Analysis of the Correlation Between Antibiotic Resistance Patterns and Virulence Determinants in Pathogenic Klebsiella pneumoniae Isolates from Egypt

Klebsiella pneumoniae is responsible for a plethora of infections involving multiple body systems. This study investigated K. pneumoniae clinical isolates for virulence-associated characters and antibiotic resistance. First, antibiotic sensitivity was determined for 40 K. pneumoniae clinical isolates. Some virulence and resistance-associated factors were studied phenotypically and genotypically. Multiple resistance profiles were observed (multidrug resistant [MDR; 42.5%], extensive drug resistant [XDR; 35%], and pandrug resistant [PDR; 5%]). Moreover, CTX-M-1, TEM, qnrS, and qnrA genes were detected in 70%, 30%, 60%, and 30% of selected isolates, respectively, and 40% of tested isolates were extended-spectrum beta-lactamases (ESBLs) producers. Interestingly, all ESBLs producers harbored class 1 integrase gene (IntI1), while 60% of ESBLs producers harbored both CTX-M-1 and TEM. All tested isolates were capsulated while 87.5% were biofilm producers. Fimbriae were detected in 90% of tested isolates (all were biofilm producers and type 3 fimbriae adhesion gene [mrkD] positive). Sequence analysis of OXA-48, qnrS, and IntI1 revealed 100% identity with published sequences, while sequencing of qnrA, OmpK-35, and iron regulatory protein gene (irp2) showed minor variations in the form of one or few single-nucleotide polymorphism. Altogether, the current study revealed that all MDR, XDR, and PDR K. pneumoniae isolates were multivirulent and all harbored 3-5 virulence genes and 2-9 antimicrobial resistance genes and exhibited 8 and 10 different virulence and antimicrobial resistance profiles, respectively. In this study, we also report a positive correlation between some virulence genes and antimicrobial resistance genes among K. pneumoniae tested isolates.