Most medically important bacteria have genomes that contain clustered regularly
interspaced short palindromic repeats (CRISPRs) and the gene Cas that they are linked to, which operate as a protective mechanism against external invaders like plasmids and viruses. The study's objective is to find out how frequently the CRISPR/Cas system is present in Klebsiella pneumoniae clinical isolates and wild-type bacteria. Further, to detect the distribution of genes encoding for extended-spectrum β-lactamase (ESBL), and carbapenemase among CRISPR positive and negative isolates using real-time PCR. Furthermore, to determine the association between drug resistance patterns and CRISPR/Cas system.
In this cross-sectional study, the various clinical specimens were collected from
different sites of infections. A total of 176 bacterial isolates were collected (One hundred were Klebsiella pneumoniae, the other isolates were Pseudomonas species 28 isolates, E. coli 23 isolates, Acinetobacter species 13 isolates, and 12 isolates Proteus species). The study patients were admitted to the Medical City and Al Ramadi Teaching Hospitals in Iraq during the period between October 2021 and March 2022. The clinical specimens were processed
and cultured in the microbiology laboratories of these same hospitals according to standard criteria. The VITEK®2 Compact B System was used for the confirmative and final identification of Klebsiella pneumoniae isolates using VITEK®2 GN ID cards. The antimicrobial susceptibility test of the study isolates was determined via the VITEK®2 Compact B system using VITEK®2 AST-GN cards according to the manufacturer’s instructions. The antimicrobial susceptibility surveillance was expressed as minimum inhibitory concentration (MIC) values and interpreted as susceptible, intermediate, or resistant. Isolates were resistant to ampicillin (98%), followed by cefazolin (85%), ceftazidime (84%), ceftriaxone (83%), cefepime and trimethoprim-sulphamethoxazole (76%), levofloxacin (50%), cefoxitin (43%), ciprofloxacin (40%), piperacillin-tazobactam (29%), gentamicin (27%), nitrofurantoin (22%), amikacin (18%), ertapenem and imipenem (15%) in addition to tigecycline (6%). II NO45 cards (ESBL test panel) of VITEK®2 Compact B System were used to test each isolate for ESBL production. The production of ESBL was detected in 71 out of 100 study isolates (71%) of ESBL isolates. It was observed that of the total study isolates of Klebsiella pneumonia, 15 (15%) were resistant to group (ertapenem and imipenem). The other 14 (14%) were negative for the production of ESBL and carbapenemase (14/100) was sensitive to the antimicrobial agents. Further, the bacteria were classified into multidrug (77%), extensively drug-resistant (11.0%), and pandrug-resistant (4.0%).
In the molecular part of the study Cas1, Cas3, CRISPR1, CRISPR2, and CRISPR3 were
detected through amplification of their primers by conventional PCR. The prevalence of the CRISPR/Cas system was 4(26.67%) in carbapenem-resistant strains and had higher pan resistance to other antibiotics, and 21(29.58%) in the extended spectrum of β-lactamase producer isolates, while it was 8(57.14%) in drug-sensitive isolates, showing a highly significant inverse correlation between prevalence and resistance. The low frequency of the CRISPR/Cas system in drug-resistant Klebsiella pneumoniae implied that CRISPR/Cas may play a role in preventing the acquisition of drug-resistance genes. The occurrence of this system for the sensitive to antimicrobial agents isolates was 6.0 (42.86%), 1.0 (7.14%), and 1.0 (7.14%) for CRISPR1/Cas, RISPR2/Cas, and CRISPR3/Cas respectively. On the other hand, the resistance ratio for the study isolates were 6.0 (8.45%), 19.0 (26.76%), and 13.0 (18.31%) for CRISPR1/Cas, CRISPR2/Cas, and CRISPR3/Cas in ESBL isolates respectively. Also, 1.0 (6.67%), 4.0 (26.67%), and 3.0 (20.0%) for CRISPR1/Cas, CRISPR2/Cas, and CRISPR3/Cas in metallo β-lactamase producer isolates respectively were detected.
The quantitative real-time polymerase chain reaction was used to detect the carbapenemase genes (qPCR). For the detection of blaKPC, blaOXA, blaNDM, blaVIM, and blaIMP genes according to the manufacturer's instructions using (Sacace Biotechnologies S.r.l., Como, Italy) with a qPCR kit (Sacace Biotechnologies S.r.l., Como, Italy). Previous carbapenemase-producing isolates that were positive for studied genes, were used as positive controls. Among the carbapenem-resistant isolates, blaVIM and blaNDM were the primary drug resistance-associated genes and other several types of genes like blaIMP blaOXA blaKPC were also tested. Our study's findings showed that out of 15 Klebsiella pneumonia III positive isolates for metallo β-lactamase all the isolates 15 (100%) had no expression for these metallo β-lactamase genes (KPC and OXA). Also, Our study's findings showed that out
of 15 Klebsiella pneumoniae-positive isolates for metallo β-lactamase, 5 (33.33%) were confirmed as co-existence of metallo β-lactamase VIM and NDM producer isolates. In contrast, 10 (66.67%) of these isolates have not expressed these genes. The results revealed that two isolates had imipenemase encoding genes for all study isolates. Resistance to different types of drugs was higher in the absence of the CRISPR/Cas system. It is suggested that due to the low prevalence of CRISPR/Cas systems in antibiotic-resistant Klebsiella pneumoniae isolates, we conclude that these systems can offer protection against exogenous antibiotic resistance which can be acquired in the absence of CRISPR/Cas modules. This is indeed important as these systems can be developed in the future to be used as tools to fight antibiotic-resistant bacteria. The CRISPR/Cas9 system provides new
opportunities to eradicate MDR strains, as this RNA-guided DNA nuclease can specifically
cleave bacterial genes, leading to the re-sensitization of antibiotic-resistant cells.
CRISPR/Cas system works as an adaptive immune system which prevents the acquisition of resistance encoding genes like ESBLs and Metallo β-lactamase encoding genes. The CRISPR/Cas system will play an important role in the diagnosis and treatment of Klebsiella pneumoniae infections.