative isolates. Median resistance among E. coli was1% in 11 (61%) of 18 nations meeting criteria, 1-5% in 6 nations (33%) and5% in 1 nation (6%). For Klebsiella spp., corresponding figures were1% in 10 (67%) of 15 nations, 1-5% in 3 nations (20%) and5% in 2 nations (13%). Comprehensive, customised search strategies with analysis and mapping of defined data elements provide an enhanced view of carbapenem-resistant E. coli and Klebsiella in Africa. These CRE are widely distributed and are generally present at low to moderate levels. Whilst use of diverse and largely clinically derived data has limitations and cannot substitute for surveillance, it can enhance situational awareness. The approaches utilised can support improved risk understanding and prioritisation and may be applied to other micro-organisms and areas where surveillance remains inadequate.

Functional gastrointestinal disorders (FGID) are one of the most common problems in children of the first year of life. The aim of the study was to assess the pathogenic potential of Klebsiella spp. strains, isolated from the colon in children of the first year of life with FGID. Material for the study included 61 coprological samples. The biological material was divided into comparison groups, depending on the type of Klebsiella excreted at a concentration of 105–108 CFU/g: 1st – with vegetation in the colon K. pneumoniae (n = 30); 2nd – with vegetation K. oxytoca (n = 31). Bacteriological study composition of the intestinal contents was carried out according to the Industry standard “Protocol of management of patients. Intestinal dysbiosis” (2003). Identification was carried out according to generally accepted schemes using commercial test systems for biochemical identification of bacteria. Statistical data processing was performed using licensed applications “MS Office Excel 2003 for Windows 7”. The data on the quantitative and qualitative changes in the composition microbiota in the comparison groups were obtained. The results of detection genetic determinants of pathogenicity in the samples of Klebsiella of two species show that among the strains of Klebsiella spp., vegetating in the intestines of children as a component of an allochthonous microbiota, a sufficiently high and virulent potential can be concentrated. Detection of pathogenicity genes in bacteria of the genus Klebsiella will expand and deepen the problem of finding the structures of adaptation of strains of bacteria that cause FGID in children of the first year of life.

This study was undertaken to detect the prevalence of CTX-M-producing Klebsiella spp. in healthy broiler, indigenous, and kuroiler birds reared in West Bengal (India) during November 2014–February 2015. In addition to CTX-M gene, the study was also conducted to reveal the occurrence of other β-lactamase and class I integron genes in Klebsiella spp. isolates along with their clonal relationship. A total of 321 cloacal swabs from healthy broiler, indigenous, and kuroiler birds were collected from different places of West Bengal, India. Klebsiella spp. isolation rate varies among different types of poultry birds (43.8–72.3%). In total, 33 (10.7%) Klebsiella spp. isolates were detected phenotypically as CTX-M producers and all the isolates possessed blaCTX-M in polymerase chain reaction. Whereas 17 (51.5%) and 16 (48.5%) Klebsiella spp. isolates possessed blaSHV, and blaTEM with blaCTX-M, respectively. None of the CTX-M-producing Klebsiella spp. isolates in this study possessed class I integron gene. Randomly...

Houston watersheds are susceptible to microbial contamination as well as chemical contaminations from bordering industrial facilities. Bacterial loads in various Houston bayous were determined, and pathogenic Gram-negative bacteria were isolated for characterization. Isolates included Klebsiella aerogenes and Klebsiella pneumoniae. To determine whether environmental exposures to lead (Pb), measured in our Houston bayou samples, resulted in bacterial adaptations, we compared growth kinetics, biofilm production, oxidative stress resistance, and eukaryotic co-culture growth of environmentally isolated K. aerogenes and K. pneumoniae to their respective commercially acquired reference strains. Interestingly, the K. aerogenes environmental isolate displayed significantly better growth than the reference strain in the presence of 50 ppb of Pb. Unexpectedly, we did not observe any differences in biofilm production of the aforementioned strains when challenged with a range of Pb (0.5-50 ppb). However, when comparing our K. pneumoniae environmental isolate to its reference strain, there were significantly higher levels of biofilm produced by the environmental isolate when challenged with Pb concentrations of 10 and 50 ppb. When grown in eukaryotic cell co-culture with either BAES 2B lung cells or CCD 841 colon epithelial cells in the presence of 20 ppb Pb, the environmental isolates of K. aerogenes and K. pneumoniae had a significantly higher fold-increase over 6 h than their respective reference strains. Taken together, the environmentally isolated Klebsiella spp. appeared to be more Pb-tolerant than their respective reference strains, a possible environmental adaptation. Such enhanced tolerance can promote environmental persistence and increase the possibility of causing human disease.

We analyzed the effects of different cefepime MIC breakpoints on Enterobacteriaceae cefepime susceptibility and the presence of AmpC and extended-spectrum β-lactamase (ESBL) genes within the cefepime MIC interpretative categories.Using Enterobacteriaceae susceptibility data from 2013 comparisons of MIC breakpoints were performed using Pearson's chi-squared test. Molecular testing on a subset of isolates was done.Among 3784 non-duplicate clinical isolates, cefepime susceptibility decreased from 97.6% to 96.1% to 93.7% for CLSI 2013, CLSI 2014, and EUCAST 2011, respectively. In ceftriaxone non-susceptible isolates, cefepime susceptibility decreased from 79% to 66% (P0.0001) using CLSI 2013 and 2014, respectively, which was greater and statistically significant for Escherichia coli and Klebsiella spp. but not for Enterobacter spp. (P=0.06). Isolates with MIC ≤1μg/mL more often harbored AmpC (77%) than ESBL (18%) genes.Lower cefepime MIC breakpoints decrease cefepime susceptibility for isolates harboring ESBLs, while sparing the majority of those with AmpCs.

Aim: The majority of clinical specimens infected can be by Klebsiella species. Furthermore the incidence of drug resistant Klebsiella is increasing, therefore drug resistance sensitivity test it seems necessary before prescribing antibiotics. The aim of this research was to determine the pattern of antimicrobial resistance of Klebsiella species from clinical.Methods: The present research was performed on 300 specimens of Klebsiella collected from hospitalized patients between 2016 and 2017. Identification was carried out according to standard procedure, and drug sensitivity test was determined by Kirby-Bauer method.Results: The frequency rates of the isolated Klebsiella species were: pneumonia (94%), oxytoca (4%), ozaenae (1%), and rhinoscleromatis (1%). The collected samples in order of frequency were: urine, sputum, vagina, scar, stool, and blood respectively. The percentage rates of resistance were as follows: Ampicillin (97%), amoxycillin (97%), cephalothin (39%), gentamicin (30%), colistin (55%), nalidixic acid (2%), chloramphenicol (26%), kanamycin (17%), tetracycline (28%), nitrofurantoin (44%), ceftazidime (2%), and amikacin (0%).Conclusion: The lowest resistance rate obtained with amikacin in all tested Klebsiella; which can be recommended as the most effective antibiotic., Amaç: Klinik örneklerin çoğu Klebsiella türleri ile enfekte olabilmektedir. Ayrıca ilaca dirençli Klebsiella insidansı artmaktadır, bu nedenle antibiyotik reçete edilmeden önce ilaç direnci duyarlılık testi gerekli görünmektedir. Bu araştırmanın amacı Klebsiella türlerinin antimikrobiyal direncini klinik olarak belirlemektir.Yöntemler: Bu araştırma, 2016 ve 2017 yılları arasında hastanede yatan hastalardan toplanan 300 Klebsiella örneği üzerinde gerçekleştirilmiştir. Tanımlama standart yönteme göre gerçekleştirilmiş ve ilaç duyarlılık testi Kirby-Bauer yöntemi ile belirlenmiştir.Bulgular: İzole Klebsiella türlerinin sıklık oranları: pnömoni (% 94), oksitoka (% 4), ozaenae (% 1) ve rinososikromatis (% 1). Sıklık sırasına göre toplanan örnekler: idrar, balgam, vajina, skar, dışkı ve kan idi. Rezistans yüzdesi şöyledir: Ampisilin (%97), amoksilin (%97), cefalotin (%39), gentamisin (%30), kolistin (%55), nalidiksik asit (%2), kloramfenikol (%26), kanamisin (%17), tetrasiklin (%28), nitrofurantoin (%44), seftazidim (%2) ve amikasin (%0).Sonuç: Test edilen Klebsiella türlerinde en düşük direnç oranı Amikasin ile elde edilmiştir ve en etkili antibiyotik olarak önerilebilir.

The indiscriminate use of carbapenems in the fight against multidrug resistant Gram-negative bacteria leads to the emergence of resistance to these antimicrobial agents. We examine the in vitro activity of carbapenems and tigecycline against ESBL-producing E. coli and Klebsiella spp. isolated in a single hospital at two different periods eight years apart. Overall resistance to carbapenems ranged from 18.7% in 2007 to 19.1% in 2015/2016. We found no isolates resistant to tigecycline, but two intermediary profiles in the 2015/2016 period. Tigecycline is an important option for treating multidrug resistant Gram-negative infections and helps in the fight against global dissemination of resistance to carbapenems.

After consumption, antibiotic residues and exposed bacteria end up via the feces in wastewater, and therefore wastewater is believed to play an important role in the spread of antimicrobial resistance (AMR). We investigated the abundance and AMR profiles of three different species over a complete wastewater pathway during a one-year sampling campaign, as well as including antimicrobial consumption and antimicrobial concentrations analysis. A total of 2886 isolates (997 Escherichia coli, 863 Klebsiella spp., and 1026 Aeromonas spp.) were cultured from the 211 samples collected. The bacterial AMR profiles mirrored the antimicrobial consumption in the respective locations, which were highest in the hospital. However, the contribution of hospital wastewater to AMR found in the wastewater treatment plant (WWTP) was below 10% for all antimicrobials tested. We found high concentrations (7&ndash, 8 logs CFU/L) of the three bacterial species in all wastewaters, and they survived the wastewater treatment (effluent concentrations were around 5 log CFU/L), showing an increase of E. coli in the receiving river after the WWTP discharge. Although the WWTP had no effect on the proportion of AMR, bacterial species and antimicrobial residues were still measured in the effluent, showing the role of wastewater contamination in the environmental surface water.

&beta, Lactam-resistant Klebsiella isolates continue to cause multidrug resistance infections worldwide. This study aimed to describe the geographical distribution of extended spectrum &beta, lactamase (ESBL), AmpC &beta, lactamase (AmpC), and carbapenemase production among 139 Klebsiella isolates recovered from patients at major referral health facilities in Ghana. The phenotypic methods of combined disc diffusion test, modified three-dimensional test, modified Hodge test (MHT), and combined disc test were performed for each isolate to detect ESBL, AmpC, carbapenemase, and metallo-&beta, lactamase (MBL) producers, respectively. Except for MBL, all other &beta, lactam resistance mechanisms were highest in the healthcare facilities situated in the northern belt of Ghana. Significant regional difference of ESBL producers was observed between the northern and middle belts as well as the northern and southern belts. Genotypic detection with polymerase chain reaction (PCR) revealed the presence of bla TEM 36/139 (25.9%), bla SHV 40/139 (28.8%), bla CTX-M 37/139 (26.6%), bla OXA-48 3/139 (2.16%), and bla NDM 1/139 (0.72%) genotypes. In conclusion, there were variations in &beta, lactam resistance among Klebsiella spp. from health facilities situated in the northern, middle, and southern belts of Ghana. The study provides preliminary evidence that emphasizes the need to direct more attention to antimicrobial resistance control, especially in the northern belt of Ghana. Findings from this study may be critical for creating and fine-tuning effective antimicrobial resistance control strategies and for informing accurate antibiotic prescription by practitioners.

Background Qnr genes are known to confer a low-level resistance to fluoroquinolone in Enterobacteriaceae. They are often found on the same resistance plasmids as extended spectrum β-lactamase (ESBL) and constitute the most common antibiotic resistance mechanism. This study aimed to detect the presence of qnr genes in ESBL-producing E. coli and Klebsiella spp. Methods From May 2013 to July 2015, 91 E. coli and 64 Klebsiella spp. strains with phenotypic resistance to quinolone were collected from several specimens and analyzed for the detection of qnrA, qnrB, qnrS genes and the β-lactamase resistance genes (blaCTX-M, blaTEM, blaSHV) using simplex and multiplex PCR. Results In the present study, 107 (69%; 61 E. coli and 46 Klebsiella spp.) of 155 bacterial strains tested were found harboring at least one qnr gene consisting of 74 (47.74%) qnrB, 73 (47.10%) qnrS and 4 (2.58%) qnrA. Of the 107 strains encoding qnr genes, 102, 96 and 52 carried CTX-M1, TEM and SHV type ESBL respectively. Conclusion This study identified quinolone resistance (qnr) gene in ESBL-producing E. coli and Klebsiella spp. in Togo. These finding which suggest a possible resistance to quinolone are of high interest for better management of patients and control of antimicrobial resistance in Togo. Electronic supplementary material The online version of this article (10.1186/s13756-019-0552-0) contains supplementary material, which is available to authorized users.

Klebsiella oxytoca is the second most frequently identified species of Klebsiella isolated from hospitalized patients. Klebsiella spp. is difficult to identify using conventional methods and is often misclassified in clinical microbiology laboratories. K. oxytoca is responsible for an increasing number of multi-resistant infections in hospitals because of insufficient detection and identification. In this study, we propose a new simple method called pehX-LM PCR/XbaI, which simultaneously indicates K. oxytoca species and genotype by the fingerprint pattern. The pehX-LM PCR/XbaI is a combination of the following two methods: species-specific amplification of pehX gene and non-specific amplification of short restriction fragments by the LM PCR method. The specificity and the discrimination power of the pehX-LM PCR/XbaI method were determined by typing 209 K. oxytoca strains (included 9 reference strains), 28 K. pneumoniae, and other 25 strains belonging to the Enterobacteriaceae. The typing results were confirmed by the PCR melting profile method. Unlike the known fingerprinting methods, the pehX-LM PCR/XbaI leads to a clear pattern (approx. 3–5 bands) with a sufficient, relatively high discriminatory power. As a result, the time and cost of a single analysis are lower. The method can be used both in clinical and environmental research. Electronic supplementary material The online version of this article (doi:10.1007/s00253-016-7881-1) contains supplementary material, which is available to authorized users.

This study was conducted in Iran in order to assess the distribution of CTX-M type ESBLs producing Enterobacteriaceae. From January 2012 to December 2013, totally 198 E. coli, 139 Klebsiella spp, 54 Salmonella spp and 52 Shigella spp from seven hospitals of six provinces in Iran were screened for resistance to extended-spectrum cephalosporins. After identification and susceptibility testing, isolates presenting multiple-drug resistance (MDR) were evaluated for ESBL production by the disk combination method and by Etest using (cefotaxime and cefotaxime plus clavulanic acid). All isolates were also screened for bla CTX-M using conventional PCR. A total of 42.92%, 33.81%, 14.81% and 7.69% of the E. coli, Klebsiella spp, Salmonella spp and Shigella spp isolates were MDR, respectively. The presence of CTX-M enzyme among ESBL-producing isolates was 85.18%, 77.7%, 50%, and 66.7%, in E. coli, Klebsiella spp, Salmonella spp and Shigella spp respectively. The overall presence of CTX-M genes in Enterobacteriaceae was 15.4% and among the resistant isolates was 47.6%. This study indicated that resistance to β-lactams mediated by CTX-M enzymes in Iran had similar pattern as in other parts of the world. In order to control the spread of resistance, comprehensive studies and programs are needed.

Hospital effluents are crucial hotspots for the dissemination of antibiotic resistant microorganisms. This study analysed hospital effluent and proximate wastewater treatment plants for the presence of antibiotic resistant Klebsiella spp. Water samples were obtained twice over a three-month period from an urban and rural hospital at three effluent points each, and from two proximate wastewater treatment plants (WWTPs) comprising influent and effluent and river water samples up/downstream the WWTPs. Presumptive Klebsiella spp. were enumerated, isolated, and phenotypically confirmed using a well-established commercial test system for Enterobacteriaceae (API20E). Clinical Klebsiella pneumoniae isolates were provided by a hospital for comparison. The antibiotic resistance profiles of Klebsiella spp. isolates to 16 selected antibiotics were established according to EUCAST (European Committee on Antimicrobial Susceptibility Testing). In addition, extended spectrum β-lactamase (ESBL) and carbapenemase production was analysed. A total of 93 confirmed Klebsiella spp. isolates from hospital effluents and 37 from WWTPs were obtained, comprising K. pneumoniae and K. oxytoca. The viable counts for confirmed Klebsiella spp. for hospital effluents ranged from 1.38 × 102 to 1.03 × 104, while those for WWTP influent were in a range of 1.76 × 103 to 5.10 × 103 CFU/ml. A higher proportion of Klebsiella spp. from urban hospital effluent was categorized as multidrug-resistant (MDR) (23%) compared to rural hospital effluent (9%). Resistance was observed to all antibiotic classes tested. Several clinical isolates presented resistance to four carbapenem antibiotics, while certain isolates from hospital effluent and WWTPs exhibited ertapenem and doripenem resistance. Fifteen Klebsiella spp. isolates (clinical and from urban hospital effluent) produced carbapenemases. Hospital effluents in South Africa contain antibiotic resistant Klebsiella spp. and may pose a risk to proximate informal communities if inadequately treated. Moreover, common phenotypic resistance profiles among isolates from the clinical-hospital effluent-wastewater works continuum suggest a need for further treatment of such effluent.

Carbapenemase-producing organisms have been an immense public health problem in recent years. Combined disc test (CDT) is a simple and widely used phenotypic method for carbapenemase detection, especially in developing countries. This study evaluates the performance of modified combined disc test (mCDT), a novel and 4 times cheaper method than CDT. In total, 572 (15.5%) Klebsiella spp. including 81 (14.2%) carbapenemase producers were isolated from 3993 clinical samples. Both mCDT and CDT showed similar sensitivity, specificity, positive predictive value, and negative predictive value for the differentiation of Class A, B, and D carbapenemase-producing Klebsiella spp.

BACKGROUND: The aim of this study was to evaluate the modified Carba NP test to differentiate KPC (Klebsiella pneumoniae carbapenemase)‐ and MBL (metallo‐β‐lactamase)‐producing Klebsiella species. METHODS: A total of 508 non‐duplicate clinical isolates of Klebsiella spp. were processed by modified Carba NP and combined disc tests which were further confirmed by conventional polymerase chain reaction (PCR), a gold standard method for statistical analysis. RESULTS: Modified Carba NP test demonstrated 91.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.8% negative predictive value (NPV) for KPC and 96.7%, 100%, 100%, and 99.5% for MBL detection, respectively. CONCLUSION: The performance of modified Carba NP test was significantly better than combined disc test, fulfilling the requirement of simple and rapid test for clinical applications.

Surveillance data on the level of resistant bacteria is needed to inform strategies to reduce the development and spread of antibiotic resistance. The aim of this study was to determine the non-susceptibility trends to extended-spectrum cephalosporins and carbapenems among Escherichia coli and Klebsiella spp. isolates from the district of Nashik in Western India during the period 2004–2014. Antibacterial susceptibility testing of clinical isolates was performed using Kirby-Bauer disc diffusion method to determine inhibitory zone diameters. The change in proportions of non-susceptible bacteria over calendar time was investigated with spline transformations in a logistic regression model. For the extended-spectrum cephalosporins, the proportions of non-susceptible E. coli and Klebsiella spp. isolates were above 78.4% and 84.9% throughout the study period, respectively. E. coli and Klebsiella spp. isolates exhibited carbapenem non-susceptibility levels as high as 76.9% and 84.1% respectively. The proportions of extended-spectrum betalactamase (ESBL)-producing isolates ranged from 38.3–85.9% in E. coli and from 45.1–93.1% in Klebsiella spp. Significantly higher proportions of non-susceptible and ESBL-producing isolates were found among isolates from inpatients compared to isolates from outpatients for both E. coli and Klebsiella spp. (p < 0.050). The high proportions of non-susceptible isolates observed show that there is great need to focus on optimal use of antibiotics to reduce the development of antibiotic resistance.

With the increasing incidence of multidrug-resistant organisms, there is a need for newer antibiotics. However, due to the lack of new antimicrobial agents, it is necessary to re-evaluate the older agents like minocycline which is a second-line antimicrobial agent. In this study, minocycline susceptibility testing was performed for 693 Escherichia coli, 316 Klebsiella spp. and 89 Acinetobacter spp. Among extended spectrum beta-lactamase producing E. coli and Klebsiella spp. percentage susceptibility to minocycline were 76 and 85, respectively. Among the carbapenem resistant E. coli, Klebsiella spp. and Acinetobacter spp. minocycline susceptibility were 52%, 55% and 42%, respectively. Based on the susceptibility profile, minocycline can be considered for treatment of infections by multidrug-resistant organisms.

In a study of 1,777 Klebsiella strains, we discovered KPN1705, which was distinct from all recognized Klebsiella spp. We closed the genome of strain KPN1705 using a hybrid of Illumina short-read and Oxford Nanopore long-read technologies. For this novel species, we propose the name Klebsiella quasivariicola sp. nov.