Characterization of resistance to last-line therapeutic molecules and genetic diversity of Klebsiella spp. strains involved in urinary tract infections in women: the case of Hôpital d’Instruction des Armées Omar Bongo Ondimba

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Introduction. Klebsiella spp. are the second most common uropathogens after Escherichia coli and are globally recognized for their high morbidity, driven by their significant ability to develop multi-drug resistance against a wide range of antimicrobials. Hypothesis/Gap Statement. In Central Africa, and particularly in Gabon, there is a significant lack of data regarding the prevalence and genetic diversity of uropathogenic Klebsiella spp. resistant to last-line antibiotics involved in urinary tract infections (UTIs) in women. Aim. This study aims to characterize the resistance of Klebsiella spp. involved in UTIs in women to last-line therapeutic molecules and to explore their genetic diversity through enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) profiling. Methodology. The germs were isolated on Urilines biphasic slides. Identification and susceptibility profiles were performed using the API 20E, ATB Ur and VITEK ® 2 COMPACT. Molecular research of carbapenemase genes ( bla KPC , bla IMP and bla VIM ) and resistance to fosfomycin ( fos A, fos B, fos C, glpT and uhpT ) was made by conventional PCR, and genetic diversity was screened using ERIC-PCR. Results. Of 343 patients, 60.64% (208 out of 343) were women, with a prevalence of UTIs of 43.75% (91 out of 208). The involvement of Klebsiella spp. uropathogens was 29.03% (27 out of 93) against 53.76% (50 out of 93) of other enterobacteria. Klebsiella spp. strains showed high levels of resistance to third-generation cephalosporins (55.56%), fourth-generation cephalosporins and fosfomycin (40.74%), average levels of resistance to third-generation fluoroquinolones (25.92%) and low levels of resistance to carbapenems (7.41%). A total of 81.82% (18 out of 22) of Klebsiella spp. strains possess antibiotic resistance genes, bla KPC (40.0%) and fos A (36.0%), respectively. The study of genetic diversity by interpretation of ERIC-PCR profiles shows 19 distinct banding patterns and 2 repeated profiles, all divided into 9 clusters. Conclusion. Uropathogenic Klebsiella spp. isolated from women have high rates of resistance to last-line antibiotics, with the exception of imipenem. They exhibit diverse ERIC-PCR profiles and possess bla KPC and fos A. These findings provide important preliminary surveillance data for the region.

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