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<p><i>Klebsiella pneumoniae</i> is one of the leading causes of bloodstream (BSI) and urinary tract infections (UTI), but limited data is available regarding community-acquired (CA) infections. This study characterized the clinical aspects of CA-BSI and CA-UTI caused by <i>K. pneumoniae</i> and the molecular features of isolates, including their resistance profiles. Sixty-five isolates (CA-BSI, <i>n</i> = 24; CA-UTI, <i>n</i> = 41) underwent antimicrobial susceptibility testing, β-lactamase and virulence gene assessment, capsular genotyping, and molecular typing. Older age, male gender, and comorbidities, particularly kidney disease, were significantly associated with CA-BSI. The MDR and carbapenem resistance rates for <i>K. pneumoniae</i> from CA infections were 24.6% and 4.6%, respectively. CA-BSI isolates were more antibiotic-resistant and had a higher proportion of ESBL-producing (37.5% <i>versus</i> 9.8%) and MDR isolates (45.8% <i>versus</i> 12.2%) than CA-UTI. The <i>bla</i><sub>CTX−M−like</sub> or <i>bla</i><sub>KPC−like</sub> genes was found in all ESBL-producing isolates, while <i>bla</i><sub>KPC−like</sub> and <i>bla</i><sub>NDM−like</sub> were detected exclusively in CA-BSI strains. The isolates’ virulence profiles were similar between the groups, although one CA-BSI and two CA-UTI isolates presented hypervirulence biomarkers. A high clonal diversity was observed, with a majority of MDR (81.3%) (ST11, ST15, ST101, ST258, ST307, and ST6852) and hypervirulent (2/3) (ST23 and ST65) isolates being high-risk pandemic clones in humans. Our data highlight the high prevalence of MDR <i>K. pneumoniae</i> in CA infections in Brazil, with CA-BSI showing significant differences in resistance profiles compared to CA-UTI.</p>

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High proportions of multidrug-resistant Klebsiella pneumoniae isolates in community-acquired infections, Brazil

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月20日

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  • Adriano de Souza Santos Monteiro,
  • Márcio de Oliveira Silva,
  • Vívian Santos Galvão,
  • Adriele Pinheiro Bomfim,
  • Lorena Galvão de Araújo,
  • Camila Maria Piñeiro Silva,
  • Maria Goreth Barberino,
  • Edilane Lins Gouveia,
  • Soraia Machado Cordeiro,
  • Joice Neves Reis

摘要

Klebsiella pneumoniae is one of the leading causes of bloodstream (BSI) and urinary tract infections (UTI), but limited data is available regarding community-acquired (CA) infections. This study characterized the clinical aspects of CA-BSI and CA-UTI caused by K. pneumoniae and the molecular features of isolates, including their resistance profiles. Sixty-five isolates (CA-BSI, n = 24; CA-UTI, n = 41) underwent antimicrobial susceptibility testing, β-lactamase and virulence gene assessment, capsular genotyping, and molecular typing. Older age, male gender, and comorbidities, particularly kidney disease, were significantly associated with CA-BSI. The MDR and carbapenem resistance rates for K. pneumoniae from CA infections were 24.6% and 4.6%, respectively. CA-BSI isolates were more antibiotic-resistant and had a higher proportion of ESBL-producing (37.5% versus 9.8%) and MDR isolates (45.8% versus 12.2%) than CA-UTI. The blaCTX−M−like or blaKPC−like genes was found in all ESBL-producing isolates, while blaKPC−like and blaNDM−like were detected exclusively in CA-BSI strains. The isolates’ virulence profiles were similar between the groups, although one CA-BSI and two CA-UTI isolates presented hypervirulence biomarkers. A high clonal diversity was observed, with a majority of MDR (81.3%) (ST11, ST15, ST101, ST258, ST307, and ST6852) and hypervirulent (2/3) (ST23 and ST65) isolates being high-risk pandemic clones in humans. Our data highlight the high prevalence of MDR K. pneumoniae in CA infections in Brazil, with CA-BSI showing significant differences in resistance profiles compared to CA-UTI.