title: Characterisation of extended-spectrum β-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique.
abstract: The aim of this study was to determine the prevalence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae isolated from urinary tract and bloodstream infections in a rural hospital in Manhiça, Mozambique. ESBLs were investigated among ceftriaxone-non-susceptible K. pneumoniae clinical isolates recovered between 2004 and 2009. Characterisation of blaCTX-M, blaSHV, blaOXAand blaTEMgenes was performed by PCR and sequencing. Epidemiological relationships were established by phylogenetic analysis, repetitive extragenic palindromic PCR (REP-PCR), pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), whilst plasmid transferability was evaluated by conjugation. In addition, the presence of class 1 and 2 integrons was studied. A total of 19 K. pneumoniae were analysed. The blaCTX-M-15gene was found in all strains. Other ESBL genes were found concomitantly, including blaSHV-5, blaSHV-2, blaSHV-2A, blaSHV-12and blaSHV-38. In addition, other β-lactamases such as blaTEM-1and blaOXA-30were also detected. REP-PCR identified 15 different epidemiological profiles. MLST analysis also showed great variability of sequence types. The blaCTX-M-15gene showed a high transfer capacity. The presence of class 1 integrons was high. High levels of multidrug resistance were also found. In conclusion, these data show the dominance of the CTX-M-type ESBL, particularly CTX-M-15, supporting its worldwide dissemination, including in areas with limited access to third-generation cephalosporins. This finding is a matter of concern for clinical management as third-generation cephalosporins are an alternative for treating severe cases of multidrug-resistant infections in this community.
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Pons
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Delfino
authors.initials: D
authors.lastname: Vubil
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisabet
authors.initials: E
authors.lastname: Guiral
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Dinis
authors.initials: D
authors.lastname: Jaintilal
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Oscar
authors.initials: O
authors.lastname: Fraile
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Soto
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Betuel
authors.initials: B
authors.lastname: Sigaúque
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Pedro
authors.initials: P
authors.lastname: Aide
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Alonso
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vila
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain. Electronic address: joruiz@clinic.ub.es.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ruiz
keywords: Bloodstream infection; CTX-M-15; ESBL; Klebsiella; Low-income countries; Urinary tract infection