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Microbiology spectrum2022; 10(3); e0215821; doi: 10.1128/spectrum.02158-21

Co-Occurrence of Multidrug Resistant Klebsiella pneumoniae Pathogenic Clones of Human Relevance in an Equine Pneumonia Case.

Abstract: The global epidemiology of multidrug resistant Klebsiella pneumoniae, a serious threat to both animal and human health, is dominated by the spread of pathogenic clones, each separately evolving via acquisition of transferable antibiotic resistance or niche-specific virulence determinants. In horses, K. pneumoniae infection can lead to severe respiratory illness. Here, we characterized multiple isolates recovered from bronchial aspirates of a mare with pneumonia refractory to antibiotics. First, we used a combination of standard microbiology, bacteriophage cross-susceptibility and antibiotic resistance testing to profile the infecting K. pneumoniae population. The genomes of isolates with distinct fingerprints (pulsed-field gel electrophoresis) and unique combined bacteriophage/antibiotic profiles were then further analyzed using whole-genome sequencing. Adhesion to human epithelial cells and biofilm production were also measured as virulence indicators. Although it is commonly expected for one clone to dominate an infection episode, we identified five coexisting multidrug resistant K. pneumoniae sharing the same niche. One was a novel sequence type (ST4656), while the other four were all members of emerging human pathogenic clonal groups (ST307, ST628, ST893 and ST392). These isolates did not display significant differences from one another in terms of virulence or resistance and differed only in plasmid content from isolates implicated in severe human infections, with equal potential to prolong duration and severity of infection when sharing the same niche. This study highlights the importance of more precise surveillance and detection measures to uncover bacterial heterogeneity, reminding us that the "single clone" concept is not an absolute in invasive bacterial infections. Multidrug resistant Klebsiella pneumoniae are agents of life-threatening infections in animals and humans, with several multidrug resistant clones causing outbreaks of disease worldwide. It is generally accepted that only one clone will be dominant in an infection episode. In this study, we investigated K. pneumoniae isolates from a horse with severe pneumonia and demonstrated co-occurrence of multiple sequence types previously identified as emerging human pathogens. The equine isolates are not significantly different from one another in terms of virulence or resistance, with equal potential to prolong duration and severity of infection, and are indistinguishable from isolates recovered from humans, except for plasmid content. Our study highlights how the "one dominant clone" concept is not an absolute in severe infection, illustrating the need for improved diagnostics to track heterogeneity of infection, and reinforces the importance of cross-monitoring of environmental and human reservoirs of multidrug resistant pathogens.
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Publication Date: 2022-05-17 PubMed ID: 35579468PubMed Central: PMC9241755DOI: 10.1128/spectrum.02158-21Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The research explored multiple strains of multidrug resistant Klebsiella pneumoniae bacteria found in a horse with severe pneumonia, contradicting the expectation that only one dominant strain would exist. The implications of this finding reach human health too, as the equine strains resembled those found in severe human infections.

Research Background and Rationale

  • The researchers were investigating Klebsiella pneumoniae, a bacterium that is widely considered to be a significant threat to both human and animal health due to its resistance to multiple drugs. This multidrug resistance is propagated through the spread of pathogenic clones that acquire antibiotic resistance or niche-specific virulence determinants.
  • They used the example of a horse suffering from severe pneumonia to explore the nature of K. pneumoniae infection. The illness in the horse had not responded to antibiotic treatment, hinting at the potential presence of multidrug resistant strains of the bacterium.
  • Unusually, instead of one dominant strain, the researchers found five distinct clones of multidrug resistant Klebsiella pneumoniae cohabiting and seemingly cooperating in worsening the infection.

Research Methodology

  • The team started by profiling the infecting K. pneumoniae population using standard microbiology techniques, bacteriophage cross-susceptibility, and antibiotic resistance testing.
  • Isolates with unique electrophoresis fingerprints and bacteriophage and antibiotic profiles then underwent whole-genome sequencing for a more in-depth analysis.
  • The team also conducted tests to gauge the capability of these bacteria to adhere to human epithelial cells and produce biofilms. These characteristics are looked at as markers of the bacteria’s virulence.

Results

  • The researchers isolated five distinct clones of multidrug resistant K. pneumoniae — a phenomenon contradicting the previously-held belief that a single clone would dominate an infection episode.
  • While one was a novel sequence type (ST4656), the other four (ST307, ST628, ST893, and ST392) were recognized as emerging pathogenic clones involved in human infections.
  • In terms of virulence and resistance, there were no significant differences among these strains. The only distinguishing factor was their plasmid content, compared to human infection-associated clones.

Research Conclusion and Recommendations

  • The results of this study demonstrate that the concept of a single dominant clone in a bacterial infection is not always accurate. Multiple harmful clones can coexist and collaborate to exacerbate an infection.
  • The occurrence of multiple sequence types of K. pneumoniae in one host underlines the need for more precise detection measures and surveillance to understand bacterial heterogeneity better.
  • The study also emphasizes the need for more robust diagnostic tools and calls for continuous cross-monitoring of multidrug-resistant pathogenic clones across different environmental and human reservoirs to prevent potential disease outbreaks.

Cite This Article

APA
Venturini C, Bowring B, Partridge SR, Ben Zakour NL, Fajardo-Lubian A, Lopez Ayala A, Qin J, Totsika M, van Galen G, Norris J, Iredell J. (2022). Co-Occurrence of Multidrug Resistant Klebsiella pneumoniae Pathogenic Clones of Human Relevance in an Equine Pneumonia Case. Microbiol Spectr, 10(3), e0215821. https://doi.org/10.1128/spectrum.02158-21

Publication

Microbiology spectrum
ISSN: 2165-0497
NlmUniqueID: 101634614
Country: United States
Language: English
Volume: 10
Issue: 3
Pages: e0215821
PII: e02158-21

Researcher Affiliations

Venturini, Carola
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Veterinary Science, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Bowring, Bethany
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
Partridge, Sally R
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Medicine, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
  • Westmead Hospital, Western Sydney Local Health District (WSLHD), Westmead, New South Wales, Australia.
Ben Zakour, Nouri L
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Medicine, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Fajardo-Lubian, Alicia
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Medicine, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Lopez Ayala, Ariana
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Medicine, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Qin, Jilong
  • Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technologygrid.1024.7, Brisbane, Queensland, Australia.
Totsika, Makrina
  • Centre for Immunology and Infection Control, School of Biomedical Sciences, Queensland University of Technologygrid.1024.7, Brisbane, Queensland, Australia.
van Galen, Gaby
  • Sydney School of Veterinary Science, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Norris, Jacqueline
  • Sydney School of Veterinary Science, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
Iredell, Jonathan
  • Centre for Infectious Diseases and Microbiology, Westmead Institute for Medical Research, Westmead, New South Wales, Australia.
  • Sydney School of Medicine, University of Sydneygrid.1013.3, Sydney, New South Wales, Australia.
  • Westmead Hospital, Western Sydney Local Health District (WSLHD), Westmead, New South Wales, Australia.

MeSH Terms

  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics
  • Clone Cells
  • Drug Resistance, Multiple, Bacterial / genetics
  • Female
  • Horses
  • Humans
  • Klebsiella Infections / epidemiology
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / veterinary
  • Klebsiella pneumoniae / genetics
  • Microbial Sensitivity Tests
  • Plasmids / genetics
  • Pneumonia
  • beta-Lactamases / genetics

Conflict of Interest Statement

The authors declare no conflict of interest.

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Citations

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