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Volume 23, Number 11—November 2017
Dispatch

Phylogenetic Analysis of Klebsiella pneumoniae from Hospitalized Children, Pakistan

Hasan Ejaz12, Nancy Wang1, Jonathan J. Wilksch, Andrew J. Page, Hanwei Cao, Shruti Gujaran, Jacqueline A. Keane, Trevor Lithgow, Ikram ul-Haq, Gordon Dougan, Richard A. Strugnell1Comments to Author , and Eva Heinz1Comments to Author 
Author affiliations: CAMS, Aljouf University, Aljouf, Saudi Arabia; The Children’s Hospital, Lahore, Pakistan (H. Ejaz); The University of Melbourne, Melbourne, Victoria, Australia (H. Ejaz, N. Wang, J.J. Wilksch, H. Cao, S. Gujaran, R.A. Strugnell); Wellcome Trust Sanger Institute, Hinxton, UK (A.J. Page, J.A. Keane, G. Dougan, E. Heinz); Monash University, Melbourne (T. Lithgow, E. Heinz); Government College University, Lahore (I.ul-Haq)

Main Article

Figure 1

Statistical overview of bacterial isolates from clinical samples collected during May 2010–February 2012 from The Children’s Hospital & The Institute of Child Health, Lahore, Pakistan. A) Map of Pakistan highlighting the main catchment area of Lahore (medium gray, population ≈10 million) and the wider area of Punjab (black, population ≈100 million). B) A total of 5,475 samples collected from children resulted in laboratory-positive cultures; the 5 most frequently occurring bacterial species

Figure 1. Statistical overview of bacterial isolates from clinical samples collected during May 2010–February 2012 from The Children’s Hospital & The Institute of Child Health, Lahore, Pakistan. A) Map of Pakistan highlighting the main catchment area of Lahore (black, population ≈10 million) and the wider area of Punjab (medium gray, population ≈100 million). B) A total of 5,475 samples collected from children resulted in laboratory-positive cultures; the 5 most frequently occurring bacterial species accounted for ≈70% of total bacterial infections, and Klebsiella pneumoniae (white bar) was the third most dominant (710 isolates). 1, Escherichia coli; 2, coagulase-negative Staphylococcus; 3, K. pneumoniae; 4, Pseudomonas aeruginosa; 5, K. oxytoca; 6, Staphylococcus aureus; 7, Acinetobacter spp.; 8, Enterococcus faecalis; 9, Citrobacter spp.; 10, Streptococcus pyogenes; 11, Burkhoderia cepacia; 12, Enterobacter clocae; 13, Salmonella enterica var. Typhi; 14, others (>100 species). C) The proportion of ESBL-producing K. pneumoniae (214 isolates) among all K. pneumoniae isolates demonstrated high prevalence of antimicrobial resistance. D) A total of 38.3% of ESBL-producing K. pneumoniae infections occurred in neonates (<29 d), an age group that also showed the highest fatality rate (34.1%). Patients who were removed from the hospital against medical advice (AMA) typically were critically ill and were taken home by the family to avoid dying in the hospital. E) The apparent hierarchy shown in panel E closely correlated with interventions given. IV line (97.7%), urinary catheter (27.5%), and ETT (8.4%) were the 3 most commonly administered procedures among sampled patients, although no temporal relationship between procedure and sample collection could be established. 1, IV line; 2, urinary catheter; 3, ETT; 4, PD catheter; 5, surgery; 6, NG tube; 7, CVP; 8, others. F) A total of 54.6% of ESBL-producing K. pneumoniae isolates were from patient blood samples, followed by urine (21.5%), CSF (6%), and ETT (6%). 1, Blood; 2, urine; 3, CSF; 4, ETT; 5, PD catheter; 6, tracheal secretions; 7, pus; 8, CVP tip; 9, ear swab; 10, pleural fluid; 11, wound swab. CSF, cerebrospinal fluid; CVP, central venous catheter tip; ESBL, extended-spectrum β-lactamase; ETT, endotracheal tube; IV, intravenous; NG, nasogastric; PD, peritoneal dialysis catheter. The regional map was derived from the Global Administrative Areas online resource (http://www.gadm.org/).

Main Article

1These authors contributed equally to this article.

2Current affiliation: CAMS, Aljouf University, Aljouf, Saudi Arabia.

Page created: October 17, 2017
Page updated: October 17, 2017
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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