Genetic Variants of Multidrug-Resistant Klebsiella pneumoniae Isolated from Al-Ramadi Teaching Hospital, Iraq

Abstract

Background K. pneumoniae stands as a prominent contributor to hospital outbreaks on a global scale. Furthermore, there is a rising trend of antibiotic-resistant strains of K. pneumoniae causing severe and potentially fatal invasive infections, leading to increased morbidity and mortality. Thus, knowledge of the genetic relatedness of this bacterium is necessary to solve this problem using the BOX–PCR technique. Objective This research aimed to determine the genetic relatedness of nosocomial K. pneumoniae isolated from different clinical sources with antibiotic resistance. Materials and Methods Between March 2021 and June 2021, a collective of 45 nosocomial K. pneumoniae isolates were obtained from various sources. Additionally, all isolates underwent diagnosis through both conventional tests and an automated system, specifically the VITEK-2. In the present study, six antibiotics from different classes were examined for activity against K. pneumoniae using Kirby–Bauer disk diffusion. DNA was extracted from fifteen isolated using Wizard™ Genomic DNA Purification Kit. Thus, BOX-PCR was used to identify the genetic relatedness of this bacterium. Results According to the source of samples, they were distributed to 25/45 (55.56%) sputum, 15/45 (33.33%) urine, 3/45(6.67%) wound, and 2/45(4.44%) blood. The antibiotic susceptibility profile revealed high resistance rates, notably against 95.5% Piperacillin-tazobactam, 80% Ceftriaxone and Ceftazidime, and 75.6% Cefepime. Of the 45 K. pneumoniae isolates analyzed, a significant proportion exhibited resistance to multiple antibiotics, with 33.33% classified as MDR strains. Molecular typing using BOX repetitive sequences demonstrated a high degree of genetic variability among the isolates, with the presence of unique genotypes and strong clonality observed. Dendrogram analysis showed the genetic relationship among antibiotics-resistant K. pneumoniae isolates. Conclusion The current work showed that the BOX-PCR technique is necessary for the investigation of the genetic diversity of K. pneumoniae, and it is an easy, reproducible, fast, and cost-effective tool.