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Detection Of Hypermucoviscous Klebsiella Pneumoniae And Phenotypic Comparison Of Their Virulence Factors With Classical Strains Among Patients Visiting Tertiary Care Hospital
Govardhan Joshi
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3819-2303
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Background: Klebsiella pneumoniae which are commonly recognized in laboratory are termed as classical K. pneumoniae (cKP). A new strain of K. pneumoniae named hypermucoviscous K. pneumoniae (hmvKP) emerging with a distinctive feature than classical strains. Our study aimed to determine the prevalence of hypermucoviscous K. pneumoniae in our hospital and their phenotypic comparison with the classical strains.
Methods : This laboratory-based cross-sectional study done from February to July 2018, in the Department of Microbiology, Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. One hundred and five clinical non-duplicative isolates of K. pneumoniae proceeded for the study. Hypermucoviscosity of isolated K. pneumoniae were tested by standard String test. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Further β-lactamases (ESBL, MBL, and KPC) were detected by the phenotypic combination disk test method. Serum resistance and biofilm production were determined to assess their virulence.
Results: A total of one hundred five non-repetitive pure and microbiologically identified K. pneumoniae were taken for study. Among the isolated K. pneumoniae, 29 (27.6%) were hypermucoviscous K. pneumoniae (hmvKP) and 76(72.4%) were classical K. pneumoniae (cKP) determined by string test. The majority of K. pneumoniae were resistant to ceftazidime (80%) and cefotaxime (78%) whereas all the isolates were found susceptible to polymyxin b and colistin. Extended spectrum beta lactamase (ESBLs) production, Metallo-beta lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC) production, biofilm, and serum resistance were compared among classical and hypermucoviscos strains and the hypermucoviscous strains revealed significantly higher expression of virulence than classical strains
Conclusion: The expression of virulence factors and antimicrobial resistance was found significantly higher among the hypermucoviscous strains when phenotypically compared. The prevalence of these hypermucoviscous strains in hospital settings may increase the risk of morbidity and mortality. Therefore, timely diagnosis and appropriate treatment strategies are crucial.
Keywords
Hypermucoviscosity, Klebsiella pneumoniae, Multi-Drug Resistance, Biofilm, Serum resistance, Nepal
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On 03 Jan, 2021
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On 25 Aug, 2020
Review #3 received
Received 20 Aug, 2020
Review #4 received
Received 16 Aug, 2020
Review #2 received
Received 12 Aug, 2020
Reviewer #4 agreed
On 07 Aug, 2020
Reviewer #3 agreed
On 06 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Reviewers invited
Invitations sent on 24 Jul, 2020
Editor assigned
On 10 Jul, 2020
Submission checks complete
On 09 Jul, 2020
Editor invited
On 09 Jul, 2020
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On 08 Jul, 2020
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Subject Areas
Infectious Diseases
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This preprint is under consideration at BMC Infectious Diseases. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Detection Of Hypermucoviscous Klebsiella Pneumoniae And Phenotypic Comparison Of Their Virulence Factors With Classical Strains Among Patients Visiting Tertiary Care Hospital
Govardhan Joshi
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3819-2303
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 13 Jan, 2021
No community comments so far
Editor assigned
On 03 Jan, 2021
Submission checks complete
On 03 Jan, 2021
Editor invited
On 03 Jan, 2021
No comments provided
Editorial decision: Major revision
On 25 Aug, 2020
Review #3 received
Received 20 Aug, 2020
Review #4 received
Received 16 Aug, 2020
Review #2 received
Received 12 Aug, 2020
Reviewer #4 agreed
On 07 Aug, 2020
Reviewer #3 agreed
On 06 Aug, 2020
Reviewer #2 agreed
On 05 Aug, 2020
Review #1 received
Received 04 Aug, 2020
Reviewer #1 agreed
On 28 Jul, 2020
Reviewers invited
Invitations sent on 24 Jul, 2020
Editor assigned
On 10 Jul, 2020
Submission checks complete
On 09 Jul, 2020
Editor invited
On 09 Jul, 2020
First submitted
On 08 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: Klebsiella pneumoniae which are commonly recognized in laboratory are termed as classical K. pneumoniae (cKP). A new strain of K. pneumoniae named hypermucoviscous K. pneumoniae (hmvKP) emerging with a distinctive feature than classical strains. Our study aimed to determine the prevalence of hypermucoviscous K. pneumoniae in our hospital and their phenotypic comparison with the classical strains.
Methods : This laboratory-based cross-sectional study done from February to July 2018, in the Department of Microbiology, Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. One hundred and five clinical non-duplicative isolates of K. pneumoniae proceeded for the study. Hypermucoviscosity of isolated K. pneumoniae were tested by standard String test. Antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Further β-lactamases (ESBL, MBL, and KPC) were detected by the phenotypic combination disk test method. Serum resistance and biofilm production were determined to assess their virulence.
Results: A total of one hundred five non-repetitive pure and microbiologically identified K. pneumoniae were taken for study. Among the isolated K. pneumoniae, 29 (27.6%) were hypermucoviscous K. pneumoniae (hmvKP) and 76(72.4%) were classical K. pneumoniae (cKP) determined by string test. The majority of K. pneumoniae were resistant to ceftazidime (80%) and cefotaxime (78%) whereas all the isolates were found susceptible to polymyxin b and colistin. Extended spectrum beta lactamase (ESBLs) production, Metallo-beta lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC) production, biofilm, and serum resistance were compared among classical and hypermucoviscos strains and the hypermucoviscous strains revealed significantly higher expression of virulence than classical strains
Conclusion: The expression of virulence factors and antimicrobial resistance was found significantly higher among the hypermucoviscous strains when phenotypically compared. The prevalence of these hypermucoviscous strains in hospital settings may increase the risk of morbidity and mortality. Therefore, timely diagnosis and appropriate treatment strategies are crucial.
Figure 1