Genetic analysis of ESBL-producing Klebsiella pneumoniae isolated from UTI patients in Indonesia |
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| Authors: | Saya Yamasaki Katsumi Shigemura Kayo Osawa Koichi Kitagawa Aya Ishii K. Kuntaman Toshiro Shirakawa Takayuki Miyara Masato Fujisawa |
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| Affiliation: | 1. Department of International Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka Suma-ku, Kobe, 654-0142, Japan;2. Department of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;3. Department of Medical Technology, Kobe Tokiwa University, 2-6-2 Otani-cho Nagata-ku, Kobe, 653-0838, Japan;4. Department of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;5. Department of Microbiology, Faculty of Medicine, Airlangga University and Dr. Soetomo Hospital, Surabaya, Indonesia;6. Department of Infection Prevention and Control, Kobe University Hospital, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;1. Department of Clinical Laboratory, Ningbo First Hospital, Ningbo, 315010, Zhejiang, China;2. Department of General Medicine, Ningbo First Hospital, Ningbo, 315010, Zhejiang, China;3. Department of Hematology, Ningbo First Hospital, Ningbo, 315010, Zhejiang, China;1. Department of Pharmacy, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan;2. Department of Infection Control, Kumamoto University Hospital, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-8556, Japan;3. Department of Pharmacy, Sapporo Medical University Hospital, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan;4. Department of Pharmacy, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan;5. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahatanishi-ku Kitakyushu, Fukuoka, 807-8555, Japan;6. Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan;1. Department of Medical Technology Faculty of Health Sciences, Kyorin University, Tokyo, Japan;2. Department of Clinical Laboratory Kyorin University School of Medicine, Tokyo, Japan;3. Department of Pharmacy, Kyorin University School of Medicine, Tokyo, Japan;4. Department of Infectious Diseases, Kyorin University School of Medicine, Tokyo, Japan;5. Department of Laboratory Medicine, Kyorin University School of Medicine, Tokyo, Japan;1. Department of Laboratory Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan;2. Department of Medical Sciences, Shinshu University Graduate School of Medicine, Science and Technology, Nagano, Japan;3. Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu University School of Medicine, Shizuoka, Japan;4. Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan;1. Department of Emergency and Critical Care Medicine, St. Luke''s International Hospital, 9-1 Akashicho, Chuo City, Tokyo, 104-8560, Japan;2. Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, 160-8582, Japan;3. Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, NIH, Bethesda, MD, 20852, USA;4. Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashiueno, Taito City, Tokyo, 110-8645, Japan;5. Zama Children''s Clinic, 2-20-24 Tatsunodai, Zama City, Kanagawa, 252-0023, Japan;6. Department of Pediatrics, Eiju General Hospital, 2-23-16 Higashiueno, Taito City, Tokyo, 110-8645, Japan;1. Division of Respiratory Medicine, Department of Internal Medicine, The Jikei University Daisan Hospital, Tokyo, Japan;2. Division of Respiratory Medicine, Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan;3. Division of Respiratory Medicine, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan |
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| Abstract: | IntroductionExtended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a serious concern for nosocomial infection and the emergence rate in Indonesia is higher than that in developed countries. The purpose of this study was to investigate the genetic characteristics of ESBL-producing K. pneumoniae isolated from UTI patients in Indonesia.Materials and methodsWe collected K. pneumoniae resistant to ceftazidime or cefotaxime isolated from UTI patients in Dr. Soetomo's Academic Hospital in Surabaya, Indonesia in 2015. Ninety-four strains were identified as ESBL-producing bacteria by confirmation tests. The isolates were investigated by antimicrobial susceptibility testing with 20 drugs and ESBL gene detection, plasmid replicon typing and virulence genes as hypermucoviscous (HMV) strains were tested by the string test.ResultsHigh rates of resistance to ciprofloxacin (86.2%), tetracycline (80.9%) and nalidixic acid (78.7%) were observed. CTX-M-15 was the most common ESBL gene (89.4%), 33 of which also carried SHV-type ESBL. IncF was the most prevalent plasmid replicon typing (47.6%). Sixteen (17.0%) strains were judged as HMV, all of which had rmpA and more than half of which had fimH, uge, and wab. IncL/M was the most common replicon plasmid in the HMV strains, and the difference in the positive rate was statistically significant (p = 0.0024).ConclusionThis study showed the high prevalence of multiple-drug resistant and predominately CTX-M-15-positive ESBL-producing K. pneumoniae in Indonesia. There was a correlation between IncL/M and the HMV phenotype in this study. As such hypervirulent strains continue to emerge, studying their dissemination with resistance determinants is an urgent priority. |
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| Keywords: | Indonesia ESBL Hypermucoviscous |
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