Proceedings of International Conference on Applied Innovation in IT  ·  2026/06/12  ·  Vol. 14  ·  Issue 4  ·  pp. 713–720
Phenotypic and Molecular Detection of Efflux Pumps in Klebsiella Pneumoniae Isolated from Sinus Infections
Maisoon Suhail Ahmed and Zainab Hussein Mahdi
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Abstract
Klebsiella pneumoniae is an opportunistic Gram-negative pathogen associated with severe hospital- and community-acquired infections. Its clinical significance has increased because of its growing multidrug resistance (MDR) and virulence potential. This study aimed to phenotypically and molecularly detect efflux pumps in K. pneumoniae isolated from patients with sinus infections and to identify the presence of the mdtK, acrAB, and oqxA genes. A total of 203 clinical swab samples were collected between August 2025 and February 2026 from patients attending the outpatient ENT clinic at Baquba Teaching Hospital, Diyala Governorate, Iraq. Among these, 110 samples were culture-positive, yielding 25 K. pneumoniae isolates that were identified by conventional methods and confirmed using the Vitek 2 system. Antibiotic susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. The highest susceptibility rates were observed for imipenem (76%), chloramphenicol (76%), and doxycycline (76%), whereas lower susceptibility rates were recorded for amikacin (56%) and cefepime (56%). Twelve isolates (48%) were classified as MDR. PCR analysis showed that the acrAB and oqxA genes were detected in 100% of the MDR isolates, whereas the mdtK gene was detected in 91.6%. The high prevalence of these efflux pump genes suggests that they contribute substantially to the multidrug-resistant phenotype by promoting active antibiotic efflux. These findings highlight the importance of molecular detection of efflux pump-mediated resistance for improving antimicrobial surveillance, guiding appropriate therapy, and supporting effective infection control strategies.
Keywords
Sinus Infections acrAB mdtK oqxA Efflux Pump Resistance
References
  1. S. Ali, M. Alam, G. M. Hasan, and M. I. Hassan, "Potential Therapeutic Targets of Klebsiella pneumoniae: A Multi-Omics Review Perspective," Briefings in Functional Genomics, vol. 21, no. 2, pp. 63-77, 2022.
  2. G. Wang, G. Zhao, X. Chao, L. Xie, and H. Wang, "The Characteristic of Virulence, Biofilm and Antibiotic Resistance of Klebsiella pneumoniae," International Journal of Environmental Research and Public Health, vol. 17, no. 17, p. 6278, 2020.
  3. I. Fontoura, T. S. Veriato, L. J. Raniero, and M. L. Castilho, "Analysis of Capped Silver Nanoparticles Combined with Imipenem Against Different Susceptibility Profiles of Klebsiella pneumoniae," Antibiotics, vol. 12, no. 3, p. 535, 2023.
  4. B. M. R. Al-Aajem, H. M. Jasim, and A. J. Saleem, "Detection of Virulent Genes Khe, iuc, rmp, magA in Klebsiella pneumoniae Isolated from Urinary Tract Infection," International Journal of Drug Delivery Technology, vol. 11, no. 4, pp. 1470-1473, 2021.
  5. M. Fuzi, J. Rodriguez Baño, and A. Toth, "Global Evolution of Pathogenic Bacteria with Extensive Use of Fluoroquinolone Agents," Frontiers in Microbiology, vol. 11, p. 271, 2020.
  6. A. Mirzaie and R. Ranjbar, "Antibiotic Resistance, Virulence-Associated Genes Analysis and Molecular Typing of Klebsiella pneumoniae Strains Recovered from Clinical Samples," AMB Express, vol. 11, no. 1, p. 122, 2021.
  7. N. D. Friedman, E. Temkin, and Y. Carmeli, "The Negative Impact of Antibiotic Resistance," Clinical Microbiology and Infection, vol. 22, no. 5, pp. 416-422, 2016.
  8. T. M. Caballero, B. S. Altillo, and A. M. Milstone, "Acute Bacterial Sinusitis: Limitations of Test-Based Treatment," JAMA, vol. 330, no. 4, pp. 326-327, 2023.
  9. J. Wu et al., "Bacterial Diversity and Community Characteristics of the Sinus and Dental Regions in Adults with Odontogenic Sinusitis," BMC Microbiology, vol. 23, no. 1, p. 201, 2023.
  10. Z. Zhang, C. E. Morgan, R. A. Bonomo, and E. W. Yu, "Cryo-EM Structures of the Klebsiella pneumoniae AcrB Multidrug Efflux Pump," mBio, vol. 14, no. 3, p. e00659-23, 2023.
  11. Y. Li, S. Kumar, L. Zhang, H. Wu, and H. Wu, "Characteristics of Antibiotic Resistance Mechanisms and Genes of Klebsiella pneumoniae," Open Medicine, vol. 18, no. 1, p. 20230707, 2023.
  12. S. Jang, "AcrAB-TolC, a Major Efflux Pump in Gram-Negative Bacteria: Toward Understanding Its Operation Mechanism," BMB Reports, vol. 56, no. 6, p. 326, 2023.
  13. S. Abid Fazaa ALmiyah, "Detection of AcrA and AcrB Efflux Pumps in Multidrug-Resistant Klebsiella pneumoniae That Isolated from Wounds Infection Patients in Al-Diwaniyah Province," Archives of Razi Institute, vol. 78, no. 1, 2023.
  14. H. Mohemmad, R. B. Zubairi, and B. A. Ghyadh, "Prevalence of acrA, acrB, and tolC Efflux Pump Genes Among Multiple-Drug Resistant Escherichia coli Strains in Isolates Obtained from Patients with Diabetes Mellitus."
  15. G. W. Procop, D. L. Church, G. S. Hall, and W. M. Janda, *Koneman's Color Atlas and Textbook of Diagnostic Microbiology*. Jones & Bartlett Learning, 2020.
  16. M. Hernández-Durán et al., "Comparison of the MicroScan WalkAway and VITEK 2 Compact Systems for the Identification and Susceptibility of Clinical Gram-Positive and Gram-Negative Bacteria," Investigación en Discapacidad, vol. 6, no. 3, pp. 105-114, 2017.
  17. M. R. Ali and A. M. Khudhair, "Detection of Colony Adhesion Factors and Genetic Background of Adhesion Genes Among Multidrug-Resistant Uropathogenic Escherichia coli Isolated in Iraq," Journal of Pure and Applied Microbiology, vol. 12, no. 4, pp. 2017-2025, 2018.
  18. S. H. Rashid and A. Saleem, "Molecular Investigation of the mqsA and mqsR Genes in the Multidrug-Resistant Bacterium Klebsiella pneumoniae," Microbes and Infectious Diseases, vol. 7, no. 2, pp. 1243-1253, 2026.
  19. S. Razavi, R. Mirnejad, and E. Babapour, "Involvement of AcrAB and OqxAB Efflux Pumps in Antimicrobial Resistance of Clinical Isolates of Klebsiella pneumoniae," Journal of Applied Biotechnology Reports, vol. 7, no. 4, pp. 251-257, 2020.
  20. P. Y. Lee, J. Costumbrado, C.-Y. Hsu, and Y. H. Kim, "Agarose Gel Electrophoresis for the Separation of DNA Fragments," Journal of Visualized Experiments, no. 62, p. 3923, 2012.
  21. H. A. Shaghati and E. H. Jassim, "Antibacterial Activity of Chitosan Nanoparticles Loaded with Syzygium aromaticum Extract Against Klebsiella pneumoniae," Iraqi Journal of Biotechnology, vol. 22, no. 1, 2023.
  22. T. W. B. M. Khalid and K. K. Ghaima, "Effect of Berberine as Efflux Pump Inhibitor in Multidrug-Resistant Klebsiella pneumoniae Isolated from Urinary Tract Infections."
  23. A. Sajjad, M. Malik, I. Javed, S. Mushtaq, F. Imran, and R. Jameel, "Detection of Metallo Beta Lactamase Production in Imipenem Resistant Gram Negative Bacilli Non Fermenters Isolated in a Tertiary Care Hospital," The Professional Medical Journal, vol. 26, no. 12, pp. 2080-2084, 2019.
  24. B. M. R. Al-Aajem, H. M. Jasim, and A. J. Saleem, "Detection of Virulent Genes Khe, iuc, rmp, magA in Klebsiella pneumoniae Isolated from Urinary Tract Infection," International Journal of Drug Delivery Technology, vol. 11, no. 4, pp. 1470-1473, 2021.
  25. M. Heiat, M. Rezaeimehr, M. Moghaddam, R. Ranjbar, and A. Najafi, "Molecular Genetic Analysis of Quinolone Resistance-Determining Region of DNA Gyrase-A in Fluoroquinolones Resistant Klebsiella pneumoniae Based on GenBank Data and Reported Studies," Molecular Genetics, Microbiology and Virology, vol. 29, no. 4, pp. 211-215, 2014.
  26. A. Moura, I. Henriques, R. Ribeiro, and A. Correia, "Prevalence and Characterization of Integrons from Bacteria Isolated from a Slaughterhouse Wastewater Treatment Plant," Journal of Antimicrobial Chemotherapy, vol. 60, no. 6, pp. 1243-1250, 2007.
  27. V. Gabasa, Y. Ratia, C. Ortega, R. Tejero, M. M. and S. Soto, "Antibiotic Resistance and Virulence Profiles of Klebsiella pneumoniae Strains Isolated from Different Clinical Sources," Frontiers in Cellular and Infection Microbiology, vol. 11, 2021.
  28. S. Bobbadi, B. Chinnam, P. Reddy, and S. Kandhan, "Analysis of Antibiotic Resistance and Virulence Patterns in Klebsiella pneumoniae Isolated from Human Urinary Tract Infections in India," Letters in Applied Microbiology, vol. 73, no. 5, pp. 590-598, 2021.
  29. A. S. Hamzah and A. J. Saleem, "Evaluation of Mutations in Efflux Pump Genes in Serratia marcescens," Journal of Natural Science, Biology and Medicine, vol. 14, pp. 39-44, 2023.
  30. S. Bialek-Davenet et al., "Differential Contribution of AcrAB and OqxAB Efflux Pumps to Multidrug Resistance and Virulence in Klebsiella pneumoniae," Journal of Antimicrobial Chemotherapy, vol. 70, no. 1, pp. 81-88, 2015.
  31. O. Albarri, M. AlMatar, I. Var, and F. Köksal, "Antimicrobial Resistance of Clinical Klebsiella pneumoniae Isolates: Involvement of AcrAB and OqxAB Efflux Pumps," Current Molecular Pharmacology, vol. 17, no. 1, p. E310323215266, 2024.
  32. K. Bhogal et al., "Strain-Dependent Contribution of the AcrAB-TolC Efflux Pump to Klebsiella pneumoniae Physiology," Microbiology, vol. 171, no. 12, p. 001647, 2025.
  33. R. S. Waheed and E. E. Shubbar, "Evaluation of Efflux Pump Activity and Biofilm Formation in Multidrug Resistant Klebsiella pneumoniae," Egyptian Journal of Medical Microbiology, vol. 34, no. 4, 2025.
  34. S. F. Swedan and D. B. Aldakhily, "Antimicrobial Resistance, Biofilm Formation, and Molecular Detection of Efflux Pump and Biofilm Genes Among Klebsiella pneumoniae Clinical Isolates from Northern Jordan," Heliyon, vol. 10, no. 14, 2024.
  35. M. R. Ali and A. H. Ibrahim, "Correlation Between Efflux Pump Genes and Biofilm Formation with Antibiotic Resistance of Klebsiella pneumoniae," Iraqi Journal of Science, pp. 114-127, 2025.

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