Epidemiology, resistance profiles, and risk factors of multidrug-resistant Klebsiella pneumoniae: experience from a low- and middle-income country.

BACKGROUND

Klebsiella pneumoniae (K. pneumoniae) is an Enterobacteriaceae and is also a normal gastrointestinal flora. Antimicrobial resistance is a growing public health concern, posing substantial challenges to modern medical practice. In this context, the aim of this study was to investigate the factors contributing to multidrug-resistant (MDR) K. pneumoniae and the prevalence and antimicrobial resistance patterns of K. pneumoniae strains isolated from patients in a major tertiary care center in Palestine. This study provides insights into multidrug-resistant pathogens, which is critical given their serious public health implications.

METHODS

From January 2022 to December 2023, a large tertiary care hospital hosted a retrospective, hospital-based study. The hospital information system provided the K. pneumoniae data. Patients of all sexes and all ages who had any kind of K. pneumoniae isolated from clinical specimens met the inclusion criteria. Patients from hemodialysis centers and outpatient clinics, as well as 20 people with insufficient medical data, were not included, resulting in a final cohort of 376 patients. This study analysed the demographic, clinical, and microbiological characteristics of patients with K. pneumoniae infections.

RESULTS

The mean age of patients with K. pneumoniae infections was 49.9 years, with a significantly lower mean age in the MDR group (48.5 vs. 56.4 years, p = 0.004). A greater proportion of patients were female across all subgroups. Common comorbidities included cardiovascular disease (43.4%), solid malignancies (25.8%), and diabetes mellitus (29%), although only hematological malignancies were significantly different among the subgroups (p = 0.013). Central line catheterization was significantly more common among ESBL-producing and CR-K. pneumoniae cases (p = 0.007). The most common culture sources were rectal swabs for CR-K. pneumoniae (56.6%) and urine samples for ESBL-producing strains (40%, p < 0.001). High resistance rates were observed against cephalosporins and ciprofloxacin, particularly in the ESBL and CR strains. Younger age was the only significant risk factor associated with MDR K. pneumoniae, whereas sex and comorbidities were not.

CONCLUSION

The findings of this study highlight the significant prevalence of multidrug-resistant Klebsiella pneumoniae, a pathogen responsible for various infections. These results emphasize the critical need for antimicrobial stewardship programs to evaluate and manage antibiotic usage effectively to help combat resistance. Additionally, stringent infection control measures are necessary to reduce the risk of cross-transmission.

CLINICAL TRIAL NUMBER: Not applicable.