{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:11:32Z","timestamp":1792541492644,"version":"4.5.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI19\/00478"],"award-info":[{"award-number":["PI19\/00478"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    is a Gram-negative bacterium capable of colonizing, invading, and causing infections in different anatomical sites of the human body. Its ability to evade the immune system, its increasing antimicrobial resistance and the emergence of hypervirulent pathotypes have become a major challenge in the medical field. In this study, 127 strains from different clinical sources (urine, respiratory tract or blood) were characterized for antimicrobial resistance, the presence of virulence factor genes, serum resistance, hypermucoviscosity and the ability to form biofilms. Specific characteristics of the uropathogenic strains were examined and compared with the other clinical groups.\n                  <\/jats:p>\n                  <jats:p>\n                    Differences were found between urine and the other groups of strains. Urine strains showed the highest antibiotic resistance (64.91%) compared to blood (63.64%) or respiratory strains (51.35%) as well as the highest extended-spectrum beta-lactamases (ESBL) production. These strains also showed statistically significant high resistance to fosfomycin (24.56%) compared to the other groups (p = 0.008). Regarding virulence, 84.21% of the urine strains presented the\n                    <jats:italic>uge<\/jats:italic>\n                    gene, showing a statistically significant difference (p = 0.03) compared to the other clinical sources, indicating a possible role of this gene in the development of urinary tract infection. In addition, 46% of biofilm-forming strains belonged to the urine sample group (p = 0.043). In conclusion,\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    strains isolated from urine samples showed higher antimicrobial resistance, ESBL production, and biofilm-forming ability compared to those isolated from respiratory or blood samples. The rapid spread of clinical strains with these characteristics is of concern, and new therapeutic alternatives are essential to mitigate their harmful effects.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2021.738223","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T21:43:35Z","timestamp":1630705415000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":179,"title":["Antibiotic Resistance and Virulence Profiles of Klebsiella pneumoniae Strains Isolated From Different Clinical Sources"],"prefix":"10.3389","volume":"11","author":[{"given":"Victoria","family":"Ball\u00e9n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaiza","family":"Gabasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Ratia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Ortega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Tejero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Soto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"B1","first-page":"1","article-title":"Informe JIACRA Espa\u00f1a. Primer An\u00e1lisis Integrado Del Consumo De Antibi\u00f3ticos Y Su Relaci\u00f3n Con La Aparici\u00f3n De Resistencia","author":"Alonso Herreras","year":"2018","journal-title":"AEMPS. Plan Nac. Resist. Antibi\u00f3ticos"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4042","DOI":"10.3390\/ijms22084042","article-title":"Prophylaxis and Treatment Against Klebsiella Pneumoniae: Current Insights on This Emerging Anti-Microbial Resistant Global Threat","volume":"22","author":"Arato","year":"2021","journal-title":"Int. J. Mol. Sci."},{"key":"B3","doi-asserted-by":"publisher","first-page":"867","DOI":"10.18388\/abp.2015_1148","article-title":"Klebsiella Pneumoniae: Characteristics of Carbapenem Resistance and Virulence Factors","volume":"62","author":"Candan","year":"2015","journal-title":"Acta Biochim. Pol."},{"key":"B4","volume-title":"CLSI. Performance Standards for Antimicrobial Susceptibility Testing","year":"2020"},{"key":"B5","doi-asserted-by":"publisher","first-page":"4377","DOI":"10.1128\/JCM.02316-14","article-title":"Multiplex PCR for Detection of Seven Virulence Factors and K1\/K2 Capsular Serotypes of Klebsiella Pneumoniae","volume":"52","author":"Compain","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1128\/jb.167.1.350-355.1986","article-title":"Characterization of iucA and iucC Genes of the Aerobactin System of Plasmid ColV-K30 in Escherichia Coli","volume":"167","author":"De Lorenzo","year":"1986","journal-title":"J. Bacteriol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"900","DOI":"10.5740\/jaoacint.17-0164","article-title":"Graphene Nanolayers as a New Method for Bacterial Biofilm Prevention: Preliminary Results","volume":"100","author":"Dybowska-Sarapuk","year":"2017","journal-title":"J. AOAC Int."},{"key":"B8","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.patbio.2012.10.004","article-title":"Virulence Profiles and Antibiotic Susceptibility Patterns of Klebsiella Pneumoniae Strains Isolated From Different Clinical Specimens","volume":"61","author":"El Fertas-Aissani","year":"2013","journal-title":"Pathol. Biol."},{"key":"B9","unstructured":"ECDC: SURVEILLANCE REPORTStockholmSurveillance of Antimicrobial Resistance in Europe 20172018"},{"key":"B10","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1084\/jem.20030857","article-title":"A Novel Virulence Gene in Klebsiella Pneumoniae Strains Causing Primary Liver Abscess and Septic Metastatic Complications","volume":"199","author":"Fang","year":"2004","journal-title":"J. Exp. Med."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/iwj.13550","article-title":"Virulent and Multidrug-Resistant Klebsiella Pneumoniae From Clinical Samples in Balochistan","volume":"18","author":"Fatima","year":"2021","journal-title":"Int. Wound J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1038\/nrurol.2010.190","article-title":"The Epidemiology of Urinary Tract Infection","volume":"7","author":"Foxman","year":"2010","journal-title":"Nat. Rev. Urol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1016\/j.micpath.2018.01.030","article-title":"Frequency of Virulence Factors in High Biofilm Formation blaKPC-2 Producing Klebsiella Pneumoniae Strains From Hospitals","volume":"116","author":"Fu","year":"2018","journal-title":"Microb. Pathog."},{"key":"B14","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.ijantimicag.2019.02.004","article-title":"Activity of Ceftolozane\/Tazobactam Against Pseudomonas Aeruginosa and Enterobacterales Isolates Recovered From Intensive Care Unit Patients in Spain: The SUPERIOR Multicentre Study","volume":"53","author":"Garc\u00eda-Fern\u00e1ndez","year":"2019","journal-title":"Int. J. Antimicrob. Agents"},{"key":"B15","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.nmni.2018.02.002","article-title":"Phenotypic and Molecular Characterization of Klebsiella Spp. Isolates Causing Community-Acquired Infections","volume":"23","author":"Garza-Ramos","year":"2018","journal-title":"New Microbes New Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1089\/1076629041310136","article-title":"Characterization and Localization of Drug Resistance","volume":"10","author":"Guerra","year":"2004","journal-title":"Microb. Drug Resist."},{"key":"B17","article-title":"Frequency, Antimicrobial Resistance and Genetic Diversity of","volume":"11","author":"Guo","year":"2016","journal-title":"Klebsiella pneumoniae Food Samples. PloS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1128\/JCM.00959-18","article-title":"Hypervirulent Klebsiella Pneumoniae: A Call for Consensus Definition and International Collaboration","volume":"56","author":"Harada","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s10096-015-2559-7","article-title":"Correlation Between Antimicrobial Resistance and Virulence in Klebsiella Pneumoniae","volume":"35","author":"Hennequin","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-017-17681-8","article-title":"Serotype and Virulence Genes of Klebsiella Pneumoniae Isolated From Mink and Its Pathogenesis in Mice and Mink","volume":"7","author":"Jian-li","year":"2017","journal-title":"Sci. Rep."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e000196","DOI":"10.1099\/mgen.0.000196","article-title":"Genetic Diversity, Mobilisation and Spread of the Yersiniabactin- Encoding Mobile Element ICE Kp in Klebsiella Pneumoniae Populations","volume":"4","author":"Lam","year":"2018","journal-title":"Microb. Genomics"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1757-4749-6-21","article-title":"Genotypes and Virulence in Serotype K2 Klebsiella Pneumoniae From Liver Abscess and Non-Infectious Carriers in Hong Kong, Singapore and Taiwan","volume":"6","author":"Lin","year":"2014","journal-title":"Gut Pathog."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2668","DOI":"10.21037\/apm-20-1052","article-title":"Clinical Characteristics and Risk Factors of Catheter-Associated Urinary Tract Infections Caused by","volume":"9","author":"Liu","year":"2020","journal-title":"Klebsiella pneumoniae. Ann. Cardiothorac. Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Bacteria: An International Expert Proposal for Interim Standard Definitions for Acquired Resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1400","DOI":"10.1111\/j.1600-0463.2007.00722.x","article-title":"Multiplex PCR Amplification Assay for the Detection of blaSHV, blaTEM and blaCTX-M Genes in Enterobacteriaceae","volume":"115","author":"Monstein","year":"2007","journal-title":"Apmis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13099-019-0304-y","article-title":"Prevalence and Pathologic Effects of Colibactin and Cytotoxic Necrotizing Factor-1 (Cnf 1) in Escherichia Coli: Experimental and Bioinformatics Analyses","volume":"11","author":"Morgan","year":"2019","journal-title":"Gut Pathog."},{"key":"B27","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1046\/j.1365-2958.1998.00797.x","article-title":"Initiation of Biofilm Formation in Pseudomonas Fluorescens WCS365","volume":"28","author":"O\u2019Toole","year":"1998","journal-title":"Mol. Microbiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"3953","DOI":"10.1128\/AAC.00915-06","article-title":"Prevalence in the United States of Aac(6\u2032)-Ib-Cr Encoding a Ciprofloxacin-Modifying Enzyme","volume":"50","author":"Park","year":"2006","journal-title":"Antimicrob. Agents Chemother."},{"key":"B29","first-page":"1415","volume-title":"Serotypes, Hemagglutinins, Siderophore Synthesis, and Serum Resistance of Klebsiella Isolates Causing Human Urinary Tract Infections","author":"Podschun","year":"2016"},{"key":"B30","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1128\/cmr.11.4.589","article-title":"Klebsiella Spp. As Nosocomial Pathogens: Epidemiology, Taxonomy, Typing Methods, and Pathogenicity Factors","volume":"11","author":"Podschun","year":"1998","journal-title":"Clin. Microbiol. Rev."},{"key":"B31","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1128\/CMR.00001-07","article-title":"Carbapenemases: The Versatile \u03b2-Lactamases","volume":"20","author":"Queenan","year":"2007","journal-title":"Clin. Microbiol. Rev."},{"key":"B32","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1128\/IAI.72.1.54-61.2004","article-title":"A Gene, Uge, Is Essential for Klebsiella Pneumoniae Virulence","volume":"72","author":"Regu\u00e9","year":"2004","journal-title":"Infect. Immun."},{"key":"B33","doi-asserted-by":"publisher","first-page":"210","DOI":"10.4103\/ijmm.IJMM_19_157","article-title":"Characterisation of Virulence Genes Associated With Pathogenicity in Klebsiella Pneumoniae","volume":"37","author":"Remya","year":"2019","journal-title":"Indian J. Med. Microbiol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1038\/nm1347","article-title":"Fluoroquinolone-Modifying Enzyme: A New Adaptation of a Common Aminoglycoside Acetyltransferase","volume":"12","author":"Robicsek","year":"2006","journal-title":"Nat. Med."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0026734","article-title":"Hypervirulent K. Pneumoniae Secretes More and More Active Iron-Acquisition Molecules Than \u201cClassical\u201d K. Pneumoniae Thereby Enhancing its Virulence","volume":"6","author":"Russo","year":"2011","journal-title":"PloS One"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.1016\/j.ajic.2014.06.013","article-title":"Evolution of the Resistance to Antibiotics of Bacteria Involved in Urinary Tract Infections: A 7-Year Surveillance Study","volume":"42","author":"Sorlozano","year":"2014","journal-title":"Am. J. Infect. Control"},{"key":"B37","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1111\/j.1574-695X.2012.00965.x","article-title":"Biofilm Formation of Klebsiella Pneumoniae on Urethral Catheters Requires Either Type 1 or Type 3 Fimbriae. FEMS Immunol","volume":"65","author":"Stahlhut","year":"2012","journal-title":"Med. Microbiol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1111\/j.1600-0463.2007.apm_630.x","article-title":"Quantification of Biofilm in Microtiter Plates: Overview of Testing Conditions and Practical Recommendations for Assessment of Biofilm Production by","volume":"115","author":"Stepanovi\u0107","year":"2007","journal-title":"staphylococci. Apmis"},{"key":"B39","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1016\/j.toxicon.2021.04.007","article-title":"Klebsiella Pneumoniae Producing Bacterial Toxin Colibactin as a Risk of Colorectal Cancer Development - A Systematic Review","volume":"197","author":"Strakova","year":"2021","journal-title":"Toxicon"},{"key":"B40","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1016\/j.ajic.2003.08.005","article-title":"Role of Biofilm in Catheter-Associated Urinary Tract Infection","volume":"32","author":"Trautner","year":"2004","journal-title":"Am. J. Infect. Control"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/ijerph17176278","article-title":"The Characteristic of Virulence, Biofilm and Antibiotic Resistance of","volume":"17","author":"Wang","year":"2020","journal-title":"Klebsiella pneumoniae. Int. J. Environ. Res. Public Health"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1128\/JCM.01988-06","article-title":"Detection of Extended-Spectrum Beta-Lactamases Among Enterobacteriaceae by Use of Semiautomated Microbiology Systems and Manual Detection Procedures","volume":"45","author":"Wiegand","year":"2007","journal-title":"J. Clin. Microbiol."},{"key":"B43","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1093\/jac\/dki412","article-title":"Multiplex PCR for Rapid Detection of Genes Encoding CTX-M Extended-Spectrum \u03b2-Lactamases [4]","volume":"57","author":"Woodford","year":"2006","journal-title":"J.\u00a0Antimicrob. Chemother."},{"key":"B44","first-page":"1","volume-title":"Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics","year":"2017"},{"key":"B45","doi-asserted-by":"publisher","first-page":"2050","DOI":"10.1080\/21505594.2021.1960101","article-title":"The Hypermucoviscosity of Hypervirulent K . Pneumoniae Confers the Ability to Evade Neutrophil-Mediated Phagocytosis","volume":"12","author":"Xu","year":"2021","journal-title":"Virulence"},{"key":"B46","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s10096-015-2551-2","article-title":"Hypervirulent Klebsiella Pneumoniae Induced Ventilator-Associated Pneumonia in Mechanically Ventilated Patients in China","volume":"35","author":"Yan","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2021.738223\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T21:43:41Z","timestamp":1630705421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2021.738223\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,1]]},"references-count":46,"alternative-id":["10.3389\/fcimb.2021.738223"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2021.738223","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,1]]},"article-number":"738223"}}