PHENOTYPIC CHARACTERIZATION OF VIRULENCE FACTORS AND ANTIBIOGRAM OF KLEBSIELLA PNEUMONIAE ISOLATED FROM DIFFERENT CLINICAL SPECIMENS – A CROSS SECTIONAL STUDY

Abstract

BACKGROUND : Klebsiella pneumoniae is gram negative, non-motile, capsulated organism. It is ubiquitous in nature, which is known to cause both community acquired and hospital acquired infections. It normally resides on the mucosal surfaces of gastrointestinal tract and occasionally in nasopharynx, thus it can gain entry into circulation and other tissues causing infections. Klebsiella pneumoniae produces life threatening infections among the critically ill patients. K. pneumoniae pathogenicity is mainly dependant on various virulence factors which allows it to overcome the host`s innate immunity and therefore produce infection in a mammalian host. These virulence factors will help in its survival in various environmental conditions. There are 2 main types of Klebsiella pneumoniae strains “classic Klebsiella pneumoniae [cKp] and hypervirulent Klebsiella pneumoniae [hvKp]. The identification of virulence factors and prompt detection of antimicrobial resistance will help the clinicians to treat the cases aggressively resulting in the better management of cases. MATERIALS & METHODS : A cross sectional observational study, conducted in Department of Microbiology of R.L. Jalappa Hospital and Research Centre, Tamaka, Kolar, from October 2019 to May 2021. Sample size of 150 RESULTS : The findings of our study on virulence factors are as follows : hemolysis 4.66 %(7 isolates), capsule 100 % (150 isolates), hypermucoviscosity (HMV) formation 44 % (66 isolates), biofilm production 54 % (81 isolates), siderophore production 73.33 % (110 isolates), protease 90 % (135 isolates), gelatinase 84 % (126 isolates), lipase production 79.33 % (119 isolates), lecithinase activity 54.66 % (82 isolates). The antibiotic resistance pattern as follows : Piperacillin (90.66 %), Piperacillin tazobactum (67.33 %), Ampicillin (100 %), Amoxyclav (90.66 %), Cefotaxime (84 %), Ceftriaxone (82.66 %), Ceftazidime (82.66 %), Ceftazidime-clavulanic acid (71.33 %), Cefoxitin (67.33 %), Cotrimoxazole (71.33 %), Imipenem (63.33 %), Meropenem (70.0 %), Ertapenem (62.66 %), Amikacin (66 %), Gentamicin (65.33 %), Tobramycin (72.0 %), Chloramphenicol (38.66 %), Doxycycline (79.33 %), Ciprofloxacin (75.33 %), Levofloxacin (70. 66 %), Norfloxacin (66.67 %), Nitrofurantoin (77.78 %). ESBL K. pneumoniae 16.67 % (n = 25 isolates), AmpC producer type 14.67 % (n = 22), multi drug resistance (MDR) – 74.20 % (n = 116), extensive drug resistant (XDR) – 20 % (n = 30), pan drug resistant (PDR) – 28 % (n = 42). Total carbapenem resistance in our study : average 65.33 % reported. CONCLUSION : The increasing coexistence of the virulence factors & antimicrobial is of particular concern as it can lead to untreatable and invasive K. pneumoniae infections. Active surveillance to be done not only for antimicrobial resistance, but also for virulence determinants is imperative now to avoid the transmission and spread of multidrug resistant strains.