Main Article Content

Abstract

One of the most significant opportunistic Gram-negative bacteria that frequently
linked to catheter associated and urinary tract infection is Klebsiella pneumoniae.
Their ability to produce biofilms and antibiotic resistance are the two main factors
that contribute to the persistent infections. The dissemination of carbapenems and
fluoroquinolones resistance offers a significant confrontation to the treatment of
life-threatening infections produced by K. pneumoniae. The study aimed to
investigation the prevalence of the carbapenems and fluoroquinolones resistance
genes (blaOXA-48, and qnrS) in K. pneumoniae. From December 2023 until July
2024, a total of 200 samples were collected in this study including urine (n=100,
50%), and semen (n=100, 50%) from admitted patients to Fertility Center and
outpatient from Private Labs in Al-Najaf, Al-Diwaniyah and Karbala
governorates. Semen culture and urine culture were done for all the patients.
Using Vitek2 compact system to identification and susceptibility to antibiotic
profiling of K. pneumoniae. PCR experiment were performed on the isolates with
specific primers to blaOXA-48, and qnrS. The results showed the recovery rate of K.
pneumoniae isolates was (n= 17, 8.5%) from the clinical samples, divided as
follow 13 isolates from urine and four isolates from semen, The prevalence of
carbapenem resistance gene among K. pneumoniae isolates was to blaOXA-48 gene
(64.7%), While fluroquinolones resistance gene qnrS was (94%). The study
concluded increased carbapenem and fluoroquinolone resistance gene in Al
Najaf, Al-Diwaniyah and Karbala governorates highlights the importance of this
problem while managing life-threatening multidrug-resistant K. pneumoniae
infections.

Keywords

Carbapenem Resistance fluoroquinolone resistance MDR K. pneumoniae genitourinary tract infections

Article Details

References

  1. Salama, L., Elageery, S., Alkasaby, N., Abou El-Khier, N., Fawzy, I., Zeid, M., & Badr, D. Molecular Characterization of
  2. Carbapenamases in Hypervirulent Klebsiella pneumoniae Isolates among Pediatric Patients. Egyptian Journal of Medical
  3. Microbiology. 2025; 34(1), 111-118. DOI: 10.21608/ejmm.2024.322402.1342
  4. Nordmann P., and Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide.
  5. Clin Microbiol Infect. 2014, 20(9): 821-830. DOI: 10.1111/1469-0691.12719.
  6. Tsai Y.K., Liou C.H., Fung C.P., Lin J.C., and Siu L.K. Single or in combination antimicrobial resistance mechanisms of Klebsiella
  7. pneumoniae contribute to varied susceptibility to different carbapenems. PLOS ONE. 2013, 8(11):
  8. e79640. DOI:
  9. 1371/journal.pone.0079640.
  10. Soleimani-Asl Y, Zibaei M, and Firoozeh F. Detection of qnrA gene among quinolone-resistant Escherichia coli isolated from
  11. urinary tract infections in Khorram Abad during 2011-2012. Feyz Medical Sciences Journal. 2013;17(5):488-94. URL:
  12. http://feyz.kaums.ac.ir/article-1-2043-en.html
  13. Ezzulddin, B., & Nooraldeen, M. Study of entB Gene and Some Quinolone Resistance Genes (qnrB and acc(6’)-Ib-cr) of Klebsiella
  14. pneumoniae in Community-Acquired Infections in Kirkuk City. Egyptian Journal of Medical Microbiology. 2025; 34(3), -. DOI:
  15. 21608/ejmm.2025.357953.1463
  16. Hoseinzadeh M, Sedighi M, Yahyapour Y, Javanian M, Beiranvand M, Mohammadi M, Zarei S, Pournajaf A, Ebrahimzadeh
  17. Namvar A. Prevalence of plasmid-mediated quinolone resistance genes in extended-spectrum beta-lactamase producing Klebsiella
  18. pneumoniae isolates in northern Iran. Heliyon. 2024; 10(18): e37534. DOI: 10.1016/j.heliyon. 2024.e37534.
  19. Sharaf, S., Ali, H., Salah, M., & Kamel, Z. Insight on the Prevalence of Clinical Klebsiella Isolates Producing Extended Spectrum
  20. Beta-Lactamases. Egyptian Journal of Medical Microbiology. 2024; 33(3), 125-131. DOI: 10.21608/ejmm.2024.298504.1267
  21. Foudraine, D.E.; Strepis, N.; Klaassen, C.H.W.; Raaphorst, M.N.; Verbon, A.; Luider, T.M.; et al. Rapid and Accurate Detection
  22. of Aminoglycoside-Modifying Enzymes and 16S rRNA Methyltransferases by Targeted Liquid Chromatography-Tandem Mass
  23. Spectrometry. J. Clin. Microbiol. 2021; 59(7): e0046421. DOI: 10.1128/JCM.00464-21.
  24. Doménech-Sánchez, A.; Martínez-Martínez, L.; Hernández-Allés, S.; Conejo, M.D.C.; Pascual, A.; Tomás, J.M.; et al. Role of
  25. Klebsiella pneumoniae OmpK35 porin in antimicrobial resistance. Antimicrob. Agents Chemother. 2003, 47(10):3332-5. DOI:
  26. 1128/AAC.47.10.3332-3335.2003.
  27. El-sayed, H., El Maghraby, H., Hussein, S., El Azawy, D., Attia, O., Mousa, B., Orabi, E., & Fahmy, Y. Acr AB and Oxq AB
  28. Efflux Pump Genes Among Resistant Klebsiella pneumoniae Isolated from Zagazig University Hospitals. Egyptian Journal of Medical
  29. Microbiology. 2024; 33(3), 67-75. DOI: 10.21608/ejmm.2024.297587.1264
  30. Nordmann, P.; Dortet, L.; and Poirel, L. Carbapenem resistance in Enterobacteriaceae: Here is the storm! Trends Mol. Med. 2012,
  31. (5): 263–272. DOI: 10.1016/j.molmed.2012.03.003.
  32. Shash R. Y, Mohamed G. A, Sheb S. E., Shokr M, and Soliman A. S. The Impact of Bacteriospermia on Semen Parameters Among
  33. Infertile Egyptian Men:A Case–Control Study. American Journal of Men’s Health. 2023; 17(3):15579883231181861. DOI:
  34. 1177/15579883231181861.
  35. Szkodziak F, Krzyżanowski J, Szkodziak P. Psychological aspects of infertility. A systematic review. J Int Med Res. 2020;
  36. (6):300060520932403. DOI: 10.1177/0300060520932403.
  37. Ochsendorf F. R. Sexually transmitted infections: impact on male fertility. Andrologia. 2008, 40(2): 72–75. DOI: 10.1111/j.1439
  38. 2007.00825.x.
  39. Zuleta-Gonzalez MC, Zapata-Salazar ME, Guerrero-Hurtado LS, Puerta-Suarez J, and Cardona-Maya WD. Klebsiella pneumoniae
  40. and Streptococcus agalactiae: passengers in the sperm travel. Arch Esp Urol. 2019; 72:939e47. PMID: 31697255.
  41. Chegini, Z.; Khoshbayan, A.; Vesal, S.; Moradabadi, A.; Hashemi, A.; and Shariati, A. Bacteriophage therapy for inhibition of
  42. multi drug-resistant uropathogenic bacteria: A narrative review. Ann. Clin. Microbiol. Antimicrob. 2021, 26;20(1):30. DOI:
  43. 1186/s12941-021-00433-y.
  44. Foxman, B. The epidemiology of urinary tract infection. Nat. Rev. Urol. 2010, 7(12):653-60. DOI: 10.1038/nrurol.2010.190.
  45. Parija, S. C. Textbook of practical microbiology. Ahuja Publishing House, 2007.
  46. CLSI. Performance Standards for Antimicrobial Susceptibility Testing. 31st ed. CLSI supplement M100. Clinical and Laboratory
  47. Standards Institute, 2021.
  48. Al-Agamy MH, Aljallal A, Radwan HH, and Shibl AM. Characterization of carbapenemases, ESBLs, and plasmid-mediated
  49. quinolone determinants in carbapenem-insensitive Escherichia coli and Klebsiella pneumoniae in Riyadh hospitals. Journal of infection
  50. and public health. 2018;11(1):64-68. DOI: 10.1016/j.jiph.2017.03.010.
  51. Cattoir V., Poirel L., Rotimi V., Soussy C.-J., and Nordmann P. Multiplex PCR for detection of plasmid-mediated quinolone
  52. resistance qnr genes in ESBL-producing enterobacterial isolates. Journal of Antimicrobial Chemotherapy. 2007, 60(2): 394–397. DOI:
  53. 1093/jac/dkm204.
  54. Al-Azawi I. H. Detection of Extended Spectrum Beta Lactamase (ESBL) in Klebseilla pneumoniae Isolated from Urinary Tract
  55. Infections. AL-Qadisiya Medical Journal. 2014, 10(18): 168-173.
  56. Rawat D, and Nair D. Extended-spectrum beta-lactamases in Gram negative bacteria. J Glob Infect Dis. 2010;2(3):263–274. DOI:
  57. 4103/0974-777X.68531.
  58. Agodi A, Barchitta M, Quattrocchi A, et al. Antibiotic trends of Klebsiella pneumoniae and Acinetobacter baumannii resistance
  59. indicators in an intensive care unit of Southern Italy, 2008–2013. Antimicrob Resist Infect Control. 2015;4(1):43–49.
  60. DOI:10.1186/s13756-015-0087-y.
  61. Federico MP, and Furtado GH. Immediate and later impacts of antimicrobial consumption on carbapenem-resistant Acinetobacter
  62. spp., Pseudomonas aeruginosa, and Klebsiella spp. in a teaching hospital in Brazil: a 10-year trend study. Eur J Clin Microbiol Infect
  63. Dis. 2018;37(11):2153–2158. DOI: 10.1007/s10096-018-3352-1.
  64. Qu X, Wang H, Chen C, et al. Surveillance of carbapenem-resistant Klebsiella pneumoniae in Chinese hospitals - a five-year
  65. retrospective study. J Infect Dev Ctries. 2019;13(12):1101–1107. DOI: 10.3855/jidc.11798.
  66. Al-Kamoosi A. M, AL-Azawi I. H. Detection of Capsular Polysaccharide Virulence Genes rmpA and magA of Klebsiella
  67. Pneumonia Isolate from Diabetic Foot Ulcer Patient in Najaf Governorate in Iraq. Indian Journal of Forensic Medicine & Toxicology.
  68. , 15(2): 3061-3067. DOI: https://doi.org/10.37506/ijfmt.v15i2.14841.
  69. Tzouvelekis L.S., Markogiannakis A., Psichogiou M., Tassios P.T., and Daikos G.L. Carbapenemases in Klebsiella Pneumoniae
  70. and Other Enterobacteriaceae: An Evolving Crisis of Global Dimensions. Clin. Microbiol. Rev. 2012; 25(4):682–707. DOI:
  71. 1128/CMR.05035-11.
  72. Shibl A., Al-agamy M., Memish Z., Senok A. The Emergence of OXA-48- and NDM-1-Positive Klebsiella pneumoniae in Riyadh,
  73. Saudi Arabia. Int. J. Infect. Dis. 2013;17(12): e1130–e1133. DOI: 10.1016/j.ijid.2013.06.016.
  74. Karn S, Pant ND, Neupane S, Khatiwada S, Basnyat S, and Shrestha B. Prevalence of carbapenem resistant bacterial strains
  75. isolated from different clinical samples: study from a tertiary care hospital in Kathmandu, Nepal. JBS. 2016;3(1):11–15. DOI:
  76. https://doi.org/10.3126/jbs.v3i1.16846.
  77. Datta P, Gupta V, Garg S, and Chander J. Phenotypic method for differentiation of carbapenemases in Enterobacteriaceae: study
  78. from north India. Indian J Pathol Microbiol. 2012;55(3):357–360. DOI: 10.4103/0377-4929.101744.
  79. Bora A, Sanjana R, Jha BK, Mahaseth SN, and Pokharel K. Incidence of metallo-beta-lactamase producing clinical isolates of
  80. Escherichia coli and Klebsiella pneumoniae in central Nepal. BMC Res Notes. 2014;7(1):557. DOI:10.1186/1756-0500-7-557.
  81. Kishk Rania, Azab Marwa, Hassan Ranya, and Dessouki Omar. Molecular Detection of bla OXA-48 Carbapenemase in
  82. Uropathogenic Klebsiella pneumoniae Strains from Suez Canal University Hospital. Egyptian Journal of Medical Microbiology. 2019,
  83. (3), 71-77. DOI: 10.21608/ejmm.2019.283029
  84. Moodley A and Perovic O. Phenotypic and genotypic correlation of carbapenememase-producing Enterobacteriaceae and
  85. problems experienced in routine screening. S Afr Med J. 2018; 108(6):495-501. DOI: 10.7196/SAMJ.2018.v108i6.12878.
  86. Smriti S, Panda SS, Dash RK, Singh N, Das L, Pattnaik D. Antibiogram of Escherichia coli and Klebsiella pneumoniae Urinary
  87. Isolates and Susceptibility of Amikacin in Extended-spectrum Beta-Lactamase Producers. J Pure Appl Microbiol. 2025;19(1):714-722.
  88. DOI: 10.22207/JPAM.19.1.62
  89. Nishino K, Yamasaki S, Nakashima R, Zwama M, Hayashi-Nishino M. Function and Inhibitory Mechanisms of Multidrug Efflux
  90. Pumps. Front Microbiol. 2021, 3;12:737288. DOI: 10.3389/fmicb.2021.737288.
  91. Livermore DM. Has the era of untreatable infections arrived? J Antimicrob Chemother. 2009;64(1):29–36. DOI:
  92. 1093/jac/dkp255.
  93. Minh Vien LT, Baker S, Phuong Thao LT, Phuong Tu LT, Thu Thuy C, Thu Nga TT, Minh Hoang NV, Campbell JI, Minh Yen
  94. L, Trong Hieu N, Vinh Chau NV, Farrar J, Schultsz C. High prevalence of plasmid-mediated quinolone resistance determinants in
  95. commensal members of the Enterobacteriaceae in Ho Chi Minh City, Vietnam. J Med Microbiol. 2009;58(Pt 12):1585-1592. DOI:
  96. 1099/jmm.0.010033-0.
  97. Okade H, Nakagawa S, Sakagami T, Hisada H, Nomura N, Mitsuyama J, Yamagishi Y, and Mikamo H. Characterization of
  98. plasmid-mediated quinolone resistance determinants in Klebsiella pneumoniae and Escherichia coli from Tokai, Japan. J. Infect.
  99. Chemother. 2014; 20(12):778-783. DOI: 10.1016/j.jiac.2014.08.018.
  100. Taitt CR, Leski TA, Erwin DP, Odundo EA, Kipkemoi NC, Ndonye JN, et al. antimicrobial resistance of Klebsiella pneumoniae
  101. stool isolates circulating in Kenya. Plos one. 2017; 12(6):e0178880. DOI: 10.1371/journal.pone.0178880.
  102. Sani, G.S., Ghane, M. & Babaeekhou, L. Fluoroquinolone-resistance mechanisms and molecular epidemiology of ciprofloxacin
  103. resistant Klebsiella pneumoniae isolates in Iran. Folia Microbiol. 2023, 68(4): 633–644. DOI: 10.1007/s12223-023-01042-2.
  104. Jacoby GA, Strahilevitz J, and Hooper DC. Plasmid‐mediated quinolone resistance. Microbiol Spectr. 2014;
  105. (5):10.1128/microbiolspec. PLAS-0006-2013. DOI: 10.1128/microbiolspec.
  106. Vol., No. , Year, pp.
  107. Mashaly, G., Mohammed, H., & Nagib, H. Plasmid Mediated Quinolone Resistance Genes (Qnr A and S) in Klebsiella pneumoniae
  108. Isolated from ICU Hospital Acquired Infection. Egyptian Journal of Medical Microbiology. 2022; 31(4), 165-171. DOI:
  109. 21608/ejmm.2022.265573

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