Evidence map›Paper›PMID 38589977›Full record

ArticleTropical medicine and health2024

The overlap of accessory virulence factors and multidrug resistance among clinical and surveillance Klebsiella pneumoniae isolates from a neonatal intensive care unit in Nepal: a single-centre experience in a resource-limited setting.

Raj Kumar Shrestha, Dhruba Shrestha, Ajaya Jang Kunwar, Sandeep Thapa, Nipun Shrestha, Bhim Gopal Dhoubhadel, Christopher M Parry

Open access · goldAbstract read
In one paragraph

Article in Tropical medicine and health, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.3field-weighted citation impact, top 51% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 2 citations in OpenAlex.

  1. Molecular Characterization and Clinical Outcomes ofChildren (Basel, Switzerland) · 2026
    Article
  2. Article
  3. Molecular epidemiology of carbapenem-resistantFrontiers in microbiology · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Raj Kumar ShresthaSiddhi Memorial Hospital, Bhimsensthan-7, Bhaktapur, Nepal.
Dhruba ShresthaSiddhi Memorial Hospital, Bhimsensthan-7, Bhaktapur, Nepal.
Ajaya Jang KunwarKathmandu Center for Genomics and Research Laboratory, Lalitpur, Nepal.
Sandeep ThapaKathmandu Center for Genomics and Research Laboratory, Lalitpur, Nepal.
Nipun ShresthaSiddhi Memorial Hospital, Bhimsensthan-7, Bhaktapur, Nepal.
Bhim Gopal DhoubhadelSchool of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, 852-8523, Japan. b-gopal@nagasaki-u.ac.jp.ORCID http://orcid.org/0000-0001-5279-2044
Christopher M ParrySchool of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, 852-8523, Japan.
Bhaktapur Cancer Hospital · NPLiverpool School of Tropical Medicine · GBNagasaki University · JP

Funding

Japan Society for the Promotion of Science 22K15924
6 · The paper itself

Abstract

backgroundThere is a lack of data on the characteristics of overlap between acquired antimicrobial resistance and virulence factors in Klebsiella pneumoniae in high-risk settings, especially with the inclusion of surveillance isolates along with the clinical. We investigated K. pneumoniae isolates, from a neonatal intensive care unit (NICU) in Nepal, for the presence of both accessory virulence factors and acquired antimicrobial resistance.

methodsThirty-eight clinical and nineteen surveillance K. pneumoniae isolates obtained between January 2017 and August 2022 in the NICU of Siddhi Memorial Hospital, Bhaktapur, Nepal were investigated with antimicrobial susceptibility testing, PCR-based detection of β-lactamases and virulence factors, and genetic similarity by ERIC-PCR.

resultsK. pneumoniae was found positive in 37/85 (43.5%) blood culture-positive neonatal bloodstream infections, 34/954 (3.6%) patient surveillance cultures, and 15/451 (3.3%) environmental surveillance samples. Among 57 isolates analyzed in this study, we detected multidrug resistance in 37/57 (64.9%), which was combined with at least one accessory virulence factor in 21/37 (56.8%). This overlap was mostly among β-lactamase producing isolates with accessory mechanisms of iron acquisition. These isolates displayed heterogenous ERIC-PCR patterns suggesting genetic diversity.

conclusionsThe clinical significance of this overlap between acquired antimicrobial resistance and accessory virulence genes in K. pneumoniae needs further investigation. Better resource allocation is necessary to strengthen infection prevention and control interventions in resource-limited settings.

Indexed as

Extended-spectrum β-lactamaseKlebsiella pneumoniaeNeonatal intensive care unit (NICU)NepalVirulence

Identifiers

PMID38589977
PMCPMC11000294
OpenAlexW4394577070

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.