Archive | 2021
Analysis of phenotypes and genetic determinants of the antibacterial resistance of Klebsiella pneumoniae, which causes infectious complications associated with the provision of medical care in the intensive care unit for surgical patients
Abstract
SummaryPurpose of the work: to study the phenotype of antibiotic resistance and the geneticmechanisms that conditioning it among isolates of Klebsiella pneumoniae in theintensive care unit (ICU).Materials and methods: local microbiological monitoring was carried out in theICU (for surgical patients) if the National Military Medical Clinical Center «MainMilitary Clinical Hospital» during 2014–2020. For the study of genetic material by thenext-generation sequencing method, 5 clinical isolates of Klebsiella pneumoniae weresent to the repository of multi-resistant microorganisms of the Military ResearchInstitute Walter Reed, USA.Results and discussion: the analysis included 631 results of microbiologicalresearch of clinical material from 88 patients, in whom 383 microorganisms wereisolated. Klebsiella pneumoniae accounted for the largest share of 26.1% (100/383).Klebsiella pneumoniae appeared to be the dominant microorganism in blood culture –24 isolates (26%). We found Klebsiella pneumoniae in 56 isolates urine cultures (21%)and 20 isolates (21%) in sputum, thus, making Klebsiella pneumoniae ranked second.The causative agents of Klebsiella pneumoniae have shown absolute resistance toaminopenicillins, third generation cephalosporins, protected cephalosporins, fluoroquinolones, gentamycin. Amikacin, phosphomycin, and the studied carbapenems wereeffective at around 30–40%. Tigecycline remained effective in more than 77% of theinvestigated isolates. The isolates were resistant to several classes of antibiotics at once.Genetic studies of 5 Klebsiella pneumoniae isolates have established the presence of 23different resistance genes in their genome. Resistance to carbapenems was correlatedwith the presence of blaOXA-48. The ESBL genes blaCTX-M-15 blaSHV, blaTEM werefound in four out of five isolates. One strain contained both the blaNDM-1 metal betalactamase and rmtC 16S methyltransferase. The isolates were assigned to three differentsequence types by MLST.Conclusions: empiric antibiotic therapy regimens must necessarily includeantibiotic combinations. The most effective is the combination of amikacin withcarbapenems. The use of fosfomycin and tigecycline must be regulated to maintain theeffectiveness of these drugs in the future.