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. 2018 Sep 23:2018:7012958.
doi: 10.1155/2018/7012958. eCollection 2018.

Association of Antibiotic Resistance, Cell Adherence, and Biofilm Production with the Endemicity of Nosocomial Klebsiella pneumoniae

María Dolores Alcántar-Curiel  1 , Carmen Alejandra Ledezma-Escalante  1   2 , Ma Dolores Jarillo-Quijada  1 , Catalina Gayosso-Vázquez  1 , Rayo Morfín-Otero  3 , Eduardo Rodríguez-Noriega  3 , María Lilia Cedillo-Ramírez  4 , José Ignacio Santos-Preciado  1 , Jorge A Girón  4   5
Affiliations

Association of Antibiotic Resistance, Cell Adherence, and Biofilm Production with the Endemicity of Nosocomial Klebsiella pneumoniae

María Dolores Alcántar-Curiel et al. Biomed Res Int. .

Abstract

Klebsiella pneumoniae is a leading cause of multiple nosocomial infections, some of which are associated with high mortality. The increasing prevalence of antibiotic-resistant strains highlights their clinical importance and how complicated managing treatment can be. In this study, we investigated antimicrobial resistance, cell adherence, and biofilm production of nosocomial K. pneumoniae strains isolated from surveillance studies in a Mexican tertiary hospital and evaluated the potential association of these phenotypes with endemicity. The great majority of the clones exhibited adhesion to cultured epithelial cells and were strong biofilm producers. A direct relationship between adhesion phenotypes, biofilm production, and endemicity was not always apparent. Biofilm formation and production of ESBL did not appear to be directly associated. Notably, all the endemic strains were multidrug-resistant. This study emphasizes that while endemic strains possess various virulence-associated properties, antimicrobial resistance appears to be a determining factor of their endemicity.

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Figures

Figure 1
Figure 1
Dendrogram representing genetic relationships among 168 K. pneumoniae strains. One representative strain of each PFGE pattern (clone) identified is presented. ESBL-producing K. pneumoniae were part of 23 different PFGE patterns.
Figure 2
Figure 2
ESBL-producing K. pneumoniae clones identified during a 45-month surveillance study period. A total of 23 clones were detected in 127 ESBL-producing K. pneumoniae strains. Arrows show four different outbreaks of bacteremia caused by K. pneumoniae.
Figure 3
Figure 3
HeLa cell adherence phenotypes exhibited by K. pneumoniae strains. The collection of K. pneumoniae strains was tested for adherence to HeLa cells and we identified 3 levels of adherence: high, moderate, and poor. These micrographs were obtained after staining of the infected monolayers with Giemsa solution and visualize using light microscopy. Images were taken at 63X. (a) K. pneumoniae 232/01 (clone 47) showing high level of cell adherence with bacterial aggregates between neighboring cells. (b) K. pneumoniae 821 (clone 9) adheres moderately to the cells and (c) K. pneumoniae 373 (clone 4) adheres poorly.
See this image and copyright information in PMC

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