Molecular and clinical insights into extended-spectrum [beta]-lactamase genes of Klebsiella pneumoniae isolated from neonatal sepsis in Ethiopia

Klebsiella bacterial strains harboring Extended-Spectrum Beta-Lactamase (ESBL) enzymes are the primary culprits behind neonatal sepsis globally. These strains significantly impact clinical outcomes due to their multi-drug resistance patterns in local healthcare settings. In response to this spiraling threat, we studied the prevalence and clinical implications of ESBL-encoding genes in neonates hospitalized with confirmed sepsis. A correlational study was conducted on 51 neonates diagnosed with sepsis caused by ESBL-positive Klebsiella pneumoniae at Jimma Medical Center spanning from May 2022 to July 2023. Antimicrobial resistance profiles of the bacterial isolates were determined using the Kirby-Bauer diffusion test, while multiplex polymerase chain reaction (mPCR) techniques were employed to identify resistance genes. The correlation between resistance genes and treatment outcomes was analyzed using the phi coefficient ([phi]) with a significance level below 0.05. The data management was executed through the utilization of WHONET and STATA software platforms. The sample consisted of 26 (50.9%) male and the remaining 25 (49.1%) female neonates, with diverse clinical characteristics. All 51 Klebsiella pneumoniae isolates were 100% resistant to trimethoprim/sulfamethoxazole and ceftriaxone, but showed varying resistance profiles ranging from 30.8% to meropenem to 94.2% to ceftazidime. Notably, all isolates demonstrated multidrug resistance, with 23% of cases showing resistance to seven different antimicrobial classes. The most prevalent resistance genes identified were bla.sub.CTX-M (96.1%), bla.sub.TEM (94.1%), and bla.sub.SHV (88.2%). The majority of isolates (94.1%) carried at least two resistance genes, such as bla.sub.TEM and bla.sub.CTX (94.1%), bla.sub.TEM and bla.sub.SHV (86.2%), and bla.sub.CTX and bla.sub.SHV (86.2%). Notably, 84.3% of the bacteria harbored the trio of bla.sub.TEM, bla.sub.CTX, and bla.sub.SHV resistance genes, and only the presence of bla.sub.SHV in monogenic ([phi] = 0.4, P = 0.01) or the trio of bla.sub.TEM, bla.sub.CTX, and bla.sub.SHV genes ([phi] = 0.3, P = 0.02) showed positive correlation with neonatal mortality. We observed a significant prevalence of multidrug-resistant Klebsiella pneumoniae strains among neonates. Moreover, ESBL-resistance genes were widespread, with the blaSHV gene showing a correlation with increased neonatal mortality. These findings emphasize the urgent need for enhanced infection prevention measures