Characterization of Hypervirulent Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Among Urinary Tract Infections: The First Report from Iran

Figures & data

Table 1 Clinical and Microbiological Characteristics of hvKp Isolates

Strains Name Clinical Characteristics	Kp3	Kp8	Kp22	Kp27	Kp42	Kp50	Kp51	Kp71	Kp83	Kp97	Kp104
Age	78	63	72	45	52	37	45	1	70	60	43
Gender	Female	Female	Male	Female	Female	Female	Female	Female	Female	Female	Male
Risk factor	Diabetes/ Kidney transplant	Immunosuppress\ Chronic renal insufficiency	Diabetes	Kidney transplant	Diabetes	Diabetes\Immunosuppress	Diabetes	–	Diabetes	Diabetes	Kidney transplant
MDR	Negative	Positive	Negative	Positive	Positive	Negative	Negative	Negative	Positive	Positive	Negative
ESBL	Positive	Positive	Positive	positive	Positive	Negative	Negative	Negative	Positive	Positive	Negative
Quinolone resistance	Positive	Positive	Positive	Positive	Positive	Negative	Negative	Negative	Positive	Positive	Negative
String test (mm)	100	60	70	60	70	90	80	70	50	70	150
Virulence associated genes	rmpA iuca K2 tem ctx-M qnrB qnrS	rmpA iuca Shv Tem qnrB qnrS	rmpA iuca K2 Shv ctx-M qnrB qnrS	rmpA iuca Shv ctx-M qnrA qnrB qnrS	rmpA iuca k2 Shv tem ctx-M qnrA qnrB	rmpA iuca K1 Shv Tem qnrB qnrS	rmpA iuca K1 Shv tem	rmpA iuca K1 Shv ctx-M	rmpA iuca K1 Shv ctx-M qnrB qnrS	rmpA iuca K1 Shv tem qnrA qnrB qnrS	rmpA iuca K1 Shv tem ctx-M qnrB
Antibiotic resistance	CIP NAL CTX	CFM SXT CIP GEN IMI MERO PTZ	CFM SXT CIP	CFM SXT GEN CIP NAL NIT CTX	CFM SXT NAL NIT CTX	NAL	–	CTX	AMC CFM FEP SXT CIP CTX	CFM FEP SXT IMI CIP NAL LEVO OFLA NIT CTX	NAL

Abbreviations: AMC, amoxicillin-clavulanic acid; CFM, cefixime; CTX, cefotaxime; CAZ, ceftazidime; FEP, cefepime; OFLA, ofloxacin; LEVO, levofloxacin; CIP, ciprofloxacin; IMI, imipenem; MERO, meropenem; GEN, gentamycin; NAl, nalidixic acid; PTZ, piperacillin-tazobactam; SXT, trimethoprim-sulfamethoxazole; NIT, nitrofurantoin.

Table 2 Percentage of Antimicrobial Resistance of K. pneumoniae

Total n=105			ESBL Positive n=55	ESBL Negative n=50	P value	ckp n=94	hvkp n=11	P value
R (%)			R (%)	R (%)		R (%)	R (%)
Cephalosporins	Cefixime	55(52.4)	36(65.5)	18(36.0)	0.010	48(51.01)	6(54.5)	0.829
	Cefotaxime	64(61.0)	41(74.5)	23(46.0)	0.005	58(61.7)	6(54.5)	0.645
	Ceftazidime	50(47.6)	40(72.7)	10(20.0)	≥.01	46(48.9)	4(36.4)	0.827
	Cefepime	27(25.7)	21(38.2)	6(12.0)	0.009	25(26.6)	2(18.2)	0.618
	Amoxicillin-clavulanic	22(21.0)	16(29.1)	6(12.0)	0.032	21(22.3)	1(9.1)	0.307
Carbapenemase	Imipenem	7(6.7)	6(10.9)	1(2.0)	0.040	5(5.3)	2(18.2)	0.235
	Meropenem	7(6.7)	5(9.1)	2(4.0)	0.214	6(6.4)	1(9.1)	0.168
Beta-lactam inhibitor	Piperacillin-tazobactam	10(9.5)	8(14.5)	2(4.0)	0.107	9(9.6)	1(9.1)	0.780
30s	Gentamycin	24(22.9)	21(38.2)	3(6.0)	≥.01	22(23.4)	2(18.2)	0.560
	Amikacin	8(7.6)	7(12.7)	1(2.0)	0.041	8(8.5)	0(0.0)	0.524
	Tobramycin	8(7.6)	8(14.5)	0(0.0)	0.012	8(8.5)	0(0.0)	0.562
Fluroguinolone	Ciprofloxacin	72(68.6)	46(83.6)	25(50.0)	≥.01	65(69.1)	6(54.5)	0.337
	Ofloxacin	30(28.6)	23(41.8)	7(14.0)	0.007	29(30.9)	1(9.1)	0.153
	Levofloxacin	30(28.6)	23(41.8)	7(14.0)	0.005	29(30.9)	1(9.1)	0.153
Quinolone	Nalidixic acid	68(64.8)	40(72.7)	23(46.0)	0.005	58(61.7)	5(45.5)	0.444
Sulfonamides	Trimethoprim-sulfamethoxazole	55(52.4)	32(58.2)	23(46.0)	0.441	49(52.1)	6(54.5)	0.508
Nitrofurans	Nitrofurantoin	25(23.8)	14(25.5)	11(22.0)	0.414	22(23.4)	3(27.3)	0.458

Table 3 Frequency of Different ESBL Genes and Capsular Serotype, Among ESBL Positive, ESBL Negative, hvkp and ckp

Genes	Total=105	ESBL Positive	ESBL Negative	P value	Within hvkp (%)	Within ckp (%)	P value
blaSHV	67(63.8)	42(62.7)	25(37.3)	0.005	10(90.9)	57(60.6)	0.048
blaTEM	62 (59.0)	33(53.2)	29(46.8)	0.835	7(63.6)	55(58.5)	0.744
blaCTX-M	61 (58.1)	38(62.3)	23(37.7)	0.017	7(63.6)	54(57.4)	0.694
K1	8 (7.6)	4(50.0)	4 (50.0)	0.888	6(54.5)	2(2.1)	≥.01
K2	70(66.6)	35(50.0)	35 (50.0)	0.253	3(27.3)	66(70.2)	0.005

Table 4 Frequency of Different qnr Genes, Among ESBL Positive, ESBL Negative, hvkp and ckp Strains

Genes	Total= 72	ESBL Positive	ESBL Negative	P value	hvkp (%)	ckp (%)	P value
qnrA	16 (22.2)	6/12(50.0)	10/12(90.9)	0.033	3/7(42.9)	13/16(81.3)	0.066
qnrB	61 (84.7)	34/35(97.1)	27/27(100.0)	0.376	9/10(90.0)	52/52(100.0)	0.022
qnrS	47 (65.2)	26/28(92.9)	21/22(95.5)	0.701	7/10(70.0)	40/40(100.0)	≥.01