Relationship between hypermucoviscous property and antimicrobial suspectibility profile of Klebsiella pneumoniae isolates in the clinical microbiology laboratory, College of Health Sciences, Makerere University.

Abstract

Introduction: Hypermucoviscous K. pneumoniae which was first described in the Asian Pacific Rim in the mid-1980s and 1990 has become an emerging strain and has been considered hypervirulent. This hypermucoviscous variant has been associated with considerable morbidity and mortality despite antibiotic therapy. However, it is not clear if there is an association between hypermucoviscous K. pneumoniae and antibiotic resistance profile. Therefore, this study was aimed at determining the association between the hypermucoviscous K. pneumoniae and antibiotic resistance profile in the Clinical Microbiology laboratory. Objectives: Prevalence of hypermucoviscous strains, antimicrobial resistance profile, association between antimicrobial resistance profile and hypermucoviscous strains of K. pneumoniae were evaluated. Methods: In this cross-sectional study, we examined N=75 K. pneumoniae isolates from clinical specimens received in the Clinical Microbiology Laboratory from September 2020 to September 2021 inclusive. The K. pneumoniae isolates were subjected to the string test to determine the phenotypic characteristics of hypermucoviscosity. Antimicrobial susceptibility testing was performed using the disk diffusion method according to the standard operating procedures of the Clinical Microbiology Laboratory. Data on the string test and antimicrobial susceptibility were entered and analyzed in Microsoft Excel 365 (2016 Version). Association between hypermucoviscosity and antimicrobial susceptibility was determined using the Chi square test. Results: Results were valid for N= 75 specimens Klebsiella pneumoniae isolates. The prevalence of the hypermucoviscous strains of K. pneumoniae were (15%, 11/75). The majority of the hypermucoviscous K. pneumoniae were from blood culture specimens (45.45%,5/11), followed tracheal aspirate (18.18%,2/11), pus aspirate, urine, sputum and pleural fluid (each with 9.09%, 1/11). However, pus swabs, wound swabs, and cerebrospinal fluid specimens showed no hypermucoviscous strains. K. pneumoniae isolates were most resistant to piperacillin (100%) and least resistant to imipenem (13%). An increased resistance to third generation cephalosporins was also observed. However, the study showed no association between hypermucoviscous phenotype and antimicrobial resistance profile. Conclusions: Our findings showed no association between antibiotic resistance profile and hypermucoviscous property of Kp. However, we noted an increased antibiotic resistance mainly against third generation cephalosporins which now limits treatment options of Klebsiella pneumoniae infections in Uganda.