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[Multidrug resistance in Klebsiella pneumoniae: multicenter study]
Ilhem Boutiba-Ben Boubaker1, Dorra Ben Salah, Makram Besbes
1Laboratoire de Recherche Résistance aux antibiotiques, Faculté de Médecine 1006, Tunis.
Abstract:
The extensive use of broad spectrum antibiotics, especially the third generation cephalosporins (C3G), was followed by the emergence of newer plasmid mediated betalactamases called extended spectrum betalactamases (ESBLs). To assess the impact of K. pneumoniae resistant to 3GC in Tunisia, this study was conducted in 3 teaching hospitals. A total of 1110 strains of K pneumoniae was collected. The antibiotics susceptibilities were tested by diffusion method using Mueller-Hinton agar. The quality control was regularly performed. I ESBLs producing solates were detected using the double-disc synergy test. Data analysis was done using the Whonet 4 software. 23.6% K. pneumoniae isolates showed phenotype pattern of ESBLs producers. The double-disc synergy test was positive in 75% of the cases. These isolates were recovered from hospitalized patients in different wards but mainly from pediatrics (23.6%), medicine (23.2%), surgery (22.9%), intensive care units (11%) and neonatology (11%). 54% were isolated from urines, 22% from blood cultures. These isolates remained susceptible to imipenem (100%) and most of them to cefoxitin (96.4%) but all had associated resistance to aminoglycosides, quinolones and trimethoprim-sulfamethoxazole. The prevalence of multidrug resistant K. pneumoniae is high. This resistance can be minimized by the implementation of infection control measures including handwashing and isolation procedures.
Insights
Extended spectrum beta-lactamases (ESBLs) are a growing threat. In Tunisia, 23.6% of Klebsiella pneumoniae isolates were ESBL producers, showing high resistance to common antibiotics.
Area of Science:
- Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Broad-spectrum antibiotics, particularly third-generation cephalosporins (C3G), have driven the emergence of extended-spectrum beta-lactamases (ESBLs).
- Klebsiella pneumoniae is a significant opportunistic pathogen, and its resistance to C3G poses a substantial public health challenge.
Purpose of the Study:
- To evaluate the prevalence and impact of third-generation cephalosporin-resistant Klebsiella pneumoniae in Tunisian teaching hospitals.
- To characterize the antimicrobial susceptibility patterns of ESBL-producing K. pneumoniae isolates.
Main Methods:
- A cross-sectional study involving the collection of 1110 K. pneumoniae strains from three Tunisian teaching hospitals.
- Antibiotic susceptibility testing using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar.
- Detection of ESBL production using the double-disc synergy test and data analysis with WHONET 4 software.
Main Results:
- 23.6% of K. pneumoniae isolates exhibited an ESBL-producing phenotype, confirmed by the double-disc synergy test in 75% of cases.
- ESBL-producing isolates were frequently recovered from pediatric (23.6%), medical (23.2%), and surgical (22.9%) wards, primarily from urine (54%) and blood cultures (22%).
- While 100% susceptibility to imipenem and 96.4% to cefoxitin were observed, all ESBL producers showed co-resistance to aminoglycosides, quinolones, and trimethoprim-sulfamethoxazole.
Conclusions:
- A high prevalence of multidrug-resistant K. pneumoniae, particularly ESBL producers, was identified in Tunisian hospitals.
- Effective infection control measures, including hand hygiene and isolation protocols, are crucial for minimizing the spread of resistant strains.
- The study highlights the urgent need for antimicrobial stewardship programs to combat rising antimicrobial resistance.