Deadly bacteria behave differently in Saudi Arabia compared with rest of world, epidemiology study finds

A new multi-institutional study led by King Abdullah University of Science and Technology (KAUST) and the Saudi Ministry of Health (MOH) provides the largest epidemiological analysis in Saudi Arabia of the multidrug-resistant bacteria species Klebsiella pneumoniae, one of the leading causes of nosocomial infections in the world and a global health priority of the World Health Organization. The study finds that the diversity of bacteria in Saudi Arabia differ from other geographical regions, indicating unique health policies are required.

The paper is published in the journal Emerging Microbes & Infections.

While healthy people infected by Klebsiella pneumoniae mostly show relatively harmless symptoms, sick or immunocompromised patients are vulnerable to pneumonia, meningitis, and other potentially mortal ailments. Antibiotics are a standard treatment. However, in recent decades, multidrug-resistant bacteria are emerging worldwide for a number of reasons including an overuse of antibiotics in medical care and other industries such as agriculture.

“Klebsiella pneumoniae has a dynamic genome allowing for the emergence of pathogenic strains from non-pathogenic ones. Understanding the epidemiology for emerging pathogenic strains will strengthen preventive measures,” explained KAUST Assistant Professor Danesh Moradigaravand, one of the lead authors of the study.

A single bacteria species evolves by cloning and exchanging genetic information with one another through processes like gene recombination and horizontal gene transfer. A dynamic genome allows for antibiotic resistance genes to rapidly mix between strains.

Already, antibiotic resistant bacteria are the sixth leading cause of death in the Kingdom, killing more people than several respiratory illnesses and neurological disorders. However, the number of patients is growing, and any one clone developing strong resistance and virulence could cause catastrophic havoc due to the inability to contain and treat.

Indeed, concern about the emergence of drug-resistant strains has led the Saudi Public Health Authority to propose an action plan for the execution and evaluation of interventions, with Klebsiella pneumoniae being one of the priority bacteria targeted. Last year, KAUST and the MOH began its collaboration to support this initiative by combining the advanced capabilities of genomics and data science at KAUST with the unique biobanks of multidrug-resistant bacteria at the MOH.

For the study, the researchers collected samples from 34 hospitals across 15 cities in Saudi Arabia on which they conducted a comprehensive genomic analysis.

Moradigaravand, KAUST Professor Arnab Pain and their colleagues found the most prevalent strains of Klebsiella pneumoniae genetically resemble strains from the Middle East and South Asia, revealing an exchange and spread in this region. More important from a health perspective, they also found that the molecular factors bestowing the bacteria drug resistance and virulence were converging, thus giving concern that the emergence of drug resistance is being accompanied by a severity of symptoms.

“The unique epidemiology observed in Saudi Arabia underscores the necessity for tailored surveillance programs specific to each country. Furthermore, our work emphasizes the need to develop new antimicrobial agents, as current global treatments may not adequately address the local threat,” said Moradigaravand.