Genomic Resistome of Multidrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Iraqi Cancer Patients.

Q2 Medicine

Asian Pacific Journal of Cancer Prevention Pub Date : 2026-09-01 DOI:10.31557/APJCP.2026.27.9.3333

Watheq Mohammed Al-Jewari, Bassam Abdul Rasool Hassan, Ali Haider Mohammed, Abu Bakar Abdul Majeed, Muhamad Faiz Othman, Ahmed Zuhair Abdulhameed Alsammarraie, Mohammed Kamil Al Qayyim, Musaab Kadhim Alabboodi

{"title":"Genomic Resistome of Multidrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Iraqi Cancer Patients.","authors":"Watheq Mohammed Al-Jewari, Bassam Abdul Rasool Hassan, Ali Haider Mohammed, Abu Bakar Abdul Majeed, Muhamad Faiz Othman, Ahmed Zuhair Abdulhameed Alsammarraie, Mohammed Kamil Al Qayyim, Musaab Kadhim Alabboodi","doi":"10.31557/APJCP.2026.27.9.3333","DOIUrl":null,"url":null,"abstract":"Background: Multidrug-resistant (MDR) Klebsiella pneumoniae is an important cause of bloodstream infection (BSI) in cancer patients, particularly those with haematological malignancies, where delayed or inappropriate therapy is associated with high mortality. Genomic data on resistance mechanisms in oncology settings in Iraq remain limited. This study aimed to characterise, using whole-genome sequencing, the antibiotic resistance determinants of MDR K. pneumoniae bloodstream isolates from cancer patients and to explore their potential implications for empirical treatment strategies in this high-risk population.Methods: This genomic substudy was nested within a prospective multi-centre cohort of cancer patients with bloodstream infection at oncology hospitals in Baghdad. Adult patients with haematological malignancies and solid tumours with monomicrobial MDR K. pneumoniae infection were included. Identification and antimicrobial susceptibility testing were performed using the VITEK 2 system and interpreted according to Clinical and Laboratory Standards Institute standards. MDR was defined as non-susceptibility to at least three antibiotic classes. Whole-genome sequencing was performed using an Illumina platform. Resistance genes were identified using curated databases and grouped into β-lactamase/carbapenemase, non-β-lactam, and efflux/regulatory categories. Clinical data (age, sex, and malignancy type) were extracted from medical records.Results: Thirty-five MDR K. pneumoniae bloodstream isolates were analysed, with most infections occurring in patients with haematological malignancies (30/35, 85.7%). Detected resistance genes included CTX-M-type extended-spectrum β-lactamases (including CTX-M-15), SHV and TEM enzymes, and OXA-48-like carbapenemases (OXA-48 and OXA-232). Non-β-lactam resistance determinants (aadA, EreA, Mph(A), Mrx, sul1, sulI) and efflux-related genes were also identified.Conclusions: MDR K. pneumoniae bloodstream infections in this cohort were predominantly observed in patients with haematological malignancies. Whole-genome sequencing identified multiple resistance determinants. These findings provide genomic insights that may help explain resistance patterns in this setting and support the need for strengthened infection prevention and locally tailored antimicrobial stewardship strategies.","PeriodicalId":55451,"journal":{"name":"Asian Pacific Journal of Cancer Prevention","volume":"27 9","pages":"3333-3340"},"PeriodicalIF":0.0000,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Asian Pacific Journal of Cancer Prevention","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.31557/APJCP.2026.27.9.3333","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Multidrug-resistant (MDR) Klebsiella pneumoniae is an important cause of bloodstream infection (BSI) in cancer patients, particularly those with haematological malignancies, where delayed or inappropriate therapy is associated with high mortality. Genomic data on resistance mechanisms in oncology settings in Iraq remain limited. This study aimed to characterise, using whole-genome sequencing, the antibiotic resistance determinants of MDR K. pneumoniae bloodstream isolates from cancer patients and to explore their potential implications for empirical treatment strategies in this high-risk population.

Methods: This genomic substudy was nested within a prospective multi-centre cohort of cancer patients with bloodstream infection at oncology hospitals in Baghdad. Adult patients with haematological malignancies and solid tumours with monomicrobial MDR K. pneumoniae infection were included. Identification and antimicrobial susceptibility testing were performed using the VITEK 2 system and interpreted according to Clinical and Laboratory Standards Institute standards. MDR was defined as non-susceptibility to at least three antibiotic classes. Whole-genome sequencing was performed using an Illumina platform. Resistance genes were identified using curated databases and grouped into β-lactamase/carbapenemase, non-β-lactam, and efflux/regulatory categories. Clinical data (age, sex, and malignancy type) were extracted from medical records.

Results: Thirty-five MDR K. pneumoniae bloodstream isolates were analysed, with most infections occurring in patients with haematological malignancies (30/35, 85.7%). Detected resistance genes included CTX-M-type extended-spectrum β-lactamases (including CTX-M-15), SHV and TEM enzymes, and OXA-48-like carbapenemases (OXA-48 and OXA-232). Non-β-lactam resistance determinants (aadA, EreA, Mph(A), Mrx, sul1, sulI) and efflux-related genes were also identified.

Conclusions: MDR K. pneumoniae bloodstream infections in this cohort were predominantly observed in patients with haematological malignancies. Whole-genome sequencing identified multiple resistance determinants. These findings provide genomic insights that may help explain resistance patterns in this setting and support the need for strengthened infection prevention and locally tailored antimicrobial stewardship strategies.

查看原文本刊更多论文

伊拉克癌症患者多药耐药肺炎克雷伯菌血液感染的基因组抵抗组。

背景：耐多药肺炎克雷伯菌是癌症患者血流感染（BSI）的一个重要原因，特别是那些血液系统恶性肿瘤患者，其中延迟或不适当的治疗与高死亡率相关。伊拉克肿瘤耐药机制的基因组数据仍然有限。本研究旨在利用全基因组测序来表征来自癌症患者的耐多药肺炎克雷伯菌血液分离株的抗生素耐药性决定因素，并探讨其对这一高危人群的经验性治疗策略的潜在影响。方法：该基因组亚研究嵌套在巴格达肿瘤医院血液感染癌症患者的前瞻性多中心队列中。包括血液学恶性肿瘤和实体肿瘤合并单微生物耐多药肺炎克雷伯菌感染的成年患者。使用VITEK 2系统进行鉴定和药敏试验，并根据临床和实验室标准协会的标准进行解释。耐多药被定义为对至少三种抗生素不敏感。使用Illumina平台进行全基因组测序。利用数据库鉴定抗性基因，并将抗性基因分为β-内酰胺酶/碳青霉烯酶、非β-内酰胺酶和外排/调控类。临床资料（年龄、性别和恶性肿瘤类型）从医疗记录中提取。结果：共分离出35株耐多药肺炎克雷伯菌血液分离株，感染以血液系统恶性肿瘤患者居多（30/35,85.7%）。检测到的耐药基因包括ctx - m型增谱β-内酰胺酶（包括CTX-M-15）、SHV和TEM酶以及OXA-48样碳青霉烯酶（OXA-48和OXA-232）。非β-内酰胺耐药决定因素（aadA、EreA、Mph(A)、Mrx、sul1、sulI）和外排相关基因也得到了鉴定。结论：该队列中耐多药肺炎克雷伯菌血流感染主要见于血液系统恶性肿瘤患者。全基因组测序确定了多个耐药决定因素。这些发现提供了基因组学见解，可能有助于解释这种情况下的耐药模式，并支持加强感染预防和当地量身定制的抗菌素管理战略的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Asian Pacific Journal of Cancer Prevention 医学-肿瘤学

CiteScore

2.80

自引率

0.00%

发文量

779

审稿时长

3 months

期刊介绍： Cancer is a very complex disease. While many aspects of carcinoge-nesis and oncogenesis are known, cancer control and prevention at the community level is however still in its infancy. Much more work needs to be done and many more steps need to be taken before effective strategies are developed. The multidisciplinary approaches and efforts to understand and control cancer in an effective and efficient manner, require highly trained scientists in all branches of the cancer sciences, from cellular and molecular aspects to patient care and palliation. The Asia Pacific Organization for Cancer Prevention (APOCP) and its official publication, the Asia Pacific Journal of Cancer Prevention (APJCP), have served the community of cancer scientists very well and intends to continue to serve in this capacity to the best of its abilities. One of the objectives of the APOCP is to provide all relevant and current scientific information on the whole spectrum of cancer sciences. They aim to do this by providing a forum for communication and propagation of original and innovative research findings that have relevance to understanding the etiology, progression, treatment, and survival of patients, through their journal. The APJCP with its distinguished, diverse, and Asia-wide team of editors, reviewers, and readers, ensure the highest standards of research communication within the cancer sciences community across Asia as well as globally. The APJCP publishes original research results under the following categories: -Epidemiology, detection and screening. -Cellular research and bio-markers. -Identification of bio-targets and agents with novel mechanisms of action. -Optimal clinical use of existing anti-cancer agents, including combination therapies. -Radiation and surgery. -Palliative care. -Patient adherence, quality of life, satisfaction. -Health economic evaluations.