First Report of Virulence Factors in Carbapenem-resistant Klebsiella pneumoniae from Maharashtra, India

Introduction: Klebsiella pneumoniae (KPN) is a major multidrug-resistant (MDR) organism all over the world which can cause various infections. These variations in the infections are due to the presence or expression of virulence factors along with the presence of antimicrobial resistance. These virulence factors play an important role in adherence, invasion, spread, and in turn the range of infections. Various virulence factors such as capsules, lipopolysaccharides, siderophores, and fimbriae ( FimH ) are reported. Objective: Molecular screening of the multidrug-resistant KPN (MDR KPN) for the most common multidrug resistant gene to characterize the virulence factors in the clinical isolates and find out their prevalence in the Maharashtra region of India. Materials and Methods: The study was conducted for 2 years at a tertiary care teaching hospital in western Maharashtra. A total of 931 extended-spectrum beta-lactamase (ESBL)-producing MDR KPN were isolated. Polymerase chain reaction (PCR) was performed for 45 purified isolates to check the presence of various multidrug-resistant (MDR) genes and to detect virulence factors. Results: Multiplex PCR was performed on 45 isolates, and the presence of ESBLs genes was detected in majority of the isolates. Among these, 97.8% harbored blaTEM and blaSHV genes, and blaCTX-M gene was found in 88.9% of isolates, whereas enterobactin ( entB) and FimH genes contributed to 93.33% (14 of 15 isolates). However, all these isolates did not harbor mucoid phenotype regulator , K2 , and Aerobactin genes screened for. The majority of the isolates expressed both entB and FimH simultaneously. Conclusion: The current study observed that the MDR isolates of KPN-producing β-lactamases harbor multiple types of virulence genes and virulence factors. Prevalence of entB and FimH virulence factors was found while other virulence factors may be absent in the Maharashtra region for MDR KPN.