Background

Klebsiella pneumoniae

(hereafter, Kp) is a major public health threat responsible for high levels of multidrug resistant (MDR) human infections. Besides, Kp also causes severe infections in the community, especially in Asia and Africa. Although most Kp infections are caused by endogenous intestinal carriage, little is known about the prevalence and microbiological characteristics of Kp in asymptomatic human carriage, and attached risk factors including environmental sources exposure.

Methods

Here, 911 pregnant women from communities in Madagascar, Cambodia, and Senegal were screened for gut colonization by Kp. Characteristics of Kp strains (antimicrobial susceptibility, genomic diversity, virulence, and resistance genes) were defined, and associated risk factors were investigated.

Results

Kp carriage rate was 55.9%, and Kp populations were highly heterogeneous (6 phylogroups, 325 sequence types, Simpson index 99.6%). One third of Kp isolates had acquired antimicrobial resistance genes. MDR-Kp (11.7% to 39.7%) and extended spectrum beta-lactamase (ESBL)-producing Kp (0.7% to 14.7%) varied among countries. Isolates with virulence genes were detected (14.5%). Environmental exposure factors including food, animal contacts, or hospitalization of household members were associated with carriage of Kp, antimicrobial resistance and hypervirulence. However, risk factors were country-specific and Kp subpopulation-specific.

Conclusion

This large-scale multicenter study uncovers the huge diversity of Kp in human gut carriage, demonstrates that antimicrobial resistance is widespread in communities of three low-income countries, and underlines the challenges posed by Kp colonization to the control of antimicrobial resistance.

中文翻译：

---

低收入国家肺炎克雷伯菌的携带：抗菌素耐药性，基因组多样性和危险因素。

背景

肺炎克雷伯菌

（以下简称Kp）是主要的公共健康威胁，可导致高水平的多药耐药（MDR）人类感染。此外，Kp还引起社区特别是亚洲和非洲的严重感染。尽管大多数Kp感染是由内源性肠运输引起的，但对无症状人类运输中Kp的流行和微生物特征以及包括环境源暴露在内的相关风险因素知之甚少。

方法

在这里，Kp对来自马达加斯加，柬埔寨和塞内加尔的911名孕妇的肠道菌落进行了筛选。定义了Kp菌株的特征（抗菌药敏感性，基因组多样性，毒力和耐药基因），并研究了相关的危险因素。

结果

Kp携带率为55.9％，并且Kp种群高度异质（6个系统群，325个序列类型，Simpson指数为99.6％）。Kp分离株的三分之一已经获得了抗药性基因。不同国家的MDR-Kp（11.7％至39.7％）和产生超广谱β-内酰胺酶（ESBL）的Kp（0.7％至14.7％）有所不同。检测到带有毒力基因的分离株（14.5％）。环境暴露因素（包括食物，动物接触或家庭成员的住院）与Kp的携带，抗菌素耐药性和高毒力有关。但是，危险因素是国家/地区和Kp亚群的。

结论

这项大规模的多中心研究揭示了人类肠道运输过程中Kp的巨大差异，表明抗药性在三个低收入国家的社区中普遍存在，并突显了Kp殖民化对控制抗药性构成的挑战。