Biofilm, virulence, and ESBL-mediated resistance: unmasking Klebsiella spp. UTIs
Abstract
Klebsiella spp. has emerged as the second leading cause of urinary tract infection and a major cause of multidrug resistance. This study investigated the prevalence of genetic determinants related to infection and drug resistance, and the effects of biofilm on drug resistance from urinary tract infection (UTI) patients. A total of 718 clean voided midstream urine samples were collected from different age group patients at Mymensingh Medical College Hospital. Bacterial isolates were initially identified by cultural and biochemical assays, and finally confirmed by rcsA and pheX gene-based polymerase chain reaction (PCR). Antimicrobial susceptibility testing was performed by the disc diffusion method. The presence of virulence, extended-spectrum beta-lactamase (ESBL), and carbapenemase genes was determined by PCR. Biofilm formation was assessed using Congo red agar and microtiter plate assays. Among culture-positive isolates, 22 were confirmed as Klebsiella spp. (20 K. pneumoniae, 2 K. oxytoca), with 77.3% from females. The fimH, mrkD, and uge were the most prevalent virulence genes. Ninety-five percent of isolates were found to be multidrug resistant (MDR), and three were extremely drug resistant (XDR). ESBL genes blaSHV (50%) and blaTEM (40%) predominated, while blaNDM (20%) and blaOXA-48 (10%) were the main carbapenemase genes. Moderate (n = 6; 27.3%) to strong (n = 4; 18.1%) biofilm producers showed significantly higher resistance (P mrkD, uge, and allS as independent…
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