Kalaivani Ramakrishnan

Abstract

Introduction: Klebsiella spp. is well known hospital as well as community acquired bacterial pathogen. It is prone to cause severe pyogenic infections like bronchopneumonia, UTI, nosocomial infection, wound infection, septicaemia, meningitis, and rarely diarrhoea leading to marked fatality rate. Klebsiella spp. primarily attack immunocompromised individuals who are hospitalized and suffering from severe underlying diseases such as diabetes mellitus, chronic pulmonary obstruction and others. By acquiring various enzymes and virulence factors, it worsens patient’s life. Thus we aimed to detect various virulence factors among the clinical isolates of Klebsiella pneumoniae. Aim: To study the prevalence of various virulence factors among Klebsiella pneumoniae isolates. Materials and Methods: Total of 115 clinical isolates of Klebsiella spp. from various clinical samples during January 2015 to June 2015 were included. Virulence factors includes biofilm formation, lipase, lecithinase, haemagglutination, protease, gelatinase, haemolysis and hypermucoviscosity were detected by standard technique. Result: Out of 115 isolates, 55% and 45% of Klebsiella pneumoniae isolates were from female and male patients. Majority of isolates were isolated from urine samples (67%) followed by 27% exudate, sputum 19% and blood 17%. Among these, 79% showed biofilm formation, 58% haemagglutination and lipase formation, 56% lecithinase, 44% protease, 41% gelatinase production and 7% hypermucoviscosity. More than 3 virulence factors were observed in 93% of isolates. Conclusion: Presence of multiple virulence factors increases pathogenic ability leading to therapeutic challenges. Among various virulence factors, biofilm formation, lecithinase and phospholipase was found to be the predominant virulence factors among the Klebsiella pneumoniae isolates. Keywords: Klebsiella pneumoniae, Virulence factors, Gram negative bacteria, Phenotypic method, Virulence detection.

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Abstract

Introduction: Neonatal sepsis is a major cause of neonatal mortality, the clinical outcome of which depends on early diagnosis and initiation of appropriate antibiotics. The emergence of multi-drug resistant strains has limited the choice of available antibiotics. Thus, antibiotic resistance pattern of pathogens iscritical for both therapy and infection control. Objective: To determine the etiological agents of neonatal sepsis and their antibiotic resistance pattern. Materials and Methods: In this study, all neonates with suspected sepsis, admitted to neonatal intensive care unit during January to December, 2014 were included. Aerobic blood culture was done using BACTEC FX system. Identification and antibiotic susceptibility testing of isolates from positive cultures was carried out. Results: Out of 522 neonates who developed clinical sepsis, 64 grew pathogens on blood culture. The most common organisms were coagulase negative Staphylococcus species (CONS)(32.8%), Klebsiella pneumoniae (18.7%), Escherichia coli (9.4%), Enterococcus faecalis (7.8%) and Candida species (7.8%). The gram negative isolates showed high resistance to ampicillin (90%), gentamicin (70%), ceftriaxone (66.7%), cotrimoxazole (56.7%), amikacin (53.3%) and ciprofloxacin (43.3%). In contrast, imipenem (16.7%), piperacillin-tazobactam (26.7%) and cefepime-tazobactam (0%) were effective with lower resistance rates. A large majority of the Enterobactericeae isolates (66.7%) were extended spectrum beta-lactamase producers. Among the gram positive isolates, resistance to penicillin, erythromycin and ciprofloxacin were 93.1%, 62.1%and 51.7% respectively. These strains showed uniform sensitivity to vancomycin, teicoplanin and linezolid. Conclusion: While CONS were the predominant isolate, gram negative bacilli and Enterococcus sp have shown high resistance to commonly used antibiotics. Low resistance was observed with Cefepime-tazobactam, imipenem (for gram-negative isolates) and vancomycin, teicoplanin and linezolid (for gram-positive isolates) in our study. Keywords: Neonatal sepsis, Bacteraemia, Antibiotic resistance, Blood culture.

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