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Community- and Hospital-Acquired Klebsiella pneumoniae Urinary Tract Infections in Portugal: Virulence and Antibiotic Resistance

1
Microbiology and Immunology Department, Interdisciplinary Research Centre Egas Moniz (CiiEM), Faculty of Pharmacy, Universidade de Lisboa, 1649-003 Lisboa, Portugal
2
Institute of Environmental Health (ISAMB), Faculty of Medicine, Universidade de Lisboa, 1649-028 Lisboa, Portugal
3
Laboratory of Microbiology, Centro Hospitalar Lisboa Norte, 1649-035 Lisboa, Portugal
4
Institute of Microbiology, Institute of Molecular Medicine, Faculty of Medicine, Universidade de Lisboa,1649-028 Lisboa, Portugal
*
Author to whom correspondence should be addressed.
Microorganisms 2019, 7(5), 138; https://doi.org/10.3390/microorganisms7050138
Received: 28 February 2019 / Revised: 30 April 2019 / Accepted: 15 May 2019 / Published: 16 May 2019
(This article belongs to the Special Issue Multidrug-Resistant Pathogens)
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Abstract

Klebsiella pneumoniae is a clinically relevant pathogen and a frequent cause of hospital-acquired (HA) and community-acquired (CA) urinary tract infections (UTI). The increased resistance of this pathogen is leading to limited therapeutic options. To investigate the epidemiology, virulence, and antibiotic resistance profile of K. pneumoniae in urinary tract infections, we conducted a multicenter retrospective study for a total of 81 isolates (50 CA-UTI and 31 HA-UTI) in Portugal. The detection and characterization of resistance and virulence determinants were performed by molecular methods (PCR, PCR-based replicon typing, and multilocus sequence typing (MLST)). Out of 50 CA-UTI isolates, six (12.0%) carried β-lactamase enzymes, namely blaTEM-156 (n = 2), blaTEM-24 (n = 1), blaSHV-11 (n = 1), blaSHV-33 (n = 1), and blaCTX-M-15 (n = 1). All HA-UTI were extended-spectrum β-lactamase (ESBL) producers and had a multidrug resistant profile as compared to the CA-UTI isolates, which were mainly resistant to ciprofloxacin, levofloxacin, tigecycline, and fosfomycin. In conclusion, in contrast to community-acquired isolates, there is an overlap between virulence and multidrug resistance for hospital-acquired UTI K. pneumoniae pathogens. The study is the first to report different virulence characteristics for hospital and community K. pneumoniae pathogens, despite the production of β-lactamase and even with the presence of CTX-M-15 ESBL, a successful international ST15 clone, which were identified in both settings. This highlights that a focus on genomic surveillance should remain a priority in the hospital environment. View Full-Text
Keywords: Klebsiella pneumoniae; multidrug resistance; virulence genes; urinary tract infections Klebsiella pneumoniae; multidrug resistance; virulence genes; urinary tract infections
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Caneiras, C.; Lito, L.; Melo-Cristino, J.; Duarte, A. Community- and Hospital-Acquired Klebsiella pneumoniae Urinary Tract Infections in Portugal: Virulence and Antibiotic Resistance. Microorganisms 2019, 7, 138.

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