Carbapenem-Resistant Klebsiella pneumoniae in Clinical Specimens at the University Teaching Hospital of Butare, Rwanda: Antimicrobial Resistance Profiles and Carbapenemase Genes.
Aug 2026· American Journal of Tropical Medicine and Hygiene· 0 citations· 27 references
Medicine
TL;DR
A high resistance rate in K. pneumoniae to a widely used antibiotic is found and the presence of blaNDM is confirmed, highlighting the need for antimicrobial stewardship and strengthened local surveillance.
Abstract
Klebsiella pneumoniae, a leading cause of health care-associated infections, increasingly exhibits multidrug-resistant phenotypes, including resistance to carbapenems, the last-resort antimicrobials, and thus compromises treatment options. However, there is a paucity of data on antimicrobial profiles and carbapenemase gene distribution in K. pneumoniae in Rwanda. A cross-sectional study was conducted from February 1 to June 30, 2025, at the University Teaching Hospital of Butare. One-hundred-fifty isolates were analyzed using traditional bacteriological identification with the API 20E system. Antimicrobial susceptibility was assessed by the modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute 2024 guidelines, and carbapenemase genes were detected through conventional polymerase chain reaction. Data were analyzed using descriptive and inferential statistical methods, and a P-value less than 0.05 was considered statistically significant. As a result, Klebsiella isolates exhibited high resistance rates to trimethoprim-sulfamethoxazole (78%), cefuroxime (71.3%), cefixime (72%), and ceftriaxone (66.7%). Moderate resistance to ciprofloxacin (30%) and amoxicillin-clavulanate (42.7%) was observed. In contrast, lower resistance to amikacin (9.3%), imipenem (12%), meropenem (13.3%), and ertapenem (14%) was observed. Of the Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates, 8 (38.1%) tested positive for the blaNDM gene, whereas none harbored the blaKPC gene. This study found a high resistance rate in K. pneumoniae to a widely used antibiotic and confirms the presence of blaNDM, highlighting the need for antimicrobial stewardship and strengthened local surveillance.
Background: Klebsiella pneumoniae is a major opportunistic pathogen responsible for a wide range of severe nosocomial and community-acquired infections. The rapid global dissemination of multidrug-resistant (MDR) and carbapenem-resistant K. pneumoniae (CRKP) strains severely restricts therapeutic alternatives and significantly raises patient mortality rates.
AIM: This study aimed to evaluate the antibiotic susceptibility pattern of K. pneumoniae from clinical isolates and evaluate the carbapenemase-producing strains using the rapid Carba NP test within a tertiary care hospital.
Materials & Methods: An observational cross-sectional study was conducted from May 2024 to July 2025 at the Department of Medical Microbiology, Santosh Medical College and Hospital (Ghaziabad) and Rama Medical College (Harpur). A total of 335 non-duplicated K. pneumoniae isolates collected from various clinical specimens (including urine, sputum, pus, and blood) across all age groups and genders were included. Bacterial identification was achieved through standard cultural characteristics and biochemical profiling. Antibiotic susceptibility testing (AST) was performed on Muller-Hinton agar using the Kirby-Bauer disc diffusion method, and phenotypic validation of carbapenemase production was executed using the Carba NP test in strict accordance with CLSI guidelines.
Results: Out of 335 isolates, the highest rate was retrieved from urine samples (40.3%), followed by sputum (26.6%) and pus (14.0%). The General Medicine ward presented the heaviest burden (54.43%), followed by Surgery (20.30%). The highest incidence occurred within the 51–60 age group (73 cases), demonstrating an overall male predominance in older populations, while a female predominance was isolated among young adults aged 21–30 years. In sensitivity pattern. Alarming rates of resistance were observed for ampicillin (>80% across sputum, pus, and blood) and early-to-late-generation cephalosporins. Carbapenems (meropenem and imipenem) sustained solid sensitivity in blood (84.4%) and urine (73.3% meropenem, 79.3% imipenem), but critical reduction in pus samples, where resistance rates were between 36.2% and 40.4%.
The Carba NP test successfully identified 45 phenotypic carbapenemase-producing isolates (yielding an overall positivity rate of 13.43%). Proportional carbapenemase positivity was most concentrated in endotracheal (ET) tube specimens (36.36%) and pus samples (31.91%).
Conclusions: The study shows an alarming level of multidrug resistance and a significant rise in carbapenemase producing K. pneumoniae isolates, particularly within device-associated (ET tube) and wound (pus) environments.
Zenab Naseem, A. Rawat, Muzaffari Yasmeen· Adolescência e Saúde· 0 citations
Background: Recently worldwide, carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has attracted a lot of attention because of the scarcity of effective drugs and the severity of the illness as well as the high death rate. This study was conducted to assess the antimicrobial susceptibility profiles and the molecular identification of CRKP isolates that were obtained from patients with lower respiratory tract infection (LRTI) at a tertiary care hospital in Sylhet, Bangladesh.
Methods: This cross-sectional study was conducted in the Department of Microbiology at Sylhet MAG Osmani Medical College, Sylhet, from July 2021 to June 2022. A total of 153 sputum samples were collected from adult patients (≥18 years) clinically diagnosed with LRTIs. Data were analyzed using SPSS version 26.
Result: Among 153 sputum samples from LRTI patients, 66.0% showed bacterial growth, with Klebsiella pneumoniae accounting for 20.9% of isolates. The mean age was 52.43±17.12 years with male predominance (69.3%). Of the Klebsiella pneumoniae isolates, 25.0% were carbapenem-resistant (CRKP), among which 75.0% produced carbapenemase and 50.0% harbored the KPC gene. Overall isolates showed high resistance to cephalosporins (up to 81.2%) and moderate sensitivity to carbapenems (around 72–75%) and amikacin (56.2%). CRKP isolates demonstrated marked multidrug resistance, with high resistance to most antibiotics, including carbapenems (75.0%).
Conclusion: In conclusion, one in every fourth KP isolate was CRKP, which highlighted the need for careful prescription of carbapenems for the therapy of infectious diseases with ESBL-producing KP. Among different genes conferring resistance to carbapenems, only the blaKPC gene was investigated in this study.
S. Chowdhury, Swarna Paul, Fouzia Ahmed Chowdhury et al.· International Journal of Res...· 0 citations
Background: Klebsiella pneumoniae is a leading cause of healthcare-associated infections and a major vehicle for the dissemination of antimicrobial resistance (AMR). Romania ranks among the most affected European countries for carbapenem-resistant K. pneumoniae (CRKP), yet data from specialized pulmonology–critical care settings remain limited. Objective: This study aimed to characterize the antimicrobial resistance profiles of K. pneumoniae clinical isolates—including MDR/XDR/PDR classification, carbapenem and colistin resistance rates, specimen and ward distribution, and category-specific resistance patterns—at a tertiary pulmonology–critical care institution in Bucharest, Romania. Methods: A retrospective, single-centre analysis of 203 K. pneumoniae clinical isolates from critical patients, which were collected at the Institute of Pneumology Marius Nasta, Bucharest, between July 2021 and May 2026. Susceptibility testing was performed using the VITEK®2 system (bioMérieux), with results interpreted per EUCAST breakpoints. Results: Of 203 isolates, 112 (55.2%) were PDR, 36 (17.7%) XDR, six (3.0%) MDR, and 49 (24.1%) non-MDR. Carbapenem resistance was present in 134 isolates (66.0%); colistin resistance was present in 49 of 73 isolates tested (67.1%). Bronchial/tracheal aspirate was the dominant specimen source (61.1%), and intensive care units accounted for 61.1% of isolates. Resistance rates exceeded 75% for monobactams, first/second-generation cephalosporins, and fluoroquinolones. Conclusions: This cohort demonstrates severe AMR burden in this setting, consistent with the most concerning reports for K. pneumoniae in the literature. The findings underscore the urgent need for enhanced antimicrobial stewardship, strengthened infection control in ICU settings, and molecular surveillance of carbapenemase-producing high-risk clonal lineages in Romanian tertiary care.
L. Manolescu, M. Solomon, Oana Popescu et al.· Antibiotics· 0 citations
Background: Acinetobacter baumannii is a healthcare associated pathogen with marked capacity to develop multidrug resistance and carbapenem resistance. Local resistance data are essential for empirical antimicrobial therapy.
Objective: This study investigated antibiotic resistance profiles of A. baumannii isolated from clinical specimens, determined the prevalence of multidrug resistant and carbapenem resistant isolates, and assessed associations with gender and specimen type in Baghdad, Iraq.
Materials and Methods: A total of 220 clinical specimens were collected from patients in Baghdad. Isolates were identified using standard microbiological methods and the VITEK 2 Compact system. Multidrug resistance was defined as resistance to at least one agent in three or more antimicrobial classes, while carbapenem resistance was defined as resistance to carbapenem antibiotics. Data were analyzed using SPSS, R, and PAST, and statistical significance was set at 0.05.
Results: Thirty nine non duplicate A.baumannii isolates were recovered. Urine was the most common source, accounting for 51.3 percent of isolates, and females represented 59 percent of cases. The highest resistance rates were recorded against cefotaxime, at 76.9 percent, and ampicillin sulbactam, at 61.5 percent, while colistin remained most active antibiotic, with 5.1 percent resistance. Rates of multidrug resistance and carbapenem resistance were 69.2 percent and 23.1 percent, respectively. Resistance patterns were more associated with specimen type than with gender.
Conclusion: Multidrug resistant and carbapenem resistant A. baumannii isolates are prevalent among specimens in Baghdad, especially urine specimens. Continuous antimicrobial resistance surveillance and evidence based empirical therapy are needed to improve treatment decisions and limit resistance dissemination.
Asmaa Samir Moshin, H. A. Jamil· SHIFAA· 0 citations
Background Multidrug-resistant Enterobacteriaceae (MDRE) is among the leading causes of hospital-acquired infections, resulting in prolonged hospitalization, increased healthcare costs, and mortality. Carbapenem are often used as last-resort antibiotics; however, the emergence of carbapenemase-producing Enterobacteriaceae (CPE) has severely limited treatment options. In Ethiopia, data on their burden from routine diagnostic laboratory settings remain limited. This study assessed the prevalence of multidrug-resistant and carbapenemase-producing Enterobacteriaceae among clinical isolates in Addis Ababa. Methods A laboratory-based cross-sectional study was conducted from January 2, 2025, to April 2, 2025 on clinical specimens referred to Wudassie Advanced Medical Laboratory in Addis Ababa, Ethiopia. A total of 1105 clinical specimens collected through convenience sampling method were processed. Bacterial identification was performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) (EXS 3000, Zybio Inc., China). Antimicrobial susceptibility testing was conducted using the Kirby–Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI 2024) guidelines. Carbapenemase production was confirmed using the modified Carbapenem Inactivation Method (mCIM). Data were analyzed using SPSS version 26. Results Of the 1105 clinical specimens, 288/1105 (26.1%) showed bacterial growth. Enterobacteriaceae accounted for 156/288 (54.2%) of the isolates. The most common isolates were Escherichia coli 89/156 (57.1%) and Klebsiella pneumoniae 47/156 (30.1%). Overall, 123/156 (78.8%) of Enterobacteriaceae were multidrug resistant. Carbapenem resistance was detected in 35/154 (22.7%) of isolates, and 30/154 (19.5%) were confirmed as carbapenemase producers. Klebsiella pneumoniae 24/30 (80%) was the predominant carbapenemase-producing organism. Most CPE isolates were recovered from urine specimens, followed by wound and sputum samples. Conclusion This study demonstrates a high prevalence of multidrug-resistant and carbapenemase-producing Enterobacteriaceae in Addis Ababa. The findings highlight the urgent need for strengthened antimicrobial stewardship programs, early detection strategies, and enhanced infection prevention and control measures in the private health facilities.
Background: Klebsiella pneumoniae is a critical contributor to both community- and hospital-acquired infections, with rising multidrug resistance (MDR) posing serious therapeutic challenges.
Objective: This study assessed the prevalence of K. pneumoniae and its antimicrobial susceptibility patterns among clinical specimens collected at Chittagong Medical College, Bangladesh.
Methodology: This cross-sectional study was conducted from July 2022 to June 2023 in Chittagong Medical College, Chattogram. A total of 320 clinical specimens (urine, wound swabs, sputum, blood) from inpatients and outpatients were subjected to culture and sensitivity. Conventional microbiological identification was confirmed by 16S rRNA PCR. Antimicrobial susceptibility (excluding colistin) was tested via the Modified Kirby–Bauer disk diffusion method (CLSI 2022). Colistin resistance was assessed using the colistin agar test, applying CLSI breakpoints.
Results: Overall culture positivity was 63.4% (203/320). Klebsiella pneumoniae was confirmed in 16.9% (54/320) of samples, most commonly isolated from sputum (51.4%), followed by wound swabs (17.1%), urine (11.8%), and blood (6.5%). Among the 54 Klebsiella pneumoniae isolates, resistance rates were highest against amoxiclav (94.4%), with lower resistance observed for aminoglycosides (amikacin, 24.1%) and meropenem (31.5%). Colistin resistance was detected in 12.9% (7/54) of Klebsiella pneumoniae isolates.
Conclusion: The prominence of Klebsiella pneumoniae and its variable degree of resistance to multiple antibiotics, underscores an urgent need for enhanced antimicrobial stewardship, accurate diagnostics, and robust surveillance in Bangladesh.
Bangladesh Journal of Medical Microbiology, January 2026;20 (1):3-9
D. Chowdhury, Sahed Uddin, Pompy Dey et al.· Bangladesh Journal of Medica...· 0 citations
