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Background: Klebsiella bacterial strains harboring Extended-Spectrum Beta-Lactamase (ESBL) enzymes are the primary culprits behind neonatal sepsis globally. These strains significantly impact clinical outcomes due to their multi-drug resistance patterns in local healthcare settings. In response to this spiraling threat, we studied the prevalence and clinical implications of ESBL-encoding genes in neonates hospitalized with confirmed sepsis. Methods: A correlational study was conducted on 51 neonates diagnosed with sepsis caused by ESBL-positive Klebsiella pneumoniae at Jimma Medical Center spanning from May 2022 to July 2023. Antimicrobial resistance profiles of the bacterial isolates were determined using the Kirby-Bauer diffusion test, while multiplex polymerase chain reaction (mPCR) techniques were employed to identify resistance genes. The correlation between resistance genes and treatment outcomes was analyzed using the phi coefficient (φ) with a significance level below 0.05. The data management was executed through the utilization of WHONET and STATA software platforms. Results: The sample consisted of 26 (50.9%) male and the remaining 25 (49.1%) female neonates, with diverse clinical characteristics. All 51 Klebsiella pneumoniae isolates were 100% resistant to trimethoprim/sulfamethoxazole and ceftriaxone, but showed varying resistance profiles ranging from 30.8% to meropenem to 94.2% to ceftazidime. Notably, all isolates demonstrated multidrug resistance, with 23% of cases showing resistance to seven different antimicrobial classes. The most prevalent resistance genes identified were blaCTX−M (96.1%), blaTEM (94.1%), and blaSHV (88.2%). The majority of isolates (94.1%) carried at least two resistance genes, such as blaTEM and blaCTX (94.1%), blaTEM and blaSHV (86.2%), and blaCTX and blaSHV (86.2%). Notably, 84.3% of the bacteria harbored the trio of blaTEM, blaCTX, and blaSHV resistance genes, and only the presence of blaSHV in monogenic (φ = 0.4, P = 0.01) or the trio of blaTEM, blaCTX, and blaSHV genes (φ = 0.3, P = 0.02) showed positive correlation with neonatal mortality. Conclusion: We observed a significant prevalence of multidrug-resistant Klebsiella pneumoniae strains among neonates. Moreover, ESBL-resistance genes were widespread, with the blaSHV gene showing a correlation with increased neonatal mortality. These findings emphasize the urgent need for enhanced infection prevention measures, robust antimicrobial resistance surveillance, innovative treatment strategies, antibiotic stewardship initiatives, further research into resistance transfer mechanisms as well as hierarchical predictors of neonatal mortality. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: ESBL-producing Escherichia coli pose a growing health risk in community and healthcare settings. We investigated the resistome, virulome, mobilome, and genetic relatedness of multidrug-resistant (MDR) E. coli isolates from patients and their environment in a Ghanaian teaching hospital. Materials and methods: Twenty-three MDR ESBL-producing or carbapenem-resistant E. coli isolates from a collection of MDR Gram-negative bacteria (GNB) from patients and environments were selected for genomic analyses. Whole genome sequencing and bioinformatics tools were used to analyze genomic characteristics and phylogeny. Results: The prevalence and incidence of rectal carriage of ESBL E. coli among patients were 13.65% and 11.32% respectively. The β-lactamase genes, blaTEM−1B (10 isolates) and blaCTX−M−15 (12 isolates) were commonly associated with IncFIB plasmid replicons and co-occurred with aminoglycoside, macrolide, and sulfamethoxazole/trimethoprim resistance. Insertion sequences, transposons, and class I integrons were found with blaCTX−M−15. Carriage and environmental isolates carried multiple virulence genes, with terC being the most prevalent in 21 isolates. Seventeen sequence types (STs) were identified, including a novel ST (ST13846). Phylogenetic analysis grouped the isolates into four main clusters, with one outlier. High genetic relatedness was observed between two carriage isolates of ST940 and between a carriage isolate and an environmental isolate of ST648. Isolates with different STs, collected at different times and locations, also showed genetic similarities. Conclusion: We identified ESBL-producing E. coli with diverse genomic characteristics circulating in different hospital directorates. Clonal relatedness was observed among isolates from patients and the environment, as well as between different patients, suggesting transmission within and between sources. [ABSTRACT FROM AUTHOR]

Clustered, regularly interspaced short palindromic repeats (CRISPRs) and their related genes (Cas) are prevalent in the genomes of several bacteria and serve as a defense mechanism against external attackers, such as plasmids and viruses. This study aimed to examine the frequency of the CRISPR/Cas system in naturally occurring strains of Klebsiella pneumoniae sub spp pneumoniae confirmed by Vitek 2 biochemical test, in the hospital setting and determine its correlation with antibiotic resistance both phenotypically and genetically (antibiotic-resistant genes, namely blaTEM and AcrA efflux pump gene). The research was conducted at Medical College/Mosul University 23 multi-drug resistant K. pneumoniae sub spp. pneumoniae that were obtained from 230 clinical samples from infected patients with different types of infections attending Al-Salam and Al-Jumhoree Teaching hospitals. PCR was used to detect blaTEM, AcrA genes, and CRISPR/Cas system genes (CAS1A and CAS1B) among the clinical isolates. The correlation between the CRISPR/Cas system and antibiotic-resistance was determined. All the isolates were multiple drug-resistant strains, and the blaTEM gene was detected in all clinical isolates, whereas AcrA gene was detected in 94% of the isolates. The frequency of CAS1A and CAS1B was 21.73% and 86.95% respectively. There was an inverse correlation between the CAS1A gene and phenotypic antibiotic resistance Disc diffusion test results, so isolates carrying CAS1A gene were less resistant to different antibiotics studied in this research. In contrast, there was no significant correlation between CRISPR / Cas genes, blaTEM, and AcrA genes at the genetic level. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae (K. pneumoniae) cultures from a hospital-wide outbreak in the UK, which lasted for over 12 months, were sequenced. We sought to sequence and genetically characterise the outbreak strain. Antibiotic Susceptibility Testing (AST) was performed on 65 K. pneumoniae isolates saved from the outbreak. All isolates were sequenced using the Oxford Nanopore Technologies (ONT) MinION flowcell: 10 isolates, including the isolate with the earliest collection date in 2017, were additionally sequenced on the NovaSeq 6000 platform to build high-accuracy nanopore-illumina assemblies. Among the sequenced strains, 60 were typed as ST628. 96.6% (n = 58/60) ST628 strains harboured a large ~247-kb FIB(K) plasmid carrying up to 11 antimicrobial resistance genes, including the extended-spectrum beta-lactamase (ESBL) gene, blaCTX-M-15. Clonality between the outbreak isolates was confirmed using single nucleotide polymorphism (SNP) typing. The outbreak strains were phylogenetically related to clinical ST628 strains identified in 2012, 6 years prior to the outbreak. A rare ESBL K. pneumoniae K2 ST628 strain harbouring a multi-drug resistant (MDR) plasmid encoding the ESBL gene blaCTX-M-15 was detected across multiple independent wards during the protracted nosocomial outbreak. Surveillance of this strain is recommended to prevent future nosocomial outbreaks. [ABSTRACT FROM AUTHOR]

The hospital environment is increasingly becoming an important reservoir for multi-drug-resistant (MDR) Gram-negative bacteria, posing serious challenges to efforts to combat antimicrobial resistance (AMR). This study aimed to investigate the role of hospital waste as a potential source of MDR ESBL-producing bacteria. Samples were collected from multiple sources within a hospital and its vicinity, including surface swabs, houseflies, and sewage samples. The samples were subsequently processed in a microbiology laboratory to identify potential pathogenic bacteria and confirmed using MALDI-TOF MS. Bacteria were isolated from 87% of samples, with the predominant isolates being E. coli (30.5%), Klebsiella spp. (12.4%), Providencia spp. (12.4%), and Proteus spp. (11.9%). According to the double disc synergy test (DDST) analysis, nearly half (49.2%) of the bacteria were identified as ESBL producers. However, despite exhibiting complete resistance to beta-lactam antibiotics, 11.8% of them did not test positive for ESBL production. The characterization of E. coli revealed that 30.6% and 5.6% of them carried blaCTX-M group 1 type-15 and blaNDM genes, respectively. This finding emphasizes the importance of proper hospital sanitation and waste management practices to mitigate the spread of AMR within the healthcare setting and safeguard the health of both patients and the wider community. [ABSTRACT FROM AUTHOR]

Simple Summary: Numerous diseases, such as liver abscesses, bacteremias, pneumonia, and urinary tract infections, are caused by Klebsiella pneumonia (K. pneumonia). Historically, immunocompromised patients have been the main target of serious infections induced by K. pneumoniae. However, with the recent appearance and dissemination of hypervirulent strains, healthy individuals have also become susceptible to infection. Moreover, treating K. pneumoniae infections is extremely difficult due to the strains' increased antibiotic resistance. This review summarizes the various virulence factors of this bacterium, especially metallophores. The bacteriology, pathology, and epidemiology of K. pneumonia are also included in this review. The opportunistic pathogen Klebsiella pneumoniae (K. pneumoniae) can colonize mucosal surfaces and spread from mucosae to other tissues, causing fatal infections. Medical equipment and the healthcare setting can become colonized by Klebsiella species, which are widely distributed in nature and can be found in water, soil, and animals. Moreover, a substantial number of community-acquired illnesses are also caused by this organism worldwide. These infections are characterized by a high rate of morbidity and mortality as well as the capacity to spread metastatically. Hypervirulent Klebsiella strains are thought to be connected to these infections. Four components are critical to this bacterium's pathogenicity—the capsule, lipopolysaccharide, fimbriae, and siderophores. Siderophores are secondary metabolites that allow iron to sequester from the surrounding medium and transport it to the intracellular compartment of the bacteria. A number of variables may lead to K. pneumoniae colonization in a specific area. Risk factors for infection include local healthcare practices, antibiotic use and misuse, infection control procedures, nutrition, gender, and age. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance of Escherichia coli is a growing problem in both developed and developing countries. This study aimed to investigate the phenotypic antimicrobial resistance of E. coli isolates (n = 260) isolated from the stool specimen of patients attending public health facilities in Addis Ababa and Hossana. This study also aimed to characterize phenotypically confirmed extended-spectrum beta-lactamase (ESBL)-producing E. coli isolates (n = 22) using whole-genome sequencing. Resistance to 18 different antimicrobials was assessed using the disc diffusion method according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. The highest resistance rate among the E. coli isolates was found for ampicillin (52.7%), followed by trimethoprim-sulfamethoxazole (29.6%). Of all isolates, 50 (19.2%) were multidrug-resistant and 22 (8.5%) were ESBL producers. ESBL genes were detected in 94.7% of the sequenced E. coli isolates, and multiple β-lactamase genes were detected in 57.9% of the isolates. The predominant ESBL gene identified was blaCTX-M-15 (78.9%). The blaTEM-1B gene was detected in combination with other ESBL genes in 57.9% of the isolates, while only one of the sequenced isolates contained the blaTEM-1B gene alone. The blaCTX-M-3 gene was detected in three isolates. The genes blaCTX-M-15 and blaTEM-1B as well as blaCTX-M-15 and blaTEM-169 were confirmed to coexist in 52.6% and 10.5% of the sequenced E. coli isolates, respectively. In addition, blaOXA-1 was identified together with blaCTX-M-15 and blaTEM-1B in one isolate, and in one isolate, blaTEM-169 together with blaCTX-M-15 and blaTEM-1B was found. The results obtained show that measures need to be taken to reduce the spread of drug resistance and ensure the long-term use of available antimicrobials. [ABSTRACT FROM AUTHOR]

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Background: The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods: Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results: 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032–1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013–1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001–0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = <0.001). UTI had no negative impact on short-term graft survival. Conclusion: Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia. Methods: Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses. Results: The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52– 65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14– 20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9– 14%], Klebsiella pneumonia, 11% [95% CI: 9– 13%], Proteus mirabilis, 8% [95% CI: 6– 10%], Acinetobacter species, 4% [95% CI: 2– 6%], Enterobacter species, 4% [95% CI: 3– 5%], and Citrobacter species, 3% [95% CI: 2– 4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66– 86%], 84% [95% CI: 78– 91%], 66% [95% CI:43– 88%], 83% [95% CI:75– 91%], 87% [95% CI:78– 96%], 68% [95% CI:50– 87%] and 71% [95% CI:46– 96%], respectively. Conclusion: There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program. [ABSTRACT FROM AUTHOR]