<abstract xmlns="http://www.w3.org/1999/xhtml">

<sec id="j_1905-7415.1001.463_s_001">
<h3>Background</h3>
<p><italic>Klebsiella</italic> species are important opportunistic pathogens causing a variety of infections, especially in hospitalized and immunocompromised patients.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_002">
<h3>Objectives</h3>
<p>To investigate the clinical prevalence of five different <italic>Klebsiella</italic> species (<italic>K. pneumoniae</italic>, <italic>K. ornithinolytica</italic>, <italic>K. oxytoca</italic>, <italic>K. terrigena</italic>, and <italic>K. rhinoscleromatis</italic>) including antibiotic resistance profiles using six different antibiotics and combinations (trimethoprim-sulfamethoxazole, ampicillin-sulbactam, imipenem, piperacillin-tazobactam, ciprofloxacin, ceftizoxime).</p>
</sec>
<sec id="j_1905-7415.1001.463_s_003">
<h3>Methods</h3>
<p>Resistance of <italic>Klebsiella</italic> spp. including multidrug resistant (MDR) strains was determined by using a Kirby–Bauer disk diffusion method and genotypical analysis was performed by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR).</p>
</sec>
<sec id="j_1905-7415.1001.463_s_004">
<h3>Results</h3>
<p>Urine samples and the urology service unit were the most common sources of <italic>K. ornithinolytica, K. pneumoniae</italic>, and <italic>K. terrigena</italic> strains. The greatest drug resistance was observed against trimethoprim-sulfamethoxazole (88%), the least resistance was observed against imipenem (12%). Apart from these, 11 different antibiotypes were generated and antibiotype AI (resistant only to trimethoprim-sulfamethoxazole) was the most frequently observed (40%). MDR profiles of <italic>Klebsiella</italic> spp. were also investigated and 25% of all <italic>Klebsiella</italic> spp. strains were found to be MDR; and 65% of these were isolated from urine samples. MDR strains were mostly found to be <italic>K. ornithinolytica</italic> (35%) followed by <italic>K. pneumoniae</italic> (29%). Genotyping was performed by using ERIC PCR and <italic>Klebsiella</italic> spp. strains were grouped in 23 genotypes with a similarity coefficient of 70%.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_005">
<h3>Conclusions</h3>
<p>Antibiotyping and antibiotype profiles may provide valuable information for hospitalized patients that could identify problem spots and allow evidence-based provision of preventive measures against nosocomial emergence of infections with new MDR strains.</p>
</sec>
</abstract>

Background
Klebsiella species are important opportunistic pathogens causing a variety of infections, especially in hospitalized and immunocompromised patients.


Objectives
To investigate the clinical prevalence of five different Klebsiella species (K. pneumoniae, K. ornithinolytica, K. oxytoca, K. terrigena, and K. rhinoscleromatis) including antibiotic resistance profiles using six different antibiotics and combinations (trimethoprim-sulfamethoxazole, ampicillin-sulbactam, imipenem, piperacillin-tazobactam, ciprofloxacin, ceftizoxime).


Methods
Resistance of Klebsiella spp. including multidrug resistant (MDR) strains was determined by using a Kirby–Bauer disk diffusion method and genotypical analysis was performed by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR).


Results
Urine samples and the urology service unit were the most common sources of K. ornithinolytica, K. pneumoniae, and K. terrigena strains. The greatest drug resistance was observed against trimethoprim-sulfamethoxazole (88%), the least resistance was observed against imipenem (12%). Apart from these, 11 different antibiotypes were generated and antibiotype AI (resistant only to trimethoprim-sulfamethoxazole) was the most frequently observed (40%). MDR profiles of Klebsiella spp. were also investigated and 25% of all Klebsiella spp. strains were found to be MDR; and 65% of these were isolated from urine samples. MDR strains were mostly found to be K. ornithinolytica (35%) followed by K. pneumoniae (29%). Genotyping was performed by using ERIC PCR and Klebsiella spp. strains were grouped in 23 genotypes with a similarity coefficient of 70%.


Conclusions
Antibiotyping and antibiotype profiles may provide valuable information for hospitalized patients that could identify problem spots and allow evidence-based provision of preventive measures against nosocomial emergence of infections with new MDR strains.


<div xmlns="http://www.w3.org/1999/xhtml">
<p>Reservoirs of drug resistant bacterial genomes and extrachromosomal DNA segments are a growing problem and cause emergence of new multidrug resistant (MDR) strains [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_001">1</a>]. Antibiotic resistance of <italic>Klebsiella</italic> infections are causing increasing morbidity and mortality, and an increase in health care costs worldwide.</p>
<p>In epidemiological research, not only phenotypical analysis, but also genotypical analysis is conducted by using various molecular typing methods such as plasmid profiling, ribotyping, and polymerase chain reaction (PCR) to find genetic relationships between clinically important bacterial species [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_002">2</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_003">3</a>]. Our present study focused on prevalence of five <italic>Klebsiella</italic> spp. (<italic>K. pneumoniae</italic>, <italic>K. ornithinolytica</italic>, <italic>K. oxytoca</italic>, <italic>K. terrigena</italic>, and <italic>K. rhinoscleromatis</italic>) found in clinical materials. We examined antibiotic resistance and multidrug resistant strains and determined enterobacterial repetitive intergenic consensus (ERIC) PCR profiles for all <italic>Klebsiella</italic> spp.</p>
<sec id="j_1905-7415.1001.463_s_006">
<div>Materials and methods</div>
<sec id="j_1905-7415.1001.463_s_006_s_001">
<div>Bacterial strains</div>
<p>We used 5 different <italic>Klebsiella</italic> spp. (<italic>K. ornithinolytica</italic>, <italic>K. pneumoniae</italic>, <italic>K. oxytoca</italic>, <italic>K. terrigena</italic>, and <italic>K. rhinoscleromatis</italic>) that had been isolated in a previous study [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_004">4</a>].</p>
</sec>
<sec id="j_1905-7415.1001.463_s_006_s_002">
<div>Antibiotic resistance testing and antibiotyping</div>
<p>The antibiotic resistance of <italic>Klebsiella</italic> species to six different antibiotics and combinations (SXT: trimethoprim-sulfamethoxazole (1.25/23.75 μg), SAM: ampicillin-sulbactam (10/10 μg), IPM: imipenem (10 μg), TZP: piperacillin tazobactam (100/10 μg), CIP: ciprofloxacin (5 μg), CZ: ceftizoxime (30 g)) were assessed using a Kirby–Bauer disc diffusion method. <italic>Klebsiella</italic> spp. that showed the same antibiotic resistance pattern, were grouped in the same antibiotype. MDR was defined as being resistant to at least three or more of antimicrobial classes [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_005">5</a>].</p>
</sec>
<sec id="j_1905-7415.1001.463_s_006_s_003">
<div>Genomic DNA Extraction</div>
<p>The genomic DNA of <italic>Klebsiella</italic> spp. was extracted from bacterial cultures by using a bacterial DNA extraction kit (BioBasic, East Markham, Ontario, Canada) and isolated DNA was stored at -20°C.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_006_s_004">
<div>Fingerprinting by enterobacterial repetitive intergenic consensus polymerase chain reaction</div>
<p>We determined the genomic fingerprint of <italic>Klebsiella</italic> spp. using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR) by using ERIC1 (5-ATG TAA GCT CCT GGG GAT TCA C-3′) and ERIC2 (5′-AAG TAA GTG ACT GGG GTG AGC G-3′) primers [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_006">6</a>]. The reaction mix contained 50 ng template of DNA, 1 × PCR buffer (10 mM Tris-HCl, pH 8.3, 50 mM KCl, 1.5 mM, MgCl<sub>2</sub>, 0.1% Triton X-100), 2.5 mM dNTP, 2.5 U Taq polymerase (Roche Diagnostics, Mannheim, Germany) and 5 mM of each primer (ERIC1 and ERIC2) in a final volume of 50 μl [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_007">7</a>]. The amplification procedure consisted of the following cycling steps: initial denaturation at 95°C for 2 min, followed by 40 cycles of denaturation at 94°C for 1 min, annealing at 52°C for 1 min, and extension at 72°C for 2 min. The final extension step was performed at 72°C for 2 min.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_006_s_005">
<div>Gel electrophoresis and data analysis</div>
<p>We analyzed PCR products using 1.8% agarose gel electrophoresis (Scie-Plas; Warwickshire, UK) by using TBE 1× buffer (0.9 M Tris, 0.9 M Boric acid, and 20 mM EDTA, pH 8.3) at 90 V for 5 h. Agarose gels were documented using a Gel Logic 200 Molecular Imaging System (Kodak; Rochester, NY, USA). To analyze the profiles <italic>of Klebsiella</italic> strains, NTSYSpc (version 2.1; Applied Biostatistics, Port Jefferson, N Y, USA) Numerical Taxonomy and Multivariate Analysis System was used and a dendrogram was constructed using an unweighted pair group method with arithmetic mean and by using Dice coefficients of similarity. <italic>Klebsiella sp</italic>. strains with a similarity coefficient of 70% were grouped in a genotype.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_006_s_006">
<div>Ethical considerations</div>
<p>This study was designed to fully protect the anonymity of patients using unlinked anonymized samples and was conducted in compliance with the principles of the contemporary version of the Declaration of Helsinki. The protocol was approved by the Hacettepe University Scientific Research Projects Coordination Unit (project No. 08D11601001).</p>
</sec>
</sec>
<sec id="j_1905-7415.1001.463_s_007">
<div>Results</div>
<p>We found that the urine samples and the urology service unit were the source of most <italic>Klebsiella</italic> spp. isolated with <italic>K. pneumoniae, K. ornithinolytica</italic>, and <italic>K. terrigena</italic> species being the most frequent (<bold><a ref-type="fig" href="#j_1905-7415.1001.463_fig_001">Figures 1</a></bold> and <bold><a ref-type="fig" href="#j_1905-7415.1001.463_fig_002">2</a></bold>).</p>
<p><figure id="j_1905-7415.1001.463_fig_001" position="float" fig-type="figure">
<h2>Figure 1</h2>
<figCaption><p><italic>Klebsiella</italic> species found in various clinical materials.</p></figCaption>
<img xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/j_1905-7415.1001.463_fig_001.jpg" src="https://sciendo-parsed.s3.eu-central-1.amazonaws.com/6470662a83f1392090d68b7c/j_1905-7415.1001.463_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20240601T211807Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=18000&amp;X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240601%2Feu-central-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=000ceb8a922ac94fc83d951757e3b3e1cbe4632ca8ec20a2878d5c4d3b1e786f" class="mw-100"/>
</figure></p>
<p><figure id="j_1905-7415.1001.463_fig_002" position="float" fig-type="figure">
<h2>Figure 2</h2>
<figCaption><p><italic>Klebsiella</italic> species found in various service units URO, urology; SIC, surgical intensive care unit; PTR, physical treatment and rehabilitation unit; IM, internal medicine; EM, emergency medicine; NEU, neurology unit; O, otorhinolaryngology</p></figCaption>
<img xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/j_1905-7415.1001.463_fig_002.jpg" src="https://sciendo-parsed.s3.eu-central-1.amazonaws.com/6470662a83f1392090d68b7c/j_1905-7415.1001.463_fig_002.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20240601T211807Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=18000&amp;X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240601%2Feu-central-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=9867b45a98d71938a412cc46a15cdad3e2f7c3416e3ea04e92e10229733aaad0" class="mw-100"/>
</figure></p>
<p>The greatest resistance was observed against trimethoprim-sulfamethoxazole (88%), the least resistance was against imipenem (12%) as shown in <bold><a ref-type="table" href="#j_1905-7415.1001.463_tab_001">Table 1</a></bold>.</p><table-wrap id="j_1905-7415.1001.463_tab_001" position="float" orientation="portrait">
<label>Table 1</label>
<caption><p>Antibiotic resistance of <italic>Klebsiella</italic> species</p></caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left">Antibiotics</th>
<th align="left"><italic>K. pneumoniae</italic></th>
<th align="left"><italic>K. ornithinolytica</italic></th>
<th align="left"><italic>K. oxytoca</italic></th>
<th align="left"><italic>K. rhinoscleromatis</italic></th>
<th align="left"><italic>K. terrigena</italic> All <italic>Klebsiella</italic> spp. (%)</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left">Ciprofloxacin</td>
<td align="left">16%</td>
<td align="left">13%</td>
<td align="left">13%</td>
<td align="left">20%</td>
<td align="left">0% 13%</td>
</tr>
<tr>
<td align="left">Imipenem</td>
<td align="left">12%</td>
<td align="left">22%</td>
<td align="left">0%</td>
<td align="left">20%</td>
<td align="left">0% 12%</td>
</tr>
<tr>
<td align="left">Ampicillin-sulbactam</td>
<td align="left">24%</td>
<td align="left">35%</td>
<td align="left">0%</td>
<td align="left">20%</td>
<td align="left">50% 28%</td>
</tr>
<tr>
<td align="left">Piperacillin-tazobactam</td>
<td align="left">20%</td>
<td align="left">35%</td>
<td align="left">38%</td>
<td align="left">20%</td>
<td align="left">50% 31%</td>
</tr>
<tr>
<td align="left">Ceftizoxime</td>
<td align="left">16%</td>
<td align="left">13%</td>
<td align="left">0%</td>
<td align="left">20%</td>
<td align="left">50% 18%</td>
</tr>
<tr>
<td align="left">Trimethoprim-sulfamethoxazole</td>
<td align="left">84%</td>
<td align="left">87%</td>
<td align="left">100%</td>
<td align="left">20%</td>
<td align="left">100% 88%</td>
</tr>
</tbody>
</table>
</table-wrap>
<p>Eleven different antibiotypes were generated. AI was the most frequently observed antibiotype, AVII and AVIII were only observed in <italic>K. pneumoniae</italic>, AIII and AV I were only observed in <italic>K. ornithinolytica</italic>, AX was only observed in <italic>K. rhinoscleromatis</italic>, and AIX was only observed in <italic>K. oxytoca</italic>. (<bold><a ref-type="fig" href="#j_1905-7415.1001.463_fig_003">Figure 3</a></bold>).</p>
<p><figure id="j_1905-7415.1001.463_fig_003" position="float" fig-type="figure">
<h2>Figure 3</h2>
<figCaption><p>Antibiotype profiles of <italic>Klebsiella</italic> species</p>
<p>Antibiotypes belong to antibiotic resistance to: <bold>AI</bold> SXT; <bold>AII</bold> SAM, IPM, TZP; <bold>AIII</bold> SAM, IPM, TZP, CIP, SXT; <bold>AIV</bold> TZP, CIP, SXT; <bold>AV</bold> SAM, TZP, CZ, SXT; <bold>AVI</bold> SAM, IPM; <bold>AVII</bold> SAM, IPM, CIP, SXT; <bold>AVIII</bold> SAM, IPM, CIP, SXT, CZ; <bold>AIX</bold> SXT, TZP; <bold>AX</bold> SAM, CZ, CIP, SXT; <bold>AXI</bold> TZP. (SXT: trimethoprim-sulfamethoxazole (1.25/23.75 μg), SAM: ampicillin-sulbactam (10/10 μg), IPM: imipenem (10 μg), TZP: piperacillin tazobactam (100/10 g), CIP: ciprofloxacin (5 μg), CZ: ceftizoxime (30 μg))</p></figCaption>
<img xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/j_1905-7415.1001.463_fig_003.jpg" src="https://sciendo-parsed.s3.eu-central-1.amazonaws.com/6470662a83f1392090d68b7c/j_1905-7415.1001.463_fig_003.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20240601T211807Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=18000&amp;X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240601%2Feu-central-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=7529061be6dff2933c22429b5685bee15414a1c1a768032385a04032c3c2b7e9" class="mw-100"/>
</figure></p>
<p>Accordingly, 25% of all <italic>Klebsiella</italic> spp. strains were found as MDR and 65% of these were isolated from urine. MDR strains were mostly isolated from the species of <italic>K. ornithinolytica</italic> (35%) followed by <italic>K. pneumoniae</italic> (29%) and they grouped in AV antibiotype profile (53%).</p>
<p>Genotyping performed by using ERIC/PCR grouped <italic>Klebsiella</italic> spp. strains into 23 different genotypes with a similarity coefficient of 70% (<bold><a ref-type="fig" href="#j_1905-7415.1001.463_fig_004">Figure 4</a></bold>). Only 43% of all genotypes included MDR strains. Accordingly, 50% of the strains in the 4<sup>th</sup> genotype (K31, K32, K36, K38) were found as MDR and all of the MDR strains of <italic>K. terrigena</italic> were grouped in the AV antibiotype profile. In the 9<sup>th</sup> genotype, there were only two MDR strains (K5, K10) and they belonged to <italic>K. ornithinolytica</italic> (<bold><a ref-type="fig" href="#j_1905-7415.1001.463_fig_004">Figure 4</a></bold>).</p>
<p><figure id="j_1905-7415.1001.463_fig_004" position="float" fig-type="figure">
<h2>Figure 4</h2>
<figCaption><p>Cluster analysis of the profiles obtained from five different <italic>Klebsiella</italic> species by ERIC-PCR analysis</p></figCaption>
<img xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="graphic/j_1905-7415.1001.463_fig_004.jpg" src="https://sciendo-parsed.s3.eu-central-1.amazonaws.com/6470662a83f1392090d68b7c/j_1905-7415.1001.463_fig_004.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&amp;X-Amz-Date=20240601T211807Z&amp;X-Amz-SignedHeaders=host&amp;X-Amz-Expires=18000&amp;X-Amz-Credential=AKIA6AP2G7AKP25APDM2%2F20240601%2Feu-central-1%2Fs3%2Faws4_request&amp;X-Amz-Signature=ea9cb942f81bd50d7f60a33ccc131e68f2d08caa8537f6663219d572919f4f2f" class="mw-100"/>
</figure></p>
</sec>
<sec id="j_1905-7415.1001.463_s_008">
<div>Discussion</div>
<p><italic>Klebsiella</italic> spp. are known as an important opportunistic pathogens among the members of the <italic>Enterobacteriaceae</italic> [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_001">1</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_008">8</a>-<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_011">11</a>]. Accordingly, <italic>Klebsiella</italic> spp. are the second most causative agent of urinary tract infections (UTIs) after <italic>Escherichia coli</italic>. They represent 6%–17% of all nosocomial UTIs and 7% of all nosocomial infections [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_009">9</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_012">12</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_013">13</a>]. Additionally, <italic>Klebsiella</italic> sp. are known as major agents complicating symptomatic or asymptomatic catheter-acquired UTIs; especially in hospitalized patients [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_014">14</a>]. We identified the major foci where these infections occurred and were able to institute defensive procedures against additional spread. As consistent with previously published findings, we found that <italic>Klebsiella</italic> infections were widespread in samples of urine and in UTIs when compared with other clinical materials [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_009">9</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_010">10</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_015">15</a>, <a ref-type="bibr" href="#j_1905-7415.1001.463_ref_016">16</a>]. We also found that the most effective antibiotic against <italic>Klebsiella</italic> spp. was imipenem. The least effective antibiotic was trimethoprim-sulfamethoxazole, and that the overall pattern of imipenem resistance was low: 0% [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_017">17</a>], 2% [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_018">18</a>], 5.4% [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_019">19</a>], 13.9%, [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_010">10</a>], and 16% [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_020">20</a>]. Additionally, we found 25% of all <italic>Klebsiella</italic> sp. in the present study to be MDR and that strains that belong to <italic>K. ornithinolytica</italic> (35%) were predominantly MDR, followed by <italic>K. pneumoniae</italic> (29%). Previously, <italic>K. pneumoniae</italic> was found to be the predominant MDR species [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_021">21</a>].</p>
<p>Various molecular typing methods, especially PCR fingerprinting assays, are now increasingly being used to identify strains in clinical practice [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_022">22</a>]. ERIC/PCR showed that there was heterogeneity between genotypes of <italic>Klebsiella</italic> spp. strains and that there was no correlation between different species according to their ERIC/PCR profiles. Similarly, phylogenetic analysis of <italic>Klebsiella</italic> in a previous study showed taxonomic heterogeneity among the species [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_023">23</a>]. Electrophoretic analysis of <italic>K. pneumoniae</italic> also showed genotypical heterogeneity [<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_024">24</a>-<a ref-type="bibr" href="#j_1905-7415.1001.463_ref_026">26</a>]. It is therefore not surprising to find genotypical heterogeneity among our five different <italic>Klebsiella</italic> species, which were isolated from various clinical materials and service units, and grouped in 11 different antibiotypes.</p>
</sec>
<sec id="j_1905-7415.1001.463_s_009">
<div>Conclusions</div>
<p>Imipenem was the most effective antibiotic against <italic>Klebsiella</italic> spp. in our geographical region of Turkey. MDR strains are widespread among <italic>Klebsiella</italic> spp., especially among <italic>K. ornithinolytica</italic> and <italic>K. pneumoniae</italic>. Genotypical heterogeneity exists among <italic>Klebsiella</italic> spp. It is important to be vigilant for nosocomial infections and to take precautions against the transmission of infectious microorganisms between hospitalized patients to prevent the emergence of MDR strains.</p>
</sec>
</div>

Antibiotic resistance, multidrug resistance and enterobacterial repetitive intergenic consensus polymerase chain reaction profiles of clinically important Klebsiella species

Asian Biomedicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Background
Klebsiella species are important opportunistic pathogens causing a variety of infections, especially in hospitalized and immunocompromised...

Antibiotic resistance, multidrug resistance and enterobacterial repetitive intergenic consensus polymerase chain reaction profiles of clinically important Klebsiella species

Article Category: Brief communication (Original)

Pubblicato online: 31 gen 2017

Pagine: 41 - 47

DOI: https://doi.org/10.5372/1905-7415.1001.463

Parole chiave
Antibiotic resistance, ERIC PCR, spp, multidrug resistance

© 2016 Nermin Hande Avcioglu, Isil Seyis Bilkay, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

Figure 4

Antibiotic resistance of Klebsiella species

Antibiotics	K. pneumoniae	K. ornithinolytica	K. oxytoca	K. rhinoscleromatis	K. terrigena All Klebsiella spp. (%)
Ciprofloxacin	16%	13%	13%	20%	0% 13%
Imipenem	12%	22%	0%	20%	0% 12%
Ampicillin-sulbactam	24%	35%	0%	20%	50% 28%
Piperacillin-tazobactam	20%	35%	38%	20%	50% 31%
Ceftizoxime	16%	13%	0%	20%	50% 18%
Trimethoprim-sulfamethoxazole	84%	87%	100%	20%	100% 88%

Antibiotic resistance, multidrug resistance and enterobacterial repetitive intergenic consensus polymerase chain reaction profiles of clinically important Klebsiella species

Article Category: Brief communication (Original)

Pubblicato online: 31 gen 2017

Pagine: 41 - 47

DOI: https://doi.org/10.5372/1905-7415.1001.463

Parole chiaveAntibiotic resistance, ERIC PCR, spp, multidrug resistance

© 2016 Nermin Hande Avcioglu, Isil Seyis Bilkay, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

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Antibiotic resistance of Klebsiella species

Parole chiave
Antibiotic resistance, ERIC PCR, spp, multidrug resistance