Clinical and genomic characterization of Klebsiella pneumoniae infections in Dhaka, Bangladesh.

Background: Klebsiella pneumoniae (Kpn), a WHO priority pathogen with high rates of antimicrobial resistance (AMR), has emerged as a leading cause of hospital acquired pneumonia and neonatal sepsis.

Objective: We aimed to define the clinical characteristics of a cohort of patients with Kpn infection in Dhaka, Bangladesh and to perform phenotypic and genetic characterization of the associated isolates.

Methods: We retrospectively extracted clinical data about patients at Dhaka Medical College Hospital from whom Klebsiella spp was isolated from a clinical specimen collected between February and September 2022. We used standard microbiologic techniques to evaluate AMR and whole-genome sequencing (WGS) to assess dominant lineages, common capsular (K) and O-polysaccharide (O) antigen types, and AMR and virulence genes.

Results: Ninety-eight patients were included, with diagnoses of pneumonia (38/98, 39%), wound infection (29/98, 31%), urinary tract infection (29/98, 31%) and bacteremia (2/98, 2%). We tested isolates for susceptibility to eight classes of antibiotics. Of the 98 isolates, 41% were multidrug resistant (MDR), 15% were extensively drug resistant (XDR), and 16% were pan-drug resistant (PDR). Three isolates (3%) were resistant to polymyxin B. Outcome data were available for 46 patients; 4 patients (8%) died from infections caused by PDR (n=2), XDR (n=1), and MDR isolates (n=1). WGS revealed a high degree of genomic diversity, with multiple sequence types (STs), O-types and K-types represented; ST16:K81:OL101 and ST43:K30:O1 were the most prevalent.

Conclusion: Our findings suggest alarming levels of AMR among Kpn isolates in Bangladesh and a critical need for improved treatment modalities and vaccine development.