Prevalence, antimicrobial resistance, and associated factors of critical superbugs Klebsiella pneumoniae and Acinetobacter species among hospitalized patients in Northwest Ethiopia.

BACKGROUND

Antimicrobial resistant Klebsiella pneumoniae and Acinetobacter species are major contributors to healthcare-associated infections globally. These organisms have emerged as critical superbugs due to their capacities to acquire multidrug resistance (MDR), cause severe infections, and persist in hospital environments. Evidence on their burden and antimicrobial resistance profile remains limited in Northwest Ethiopia. This study aimed to determine the prevalence, antimicrobial resistance profiles, and associated factors of K. pneumoniae and Acinetobacter species among hospitalized patients in Northwest Ethiopia.

METHODS

A multicenter cross-sectional study was conducted among 1,070 hospitalized patients at four comprehensive specialized hospitals in Northwest Ethiopia, namely University of Gondar, Felege Hiwot, Tibebe Ghion, and Debre Markos hospitals. Socio-demographic and clinical data were collected using structured questionnaire. Blood, urine, sputum, and wound specimens were collected. Bacterial isolation and identification were performed using culture and biochemical methods. Antimicrobial susceptibility testing was performed by using the Kirby-Bauer disk diffusion method in accordance with the Clinical and Laboratory Standards Institute guidelines. Logistic regression identified factors associated with infection and MDR.

RESULTS

Out of the total 1070 patients, 175 (16.4%; 95%CI: 14.1-18.6) were infected with K. pneumoniae or Acinetobacter species. Among these patients, 7 (4.0%) had co-infections, resulting in a total of 182 bacterial isolates. Of these isolates, 136 (75%) were K. pneumoniae and 46 (25%) were Acinetobacter species. High resistance was observed to ceftriaxone, cefotaxime, ceftazidime (89-94%), piperacillin, piperacillin-tazobactam, amoxicillin-clavulanate, ampicillin-sulbactam (70-84%), ciprofloxacin (64-74%), meropenem and imipenem (~ 59%), while amikacin showed the highest susceptibility (82-85%). MDR was detected in 91.2% of isolates, and prior antibiotic use (AOR = 6.43; 95% CI: (1.95-21.2)) was the only factor significantly associated with MDR. Being neonate (AOR = 2.73; 95% CI: (1.48-5.07)), male (AOR = 1.49; 95% CI: (1.05-2.11)), short hospitalization (AOR = 0.59; 95% CI: (0.39-0.90)), prior antibiotic exposure (AOR = 1.64; 95% CI: (1.01-2.67)), and device use before admission (AOR = 1.49; 95% CI: (1.03-2.18)) were associated with infection.

CONCLUSION

Multidrug-resistant K. pneumoniae and Acinetobacter species were highly prevalent in Northwest Ethiopian hospitals, including alarming carbapenem resistance. Enhanced infection control, antimicrobial stewardship, and targeted interventions for high-risk patients are urgently needed.