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. 2021 Jun 5;21(1):526.
doi: 10.1186/s12879-021-06245-x.

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Arsénia J Massinga  1 , Marcelino Garrine  1   2 , Augusto Messa Jr  1 , Nélio A Nobela  1 , Nadia Boisen  3 , Sergio Massora  1 , Anélsio Cossa  1 , Rosauro Varo  4 , António Sitoe  1 , Juan Carlos Hurtado  4 , Jaume Ordi  4 , Hélio Mucavele  1 , Tacilta Nhampossa  1   5 , Robert F Breiman  6 , Cynthia G Whitney  6 , Dianna M Blau  7 , Quique Bassat  1   4   8   9 , Inácio Mandomando  10   11
Affiliations

Klebsiella spp. cause severe and fatal disease in Mozambican children: antimicrobial resistance profile and molecular characterization

Arsénia J Massinga et al. BMC Infect Dis. .

Abstract

Background: Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children.

Methods: Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR.

Results: Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75).

Conclusion: Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.

Keywords: Bacteremia; CTX-M-15; ESBL genes; Hypermucoviscosity; Hypervirulence; Mozambique; SPATEs.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Demographic characteristics of the children from whom the isolates were recovered
Fig. 2
Fig. 2
Comparisons between isolates from children with bacteremia who survived, who died and postmortem children included in the CHAMPS study for (A) non-susceptibility to antimicrobials used for empirical treatment (B) and the common virulence genes for each group
See this image and copyright information in PMC

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