Identification of Klebsiella pneumoniae complex members using MALDI-TOF mass spectrometry

Abstract

Klebsiella pneumoniae (phylogroup Kp1), one of the most problematic pathogens associated with antibiotic resistance worldwide, is phylogenetically closely related to K. quasipneumoniae [subsp. quasipneumoniae (Kp2) and subsp. similipneumoniae (Kp4)], K. variicola (Kp3) and two unnamed phylogroups (Kp5 and Kp6). Together, Kp1 to Kp6 make-up the K. pneumoniae complex. Currently, the phylogroups can be reliably identified only by gene sequencing. Misidentification using standard methods is common and the clinical significance of K. pneumoniae complex members is therefore imprecisely defined. Here, we evaluated the potential of MALDI-TOF mass spectrometry to discriminate K. pneumoniae complex members. We report for the first time the existence of mass spectrometry biomarkers associated with the phylogroups, with a sensitivity and specificity ranging between 80-100% and 97-100%, respectively. Strains within phylogroups Kp1, Kp2, Kp4 and Kp5 each shared two specific peaks not observed in other phylogroups. Kp3 strains shared a peak that was only observed otherwise in Kp5. Finally, Kp6 had a diagnostic peak shared only with Kp1. Kp3 and Kp6 could therefore be identified by exclusion criteria (lacking Kp5 and Kp1-specific peaks, respectively). Further, ranked Pearson correlation clustering of spectra grouped strains according to their phylogroup. These results call for incorporation of spectra of all K. pneumoniae complex members into reference MALDI-TOF spectra databases, in which they are currently lacking. This advance may allow for simple and precise identification of K. pneumoniae and closely related species, opening the way to a better understanding of their epidemiology, ecology and pathogenesis.