Hypermucoviscosity in Clinical Isolates of Klebsiella pneumoniae Correlates with High Multiple Antibiotic Resistance (MAR) Index

Klebsiella pneumoniae is an opportunistic pathogen of medical importance and the capsule and mucoid phenotype in this organism are considered as requisite virulence determinants. A total of 62 clinical samples from ATBUTH were collected and screened for K. pneumoniae. The isolates were identified using standard tests for this organism. The string test was used to detect the mucoid (hypermucoviscous) phenotype and the antimicrobial susceptibility test to 10 antibiotics was carried out with the disk diffusion technique after standardizing inoculum. A K. pneumoniae prevalence of 24% (15/62) was obtained of which 47% (7/15) were mucoid (hypermucoviscous) and 53% (8/15) were non-mucoid. Colonial sizes of the two strains do not reveal any significant differences in growth fitness of the strains. On blood agar, the mucoid and non-mucoid strains had a mean colonial size ± standard deviations of 4.41 ± 0.58 mm and 4.27 ± 0.42 mm respectively. The antibiotic susceptibility rate showed that the mucoid strains compared to the non-mucoid were more resistant to nine out of 10 antibiotics. The mucoid strains were outrightly resistant to augmentin, amoxicillin, septrin, sparfloxacin and perfloxacin. The non-mucoid strains showed no complete resistant to any antibiotic tested but had a higher resistant rate to chloramphenicol only. The Multiple Antibiotic Resistance (MAR) index shows the themucoid strains with a high MAR index range of 0.7 - 1.0 with a median MAR index of 0.8, while the non-mucoid strains had a MAR index of 0.2 - 0.8 with a median MAR index of 0.35. The data suggest that the mucoid phenotype could be associated with extrachromsomal element(s) carrying resistance genes to antibiotics and that these extrachromosomal elements may not harbour resistance determinants to chloramphenicol. Furthermore, the extrachromosomal elements bearing the mucoid phenotype and the resistance elements in the mucoid strains do not significantly impact on the fitness of the cognate strain. Whether these phenotype and resistances that had no fitness cost to the bacterium could significantly affect the virulence of the bacteria in vivo remains to be investigated.