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.

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 (fosA, fosB, fosC, 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 fosA (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 fosA. These findings provide important preliminary surveillance data for the region.