Autor(es):
Massinga, Arsénia J. ; Garrine, Marcelino ; Messa, Augusto ; Nobela, Nélio A. ; Boisen, Nadia ; Massora, Sergio ; Cossa, Anélsio ; Varo, Rosauro ; Sitoe, António ; Hurtado, Juan Carlos ; Ordi, Jaume ; Mucavele, Hélio ; Nhampossa, Tacilta ; Breiman, Robert F. ; Whitney, Cynthia G. ; Blau, Dianna M. ; Bassat, Quique ; Mandomando, Inácio
Data: 2021
Identificador Persistente: http://hdl.handle.net/10362/180763
Origem: Repositório Institucional da UNL
Assunto(s): Bacteremia; CTX-M-15; ESBL genes; Hypermucoviscosity; Hypervirulence; Mozambique; SPATEs; Infectious Diseases; Biochemistry, Genetics and Molecular Biology (miscellaneous); Microbiology; Epidemiology; Pharmacology, Toxicology and Pharmaceutics (miscellaneous); SDG 3 - Good Health and Well-being; SDG 10 - Reduced Inequalities
Descrição
Funding Information: CISM is supported by the Government of Mozambique and the Spanish Agency for International Development Cooperation (AECID). CHAMPS is funded by the Bill & Melinda Gates Foundation under the Grant OPP1126780 to Robert Breiman, subcontract SC00003286. ISGlobal receives support from the Spanish Ministry of Science and Innovation through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018–000806-S), and support from the Generalitat de Catalunya through the CERCA Program. Funding Information: The authors thank the CISM and MDH staff for collecting and processing data; and the District Health Authorities for their collaboration in the research activities on-going in the Manhi?a district. Special thanks for the CISM Microbiology and Molecular Biology laboratory technicians for sample processing, particularly Sultuane Giv?, Samira Sirage, Mariano Sita?be, Esperan?a L?zaro and Efraim Honwana. We are indebted to the children and mothers/caretakers for participating in the study. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of [the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry]. Publisher Copyright: © 2021, The Author(s).
Background: Klebsiella spp. are important pathogens associated with bacteremia among admitted children and is among the leading cause of death in children < 5 years in postmortem studies, supporting a larger role than previously considered in childhood mortality. Herein, we compared the antimicrobial susceptibility, mechanisms of resistance, and the virulence profile of Klebsiella spp. from admitted and postmortem children. Methods: Antimicrobial susceptibility and virulence factors of Klebsiella spp. recovered from blood samples collected upon admission to the hospital (n = 88) and postmortem blood (n = 23) from children < 5 years were assessed by disk diffusion and multiplex PCR. Results: Klebsiella isolates from postmortem blood were likely to be ceftriaxone resistant (69.6%, 16/23 vs. 48.9%, 43/88, p = 0.045) or extended-spectrum β-lactamase (ESBL) producers (60.9%, 14/23 vs. 25%, 22/88, p = 0.001) compared to those from admitted children. blaCTX-M-15 was the most frequent ESBL gene: 65.3%, 9/14 in postmortem isolates and 22.7% (5/22) from admitted children. We found higher frequency of genes associated with hypermucoviscosity phenotype and invasin in postmortem isolates than those from admitted children: rmpA (30.4%; 7/23 vs. 9.1%, 8/88, p = 0.011), wzi-K1 (34.7%; 8/23 vs. 8%; 7/88, p = 0.002) and traT (60.8%; 14/23 vs. 10.2%; 9/88, p < 0.0001), respectively. Additionally, serine protease auto-transporters of Enterobacteriaceae were detected from 1.8% (pic) to 12.6% (pet) among all isolates. Klebsiella case fatality rate was 30.7% (23/75). Conclusion: Multidrug resistant Klebsiella spp. harboring genes associated with hypermucoviscosity phenotype has emerged in Mozambique causing invasive fatal disease in children; highlighting the urgent need for prompt diagnosis, appropriate treatment and effective preventive measures for infection control.
