{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:14:23Z","timestamp":1789733663626,"version":"4.0.1"},"reference-count":89,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,9,7]],"date-time":"2022-09-07T00:00:00Z","timestamp":1662508800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"US Centers for Disease Control and Prevention (CDC)","award":["CoAg#U01GH001207"],"award-info":[{"award-number":["CoAg#U01GH001207"]}]},{"name":"commitment of US CDC","award":["CoAg#U01GH001207"],"award-info":[{"award-number":["CoAg#U01GH001207"]}]},{"name":"Governments of Bangladesh, Canada, Sweden","award":["CoAg#U01GH001207"],"award-info":[{"award-number":["CoAg#U01GH001207"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>The emergence of virulent extended spectrum \u03b2-lactamase producing Klebsiella pneumoniae (ESBL-KP) including carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospital-acquired infections has resulted in significant morbidity and mortality worldwide. We investigated the antibiotic resistance and virulence factors associated with ESBL-KP and CRKP in tertiary care hospitals in Bangladesh and explored their ability to form biofilm. A total of 67 ESBL-KP were isolated from 285 Klebsiella pneumoniae isolates from environmental and patient samples from January 2019 to April 2019. For ESBL-KP isolates, molecular typing was carried out using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR), antibiotic susceptibility testing, PCR for virulence and drug-resistant genes, and biofilm assays were also performed. All 67 isolates were multidrug-resistant (MDR) to different antibiotics at high levels and 42 isolates were also carbapenem-resistant. The most common \u03b2-lactam resistance gene was blaCTX-M-1 (91%), followed by blaTEM (76.1%), blaSHV (68.7%), blaOXA-1 (29.9%), blaGES (14.9%), blaCTX-M-9 (11.9%), and blaCTX-M-2 (4.5%). The carbapenemase genes blaKPC (55.2%), blaIMP (28.4%), blaVIM (14.9%), blaNDM-1 (13.4%), and blaOXA-48 (10.4%) and virulence-associated genes such as fimH (71.6%), ugeF (58.2%), wabG (56.7%), ureA (47.8%) and kfuBC (28.4%) were also detected. About 96.2% of the environmental and 100% of the patient isolates were able to form biofilms. ERIC-PCR-based genotyping and hierarchical clustering of K. pneumoniae isolates revealed an association between environmental and patient samples, indicating clonal association with possible transmission of antimicrobial resistance genes. Our findings can help in improving patient care and infection control, and the development of public health policies related to hospital-acquired infections.<\/jats:p>","DOI":"10.3390\/ph15091116","type":"journal-article","created":{"date-parts":[[2022,9,8]],"date-time":"2022-09-08T01:40:13Z","timestamp":1662601213000},"page":"1116","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Healthcare Facilities as Potential Reservoirs of Antimicrobial Resistant Klebsiella pneumoniae: An Emerging Concern to Public Health in Bangladesh"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3278-0622","authenticated-orcid":false,"given":"Zahid Hayat","family":"Mahmud","sequence":"first","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman Zahir","family":"Uddin","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Moniruzzaman","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0376-8803","authenticated-orcid":false,"given":"Sobur","family":"Ali","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"},{"name":"Burnett School of Biomedical Sciences, University of Central Florida, Orlando, FL 32816, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monir","family":"Hossain","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Tamzid","family":"Islam","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorin Teresa D.","family":"Costa","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Rafiqul","family":"Islam","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Shafiqul","family":"Islam","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5888-1558","authenticated-orcid":false,"given":"Md. Zakiul","family":"Hassan","sequence":"additional","affiliation":[{"name":"Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1176-9600","authenticated-orcid":false,"given":"Li-Ann","family":"Ong","sequence":"additional","affiliation":[{"name":"School of Geography and the Environment, University of Oxford, Oxford OX1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin E.","family":"Moore","sequence":"additional","affiliation":[{"name":"Big Data Institute, Nuffield Department of Medicine, University of Oxford, Oxford OX1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2236-7589","authenticated-orcid":false,"given":"Katrina J.","family":"Charles","sequence":"additional","affiliation":[{"name":"School of Geography and the Environment, University of Oxford, Oxford OX1 2JD, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinesh","family":"Mondal","sequence":"additional","affiliation":[{"name":"Laboratory of Environmental Health, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1476-2108","authenticated-orcid":false,"given":"Bruno Silvester","family":"Lopes","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen AB25 2ZD, UK"},{"name":"National Horizons Centre, Teesside University, Darlington DL1 1HG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahana","family":"Parveen","sequence":"additional","affiliation":[{"name":"Emerging Infections, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.3201\/eid1710.110655","article-title":"Global Spread of Carbapenemase-Producing Enterobacteriaceae","volume":"17","author":"Nordmann","year":"2011","journal-title":"Emerg. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/nyas.12537","article-title":"Carbapenem-resistant Enterobacteriaceae: Biology, Epidemiology, and Management","volume":"1323","author":"Temkin","year":"2014","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1128\/JCM.43.2.991-992.2005","article-title":"Liver Abscess Caused by MagA+ Klebsiella pneumoniae in North America","volume":"43","author":"Fang","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1086\/519262","article-title":"Klebsiella pneumoniae Genotype K1: An Emerging Pathogen That Causes Septic Ocular or Central Nervous System Complications from Pyogenic Liver Abscess","volume":"45","author":"Fang","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"76","DOI":"10.4103\/jms.jms_25_17","article-title":"World Health Organization Releases Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics","volume":"32","author":"Shrivastava","year":"2018","journal-title":"J. Med. Soc."},{"key":"ref_6","doi-asserted-by":"crossref","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":"ref_7","doi-asserted-by":"crossref","unstructured":"Brinkworth, A.J., Hammer, C.H., Olano, L.R., Kobayashi, S.D., Chen, L., Kreiswirth, B.N., and DeLeo, F.R. (2015). Identification of Outer Membrane and Exoproteins of Carbapenem-Resistant Multilocus Sequence Type 258 Klebsiella pneumoniae. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123219"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1351","DOI":"10.1086\/503420","article-title":"Association between RmpA and MagA Genes and Clinical Syndromes Caused by Klebsiella pneumoniae in Taiwan","volume":"42","author":"Yu","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1128\/IAI.00372-06","article-title":"Yersiniabactin Is a Virulence Factor for Klebsiella pneumoniae during Pulmonary Infection","volume":"75","author":"Lawlor","year":"2007","journal-title":"Infect. Immun."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Wu, C.-C., Wang, C.-K., Chen, Y.-C., Lin, T.-H., Jinn, T.-R., and Lin, C.-T. (2014). IscR Regulation of Capsular Polysaccharide Biosynthesis and Iron-Acquisition Systems in Klebsiella pneumoniae CG43. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107812"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1128\/iai.40.1.56-61.1983","article-title":"Virulence for Mice of Klebsiella Strains Belonging to the O1 Group: Relationship to Their Capsular (K) Types","volume":"40","author":"Mizuta","year":"1983","journal-title":"Infect. Immun."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"4208","DOI":"10.1128\/iai.61.10.4208-4216.1993","article-title":"Genetic Exchange of Determinants for Capsular Polysaccharide Biosynthesis between Klebsiella pneumoniae Strains Expressing Serotypes K2 and K21a","volume":"61","author":"Ofek","year":"1993","journal-title":"Infect. Immun."},{"key":"ref_13","first-page":"386","article-title":"New Klebsiella Capsular Antigen, K82, and the Deletion of Five of Those Previously Assigned","volume":"27","year":"1977","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1128\/cdli.4.5.550-555.1997","article-title":"O-Antigen Seroepidemiology of Klebsiella Clinical Isolates and Implications for Immunoprophylaxis of Klebsiella Infections","volume":"4","author":"Trautmann","year":"1997","journal-title":"Clin. Diagn. Lab. Immunol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Edwards, P.R., and Fife, M.A. (1952). Capsule Types of Klebsiella. J. Infect. Dis., 92\u2013104.","DOI":"10.1093\/infdis\/91.1.92"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/infdis\/94.1.65","article-title":"Further Klebsiella Capsule Types","volume":"94","author":"Edmunds","year":"1954","journal-title":"J. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1099\/jmm.0.015198-0","article-title":"V PCR Characterization and Typing of Klebsiella pneumoniae Using Capsular Type-Specific, Variable Number Tandem Repeat and Virulence Gene Targets","volume":"59","author":"Turton","year":"2010","journal-title":"J. Med. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","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":"ref_19","doi-asserted-by":"crossref","first-page":"17880","DOI":"10.1074\/jbc.272.28.17880","article-title":"Diversity of the Escherichia Coli Type 1 Fimbrial Lectin: Differential Binding to Mannosides and Uroepithelial Cells","volume":"272","author":"Sokurenko","year":"1997","journal-title":"J. Biol. Chem."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.resmic.2005.06.006","article-title":"The Role of Klebsiella pneumoniae Urease in Intestinal Colonization and Resistance to Gastrointestinal Stress","volume":"157","author":"Maroncle","year":"2006","journal-title":"Res. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1128\/CMR.15.2.167-193.2002","article-title":"Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms","volume":"15","author":"Donlan","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.3390\/molecules14072535","article-title":"Bacterial Extracellular Polysaccharides Involved in Biofilm Formation","volume":"14","author":"Vu","year":"2009","journal-title":"Molecules"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1038\/nrd1008","article-title":"Understanding Biofilm Resistance to Antibacterial Agents","volume":"2","author":"Davies","year":"2003","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1128\/MMBR.00013-14","article-title":"Biofilm-Related Infections: Bridging the Gap between Clinical Management and Fundamental Aspects of Recalcitrance toward Antibiotics","volume":"78","author":"Lebeaux","year":"2014","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1099\/jmm.0.000032","article-title":"Healthcare-Associated Infections, Medical Devices and Biofilms: Risk, Tolerance and Control","volume":"64","author":"Percival","year":"2015","journal-title":"J. Med. Microbiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1771","DOI":"10.1128\/JCM.37.6.1771-1776.1999","article-title":"The Calgary Biofilm Device: New Technology for Rapid Determination of Antibiotic Susceptibilities of Bacterial Biofilms","volume":"37","author":"Ceri","year":"1999","journal-title":"J. Clin. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/S0140-6736(01)05321-1","article-title":"Antibiotic Resistance of Bacteria in Biofilms","volume":"358","author":"Stewart","year":"2001","journal-title":"Lancet"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.4308\/hjb.20.4.171","article-title":"Genetic Diversity of Klebsiella Spp. Isolated from Tempe Based on Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction (ERIC-PCR)","volume":"20","author":"Barus","year":"2013","journal-title":"HAYATI J. Biosci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1016\/j.foodcont.2006.04.009","article-title":"Incidence of Klebsiella Pneumonia in Street Foods Sold in Malaysia and Their Characterization by Antibiotic Resistance, Plasmid Profiling, and RAPD-PCR Analysis","volume":"18","author":"Haryani","year":"2007","journal-title":"Food Control"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.diagmicrobio.2014.09.005","article-title":"Comparison of Multilocus Sequence Typing, RAPD, and MALDI-TOF Mass Spectrometry for Typing of \u03b2-Lactam-Resistant Klebsiella pneumoniae Strains","volume":"80","author":"Sachse","year":"2014","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_31","first-page":"371","article-title":"Defining and Evaluating a Core Genome Multilocus Sequence Typing Scheme for Whole-Genome Sequence-Based Typing of Klebsiella pneumoniae","volume":"8","author":"Zhou","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"289","DOI":"10.3389\/fmicb.2018.00289","article-title":"Phenotypic and Genotypic Characterization of Klebsiella pneumoniae Isolated from Retail Foods in China","volume":"9","author":"Zhang","year":"2018","journal-title":"Front. Microbiol."},{"key":"ref_33","doi-asserted-by":"crossref","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":"ref_34","doi-asserted-by":"crossref","first-page":"38929","DOI":"10.1038\/srep38929","article-title":"Molecular Typing and Virulence Analysis of Multidrug Resistant Klebsiella pneumoniae Clinical Isolates Recovered from Egyptian Hospitals","volume":"6","author":"Wasfi","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1128\/CMR.00059-12","article-title":"Antimicrobial Resistance and Virulence: A Successful or Deleterious Association in the Bacterial World?","volume":"26","author":"Beceiro","year":"2013","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3357","DOI":"10.3389\/fmicb.2020.612020","article-title":"Characteristics of Carbapenemase-Producing Klebsiella pneumoniae Isolated in the Intensive Care Unit of the Largest Tertiary Hospital in Bangladesh","volume":"11","author":"Okanda","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-018-3602-4","article-title":"Methicillin-Resistant Staphylococcus Aureus Contamination and Distribution in Patient\u2019s Care Environment at Muhimbili National Hospital, Dar Es Salaam-Tanzania","volume":"11","author":"Nkuwi","year":"2018","journal-title":"BMC Res. Notes"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ajic.2017.07.010","article-title":"Control of Multidrug-Resistant Acinetobacter Baumannii in Hong Kong: Role of Environmental Surveillance in Communal Areas after a Hospital Outbreak","volume":"46","author":"Cheng","year":"2018","journal-title":"Am. J. Infect. Control"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1476-0711-13-16","article-title":"Molecular Characterization of Clinical Multidrug-Resistant Klebsiella pneumoniae Isolates","volume":"13","author":"Cao","year":"2014","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"105","DOI":"10.7324\/JAPS.2018.8614","article-title":"Cephalosporin-3G, Highly Prescribed Antibiotic to Outpatients in Rajshahi, Bangladesh: Prescription Errors, Carelessness, Irrational Uses Are the Triggering Causes of Antibiotic Resistance","volume":"8","author":"Chouduri","year":"2018","journal-title":"J. Appl. Pharm. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1093\/jac\/dks396","article-title":"Update of the Molecular Epidemiology of KPC-2-Producing Klebsiella pneumoniae in Brazil: Spread of Clonal Complex 11 (ST11, ST437 and ST340)","volume":"68","author":"Pereira","year":"2013","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s12199-015-0468-0","article-title":"Understanding the Contribution of Environmental Factors in the Spread of Antimicrobial Resistance","volume":"20","author":"Fletcher","year":"2015","journal-title":"Environ. Health Prev. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/jtm.12231","article-title":"Multidrug-Resistant Bacteria without Borders: Role of International Trips in the Spread of Multidrug-Resistant Bacteria","volume":"22","author":"Vila","year":"2015","journal-title":"J. Travel Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.tcmj.2016.04.005","article-title":"Emergence of Carbapenemase-Producing Urinary Isolates at a Tertiary Care Hospital in Dhaka, Bangladesh","volume":"28","author":"Begum","year":"2016","journal-title":"Tzu Chi Med. J."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1568","DOI":"10.1089\/mdr.2018.0063","article-title":"Prevalence and Molecular Epidemiology of Clinical Isolates of Escherichia Coli and Klebsiella pneumoniae Harboring Extended-Spectrum Beta-Lactamase and Carbapenemase Genes in Bangladesh","volume":"24","author":"Khan","year":"2018","journal-title":"Microb. Drug Resist."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2593","DOI":"10.1007\/s10096-012-1601-2","article-title":"Emergence of Multidrug-Resistant NDM-1-Producing Gram-Negative Bacteria in Bangladesh","volume":"31","author":"Islam","year":"2012","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1128\/AAC.00736-08","article-title":"First Report of KPC-2-Producing Klebsiella pneumoniae Strains in Brazil","volume":"53","author":"Monteiro","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1093\/jac\/dkn484","article-title":"Carbapenem-Hydrolysing \u03b2-Lactamase KPC-2 in Klebsiella pneumoniae Isolated in Rio de Janeiro, Brazil","volume":"63","author":"Peirano","year":"2009","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1128\/JCM.01507-09","article-title":"Detection of CTX-M-Type Extended-Spectrum Beta-Lactamase (ESBLs) by Testing with MicroScan Overnight and ESBL Confirmation Panels","volume":"48","author":"Jorgensen","year":"2010","journal-title":"J. Clin. Microbiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"249","DOI":"10.4103\/0377-4929.134698","article-title":"Prevalence of BlaTEM, BlaSHV and BlaCTX-M Genes in Clinical Isolates of Escherichia Coli and Klebsiella pneumoniae from Northeast India","volume":"57","author":"Bora","year":"2014","journal-title":"Indian J. Pathol. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/jac\/dki166","article-title":"Emergence of Enterobacteriaceae Producing Extended-Spectrum \u03b2-Lactamases (ESBLs) in the Community","volume":"56","author":"Pitout","year":"2005","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1056\/NEJMra041359","article-title":"Mechanisms of Disease: The New Beta-Lactamases","volume":"352","author":"George","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2863","DOI":"10.2147\/IDR.S262493","article-title":"Genotypic to Phenotypic Resistance Discrepancies Identified Involving \u03b2-Lactamase Genes, BlaKPC, BlaIMP, BlaNDM-1, and BlaVIM in Uropathogenic Klebsiella pneumoniae","volume":"13","author":"Urmi","year":"2020","journal-title":"Infect. Drug Resist."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.diagmicrobio.2013.08.031","article-title":"Molecular Characterization of Klebsiella pneumoniae Isolated from Renal Transplanted Patients: Virulence Markers, Extended-Spectrum \u03b2-Lactamases, and Genetic Relatedness","volume":"79","author":"Calhau","year":"2014","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_55","first-page":"591","article-title":"Investigations on the Virulence, Serotypes and Genotyping of Klebsiella pneumoniae Producing KPC-2","volume":"33","author":"Cheng","year":"2015","journal-title":"Chin. J. Clin. Lab. Sci"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"501","DOI":"10.5604\/01.3001.0010.7042","article-title":"The Determination and Correlation of Various Virulence Genes, ESBL, Serum Bactericidal Effect and Biofilm Formation of Clinical Isolated Classical Klebsiella pneumoniae and Hypervirulent Klebsiella pneumoniae from Respiratory Tract Infected Patients","volume":"66","author":"Shah","year":"2017","journal-title":"Pol. J. Microbiol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1007\/s10096-014-2100-4","article-title":"Clinical and Microbiological Characteristics of Klebsiella pneumoniae from Community-Acquired Recurrent Urinary Tract Infections","volume":"33","author":"Lin","year":"2014","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1017\/S0950268812000933","article-title":"Microbiological and Clinical Characteristics of Bacteraemia Caused by the Hypermucoviscosity Phenotype of Klebsiella pneumoniae in Korea","volume":"141","author":"Jung","year":"2013","journal-title":"Epidemiol. Infect."},{"key":"ref_59","doi-asserted-by":"crossref","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":"Hita","year":"2004","journal-title":"Infect. Immun."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"7213","DOI":"10.1128\/JB.185.24.7213-7221.2003","article-title":"The Klebsiella pneumoniae WabG Gene: Role InBiosynthesis of the Core Lipopolysaccharide AndVirulence","volume":"185","author":"Izquierdo","year":"2003","journal-title":"J. Bacteriol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1086\/430619","article-title":"Genomic Heterogeneity in Klebsiella pneumoniae Strains Is Associated with Primary Pyogenic Liver Abscess and Metastatic Infection","volume":"192","author":"Ma","year":"2005","journal-title":"J. Infect. Dis."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.3389\/fmicb.2017.01913","article-title":"Exploring the Genome and Phenotype of Multi-Drug Resistant Klebsiella pneumoniae of Clinical Origin","volume":"8","author":"Anes","year":"2017","journal-title":"Front. Microbiol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e30682","DOI":"10.5812\/jjm.30682","article-title":"Evaluation of Biofilm Formation among Klebsiella pneumoniae Isolates and Molecular Characterization by ERIC-PCR","volume":"9","author":"Seifi","year":"2016","journal-title":"Jundishapur J. Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s13594-015-0235-4","article-title":"Diversity and Biofilm-Forming Capability of Bacteria Recovered from Stainless Steel Pipes of a Milk-Processing Dairy Plant","volume":"96","author":"Didouh","year":"2016","journal-title":"Dairy Sci. Technol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"3477","DOI":"10.1128\/AAC.48.9.3477-3482.2004","article-title":"Increased Serum Resistance in Klebsiella pneumoniae Strains Producing Extended-Spectrum \u03b2-Lactamases","volume":"48","author":"Sahly","year":"2004","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"3029","DOI":"10.1128\/AAC.00010-08","article-title":"Extended-Spectrum \u03b2-Lactamase Production Is Associated with an Increase in Cell Invasion and Expression of Fimbrial Adhesins in Klebsiella pneumoniae","volume":"52","author":"Sahly","year":"2008","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1089\/mdr.2018.0027","article-title":"Relationship between Biofilm Formation and Antimicrobial Resistance in Gram-Negative Bacteria","volume":"25","author":"Cepas","year":"2019","journal-title":"Microb. Drug Resist."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"7149","DOI":"10.1128\/IAI.68.12.7149-7151.2000","article-title":"Identification of Genes Present Specifically in a Virulent Strain of Klebsiella pneumoniae","volume":"68","author":"Lai","year":"2000","journal-title":"Infect. Immun."},{"key":"ref_69","unstructured":"(2022, August 27). Large Detailed Map of Bangladesh with Cities. Available online: https:\/\/ontheworldmap.com\/bangladesh\/large-detailed-map-of-bangladesh-with-cities.html."},{"key":"ref_70","unstructured":"Aurna, S.T. (2017). Rapid Identification of Klebsiella pneumoniae Using PCR Based Method Targeting 16S RRNA Gene. [Bachelor\u2019s Thesis, BRAC University]."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.micres.2005.04.005","article-title":"Isolation and Molecular Characterization of Toxigenic Vibrio Parahaemolyticus from the Kii Channel, Japan","volume":"161","author":"Mahmud","year":"2006","journal-title":"Microbiol. Res."},{"key":"ref_72","first-page":"e3064","article-title":"Aseptic Laboratory Techniques: Plating Methods","volume":"63","author":"Sanders","year":"2012","journal-title":"JoVE J. Vis. Exp."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1111\/j.1472-765X.2010.02945.x","article-title":"Evaluation of a Chromogenic Agar Medium for the Detection of Extended-spectrum \u0392-lactamase-producing Enterobacteriaceae","volume":"51","author":"Saito","year":"2010","journal-title":"Lett. Appl. Microbiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e00213","DOI":"10.1128\/JCM.00213-21","article-title":"Overview of Changes to the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing, M100","volume":"59","author":"Humphries","year":"2021","journal-title":"J. Clin. Microbiol."},{"key":"ref_75","unstructured":"European Committee on Antimicrobial Susceptibility Testing (2022, August 27). Clinical Breakpoints and Dosing of Antibiotics 2020. Available online: https:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"ref_76","unstructured":"Clinical and Laboratory Standards Institute (2021). Performance standards for antimicrobial susceptibility testing. 31st ed.. CLSI Suppl. M100, 41, 1\u2013352."},{"key":"ref_77","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2022, August 27). Breakpoint Tables for Interpretation of MICs and Zone Diameters 2021. Available online: https:\/\/www.eucast.org\/eucast_news\/news_singleview\/?tx_ttnews%5Btt_news%5D=416&cHash=0af950182d1dea8f854e2be8b11cbbe4."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"783019","DOI":"10.3389\/fpubh.2021.783019","article-title":"ESBL Producing Escherichia Coli in Faecal Sludge Treatment Plants: An Invisible Threat to Public Health in Rohingya Camps, Cox\u2019s Bazar, Bangladesh","volume":"9","author":"Hossain","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"228","DOI":"10.3389\/fpubh.2020.00228","article-title":"Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli in Drinking Water Samples from a Forcibly Displaced, Densely Populated Community Setting in Bangladesh","volume":"8","author":"Mahmud","year":"2020","journal-title":"Front. Public Health"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1093\/jac\/dkp498","article-title":"Development of a Set of Multiplex PCR Assays for the Detection of Genes Encoding Important \u03b2-Lactamases in Enterobacteriaceae","volume":"65","author":"Dallenne","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Brisse, S., Fevre, C., Passet, V., Issenhuth-Jeanjean, S., Tournebize, R., Diancourt, L., and Grimont, P. (2009). Virulent Clones of Klebsiella pneumoniae: Identification and Evolutionary Scenario Based on Genomic and Phenotypic Characterization. PLoS ONE, 4.","DOI":"10.1371\/journal.pone.0004982"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"4","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":"ref_83","doi-asserted-by":"crossref","first-page":"O818","DOI":"10.1111\/1469-0691.12664","article-title":"Molecular Epidemiology and Virulence Factors of Pyogenic Liver Abscess Causing Klebsiella pneumoniae in China","volume":"20","author":"Luo","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Du, J., Li, P., Liu, H., L\u00fc, D., Liang, H., and Dou, Y. (2014). Phenotypic and Molecular Characterization of Multidrug Resistant Klebsiella pneumoniae Isolated from a University Teaching Hospital, China. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0095181"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"635539","DOI":"10.3389\/fmicb.2021.635539","article-title":"Characterization of Pathogenic Vibrio Parahaemolyticus Isolated from Fish Aquaculture of the Southwest Coastal Area of Bangladesh","volume":"12","author":"Siddique","year":"2021","journal-title":"Front. Microbiol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/S1413-8670(11)70197-0","article-title":"Evaluation of Different Detection Methods of Biofilm Formation in the Clinical Isolates","volume":"15","author":"Hassan","year":"2011","journal-title":"Braz. J. Infect. Dis."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1111\/jam.15093","article-title":"Diversity of Vibrio Parahaemolyticus in Marine Fishes of Bangladesh","volume":"131","author":"Ali","year":"2021","journal-title":"J. Appl. Microbiol."},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Zhao, S., Guo, Y., Sheng, Q., and Shyr, Y. (2014). Heatmap3: An Improved Heatmap Package with More Powerful and Convenient Features. BMC Bioinform., 15.","DOI":"10.1186\/1471-2105-15-S10-P16"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s00357-014-9161-z","article-title":"Ward\u2019s Hierarchical Agglomerative Clustering Method: Which Algorithms Implement Ward\u2019s Criterion?","volume":"31","author":"Murtagh","year":"2014","journal-title":"J. Classif."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/15\/9\/1116\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:25:11Z","timestamp":1760142311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/15\/9\/1116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,7]]},"references-count":89,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9]]}},"alternative-id":["ph15091116"],"URL":"https:\/\/doi.org\/10.3390\/ph15091116","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,7]]}}}