Genotypic to Phenotypic Resistance Discrepancies Identified Involving β-Lactamase Genes, blaKPC, blaIMP, blaNDM-1, and blaVIM in Uropathogenic Klebsiella pneumoniae

Figures & data

Figure 1 Gender and age distribution of K. pneumonia-positive and -negative UTI patients. Frequency distribution of urine culture with K. pneumonia positive (+ve) and negative (-ve) according to sex (male and female) and age group (1–20 YO, 21–40 YO and more than 40 YO) (n=142, Years Old = YO).

Figure 2 Impact of Extended Spectrum β-lactamase (ESBL) genes on the phenotypic susceptibilities of β-lactam antibiotics. The comparative susceptibilities of the ESBL-positive and -negative isolates were evaluated against selected b-lactam antibiotics, namely Amoxycillin+Clavulinic acid (AMC 30 µg), Cefepime (FEP 30 µg), Cefuroxime Sodium (CXM 30 µg), Cephalexin (CL 30 µg), Ceftriaxone (CRO 30 µg), Imipenem (IMP 10 µg). (A). The Y-axis values of black bars indicate the percentage of ESBL gene-carrying isolates showing as susceptible against respective antibiotics shown on the X-axis. Similarly, the white bars illustrate the percentages of susceptible isolates that do not carry the respective ESBL genes. Susceptibilities of (A) blaKPC-positive (n=9) and -negative (n=49), (B) blaIMP-positive (n=6) and -negative (n=52), (C) blaVIM-positive (n=11) and -negative (n=47), and (D) blaNDM1-positive (n=13) and -negative (n=45), isolates are shown separately.

Table 1 Association Between Phenotypic Antimicrobial Susceptibility of Urine K. Pneumoniae with Age and Sex (Fisher’s Exact Test, n=58)

Antimicrobials	Age Groups Frequency (%)		p-value	Sex Frequency (%)		p-value
	≤ 30 YO (n=28)	> 30 YO (n=30)		Male (n=16)	Female (n=42)
Cefuroxime
Sensitive	0 (0)	2 (6.7)	0.492	1 (6.3)	1 (2.4)	0.479
Resistant	28 (100)	28 (93.3)		15 (93.8)	41 (97.6)
Trimethoprim/sulfamethoxazole
Sensitive	6 (21.4)	5 (16.7)	0.644*	6 (37.5)	5 (11.9)	0.055
Resistant	22 (78.6)	25 (83.3)		10 (62.5)	37 (88.1)
Ceftriaxone
Sensitive	3 (10.7)	2 (6.7)	0.665	2 (12.5)	3 (7.1)	0.609
Resistant	25 (89.3)	28 (93.3)		14 (87.5)	39 (92.9)
Amoxycillin-Clavulanic acid
Sensitive	0 (0)	1 (3.3)	1.000	0 (0)	1 (2.4)	1.000
Resistant	28 (100)	29 (96.7)		16 (100)	41 (97.6)
Cefepime
Sensitive	0 (0)	5 (16.7)	0.053	1 (6.3)	4 (9.5)	1.000
Resistant	28 (100)	25 (83.3)		15 (93.8)	38 (90.5)
Ciprofloxacin
Sensitive	9 (32.1)	13 (43.3)	0.380*	7 (43.8)	15 (35.7)	0.573*
Resistant	19 (67.9)	17 (56.7)		9 (56.3)	27 (64.3)
Imipenem
Sensitive	6 (21.4)	9 (30.0)	0.456*	6 (37.5)	9 (21.4)	0.314
Resistant	22 (78.6)	21 (70.0)		10 (62.5)	33 (78.6)

Note: *Chi-square test.

Table 2 Association Between Genotypic blaKPC, blaIMP, blaNDM-1, and blaVIM of Urine K. Pneumoniae with Age and Sex (Fisher’s Exact Test, n=58)

	Age Groups Frequency (%)		p-value	Sex Frequency (%)		p-value
	≤ 30 YO (n=28)	> 30 YO (n=30)		Male (n=16)	Female (n=42)
blaKPC
Positive	5 (17.9)	5 (16.7)	1.000	2 (12.5)	8 (19.0)	0.710
Negative	23 (82.1)	25 (83.3)		14 (87.5)	34 (81.0)
blaIMP
Positive	5 (17.9)	1 (3.3)	0.097	0 (0)	6 (14.3)	0.173
Negative	23 (82.1)	29 (96.7)		16 (100)	36 (85.7)
blaNDM-1*
Positive	2 (11.8)	6 (27.3)	0.426	2 (28.6)	6 (18.8)	0.617
Negative	15 (88.2)	16 (72.7)		5 (71.4)	26 (81.3)
blaVIM*
Positive	5 (21.7)	6 (24.0)	0.852**	2 (22.2)	9 (23.1)	1.000
Negative	18 (78.3)	19 (76.0)		7 (77.8)	30 (76.9)

Notes: *With some missing values **Chi-square test.

Table 3 Phenotypic Antibiotic-Resistance of Bacterial Isolates Carrying Single-Type versus Combined-Types ESBL^a Genes

ESBL Gene	Isolates	Susceptibilities to β-Lactam Antibiotics^b
		AMC-Clav	CL	CXM	CRO	FEP	IMP
bla-KPC	UJ 15	R	R	R	R	R	R
	UJ 21	R	R	R	R	R	S
	UJ 27, C1	R	R	R	R	R	R
	UJ 38	R	R	R	R	S	S
	UJ 45, C1	R	R	R	R	R	R
	UJ 66, C1	R	R	R	R	R	R
	UJ 94	R	R	R	R	R	S
	UJ 123	R	R	R	R	R	R
bla-VIM + bla-KPC	UJ62	R	R	R	R	R	R
bla-IMP	UJ 34	R	R	R	R	R	S
	UJ 69, C1	R	R	R	R	R	R
	UJ 70	R	R	R	S	R	R
	UJ 95	S	R	S	R	S	S
bla-VIM + bla-IMP	UJ 59	R	R	R	R	R	R
bla-NDM-1+ bla-IMP	UJ 40, C1	R	R	R	R	R	R
bla-VIM	UJ 39	R	R	R	R	R	R
	UJ 75	R	R	R	R	R	R
	UJ 76, C1	R	R	R	R	R	R
	UJ 119	R	R	R	R	R	R
bla-NDM-1	UJ 20	R	R	R	R	R	S
	UJ 29	R	R	R	R	R	R
	UJ 49	R	R	R	R	R	R
	UJ 73	R	R	R	R	R	R
	UJ 78, C2	R	R	R	R	R	R
	UJ 90	R	R	R	R	R	R
	UJ 92	R	R	R	R	R	R
bla-VIM + bla-NDM-1	UJ 48	R	R	R	R	R	R
	UJ 87, C1	R	R	R	R	R	R
	UJ 87, C2	R	R	R	R	R	S
	UJ 88	R	R	R	R	R	R
	UJ 105	R	R	R	R	R	S

Notes: ^aESBL, extended spectrum β-lactamase; ^bS, susceptible; R, resistant; AMC-Clav, amoxycillin with clavulanic acid, 30 µg; CL, cephalexin, a first generation cephalosporin antibiotic, 30 µg; CXM, cefuroxime sodium, a second generation cephalosporin antibiotic, 30 µg; CRO, ceftriaxone, a third generation cephalosporin antibiotic, 30 µg; FEP, cefepime, a fourth generation cephalosporin antibiotic, 30 µg; IMP, imipenem, a carbapenem antibiotic, 10 µg.

Figure 3 Overlapping Extended Spectrum β-lactamase (ESBL) genes. The Venn-diagram shows the mutual prevalence of ESBL genes, such as blaKPC, blaIMP, blaVIM, and blaNDM-1 in the uropathogen Klebsiella pneumoniae. Each circle is labeled with the respective gene-name, and the number in the bracket indicates the total count of isolates positive for the specific gene. Numbers in the non-overlapping region show the count of isolates carrying respective single-type ESBL genes. Numerates in the overlapping region indicate the isolate number carrying the respective genes mutually.