Association between ESBL Production and the Presence of magA Gene among the Clinical Isolates of Klebsiella pneumoniae

Authors
N. Izadi 1
M. Naderi Nasab 2
E. Harifi Mood 2
M. M. H. Momen Heravi 2
Z. Meshkat 2
1 Student Research Committee (SRC), Mashhad University of Medical Sciences, Mashhad, IR Iran and Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
2 Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran
Abstract
Background: Klebsiella pneumoniae (K. pneumoniae) causes a wide range of nosocomial and community-acquired infections. In recent decades, K. pneumoniae has been known as the agent of community-acquired primary pyogenic liver abscess. In attempts to find the causes of this disease, researchers found a new virulence gene called magA (mucoviscosity-associated gene A). The present study was performed to determine the prevalence rate of magA gene among the extended-spectrum beta lactamase (ESBL)-positive and ESBL-negative K. pneumoniae strains.
Materials and Methods: The current cross-sectional study was conducted on 130 K. pneumoniae isolates collected from patients in Imam Reza hospital and its associated clinics in Mashhad city (Iran) from May 2011 to July 2012. The presence of K. pneumoniae species was confirmed by conventional microbio­logical methods. Samples were tested for the production of ESBLs by the double disk diffusion (DDS) test. PCR was performed to detect magA gene. The hypermucoviscosity (HV) phenotype of Klebsiella isolates was char­acterized by the string test.
Results: magA gene was detected in 11(8.5%) out of 130 isolates of K. pneu­moniae. Of 11 isolates with positive result for magA gene, three cases were HV+, and 8 cases were HV- phe­notype. Of 130 K. pneu­moniae isolates, 56 isolates were ESBL-positive, and 74 isolates were ESBL-negative. The magA gene was detected in 4 out of 56 (7.14%) ESBL-positive, and 7 out of 74 (9.46%) ESBL-negative samples.
Conclusion: In the present study, no correlation was observed between the presence of magA gene and the production of ESBL in K. pneumoniae strains isolated from different clinical samples in Mashhad.

Keywords

1.    Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998 Oct;11(4):589-603. PubMed PMID: 9767057. Pubmed Central PMCID: 88898. Epub 1998/10/10. eng.
2.    Frazee BW, Hansen S, Lambert L. Invasive infection with hypermucoviscous Klebsiella pneumoniae: multiple cases presenting to a single emergency department in the United States. Annals of emergency medicine. 2009 May;53(5):639-42. PubMed PMID: 19135282.
3.    Sobirk SK, Struve C, Jacobsson SG. Primary Klebsiella pneumoniae Liver Abscess with Metastatic Spread to Lung and Eye, a North-European Case Report of an Emerging Syndrome. The open microbiology journal. 2010;4:5-7. PubMed PMID: 20448814. Pubmed Central PMCID: 2864426.
4.    Okano H, Shiraki K, Inoue H, Kawakita T, Yamamoto N, Deguchi M, et al. Clinicopathological analysis of liver abscess in Japan. International journal of molecular medicine. 2002 Nov;10(5):627-30. PubMed PMID: 12373305.
5.    Turton JF, Englender H, Gabriel SN, Turton SE, Kaufmann ME, Pitt TL. Genetically similar isolates of Klebsiella pneumoniae serotype K1 causing liver abscesses in three continents. Journal of medical microbiology. 2007 May;56(Pt 5):593-7. PubMed PMID: 17446279.
6.    Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2007 Aug 1;45(3):284-93. PubMed PMID: 17599305.
7.    Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Archives of internal medicine. 1986 Oct;146(10):1913-6. PubMed PMID: 3532983.
8.    Lee CH, Leu HS, Wu TS, Su LH, Liu JW. Risk factors for spontaneous rupture of liver abscess caused by Klebsiella pneumoniae. Diagnostic microbiology and infectious disease. 2005 Jun;52(2):79-84. PubMed PMID: 15964493.
9.    Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. The Journal of experimental medicine. 2004 Mar 1;199(5):697-705. PubMed PMID: 14993253. Pubmed Central PMCID: 2213305.
10.  Tsay RW, Siu LK, Fung CP, Chang FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Archives of internal medicine. 2002 May 13;162(9):1021-7. PubMed PMID: 11996612.
11.  Lin J-C, Siu L, Fung C-P, Yeh K-M, Chang F-Y. Nosocomial liver abscess caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Journal of Clinical Microbiology. 2007;45(1):266-9.
12.  Ben-Ami R, Rodriguez-Bano J, Arslan H, Pitout JD, Quentin C, Calbo ES, et al. A multinational survey of risk factors for infection with extended-spectrum beta-lactamase-producing enterobacteriaceae in nonhospitalized patients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2009 Sep 1;49(5):682-90. PubMed PMID: 19622043.
13.  Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. The Lancet infectious diseases. 2008 Mar;8(3):159-66. PubMed PMID: 18291338.
14.  Nabavinia MS, Nasab MN, Meshkat Z, Derakhshan M, Khaje-Karamadini M. Construction and evaluation of an expression vector containing Mtb32C (Rv0125) of Mycobacterium tuberculosis. Avicenna Journal of Medical Biotechnology. 2011;3(4):207.
15.  d'Azevedo PA, Goncalves AL, Musskopf MI, Ramos CG, Dias CA. Laboratory tests in the detection of extended spectrum beta-lactamase production: National Committee for Clinical Laboratory Standards (NCCLS) screening test, the E-test, the double disk confirmatory test, and cefoxitin susceptibility testing. Braz J Infect Dis. 2004 Oct;8(5):372-7. PubMed PMID: 15798813. Epub 2005/03/31. eng.
16.  Struve C, Bojer M, Nielsen EM, Hansen DS, Krogfelt KA. Investigation of the putative virulence gene magA in a worldwide collection of 495 Klebsiella isolates: magA is restricted to the gene cluster of Klebsiella pneumoniae capsule serotype K1. Journal of medical microbiology. 2005;54(11):1111-3.
17.  Zamani A, Mashouf RY, Namvar AME, Alikhani MY. Detection of magA Gene in Klebsiella spp. Isolated from Clinical SamplesDetection of magA. Iranian journal of basic medical sciences. 2013;16(2):173.
18.  Zamani A, Yousefi Mashouf R, Ebrahimzadeh Namvar AM, Alikhani MY. Detection of magA Gene in Klebsiella spp. Isolated from Clinical SamplesDetection of magA. Iran J Basic Med Sci. 2013 Feb;16(2):173-6. PubMed PMID: 24298386. Pubmed Central PMCID: 3843861.
19.  Struve C, Bojer M, Nielsen EM, Hansen DS, Krogfelt KA. Investigation of the putative virulence gene magA in a worldwide collection of 495 Klebsiella isolates: magA is restricted to the gene cluster of Klebsiella pneumoniae capsule serotype K1. Journal of medical microbiology. 2005 Nov;54(Pt 11):1111-3. PubMed PMID: 16192445.
20.  Yeh KM, Kurup A, Siu LK, Koh YL, Fung CP, Lin JC, et al. Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan. J Clin Microbiol. 2007 Feb;45(2):466-71. PubMed PMID: 17151209. Pubmed Central PMCID: 1829066.
21.  Yeh KM, Chang FY, Fung CP, Lin JC, Siu LK. magA is not a specific virulence gene for Klebsiella pneumoniae strains causing liver abscess but is part of the capsular polysaccharide gene cluster of K. pneumoniae serotype K1. Journal of medical microbiology. 2006 Jun;55(Pt 6):803-4. PubMed PMID: 16687604.
22.  Yeh KM, Lin JC, Yin FY, Fung CP, Hung HC, Siu LK, et al. Revisiting the importance of virulence determinant magA and its surrounding genes in Klebsiella pneumoniae causing pyogenic liver abscesses: exact role in serotype K1 capsule formation. The Journal of infectious diseases. 2010 Apr 15;201(8):1259-67. PubMed PMID: 19785524.