Incidence of Multidrug-Resistant Klebsiella pneumoniae Related to Nosocomial Infection in Pediatric Wards

Abstract

Multidrug-resistant Klebsiella pneumoniae is an important cause of healthcare-associated infections, particularly in pediatric settings, where environmental contamination may contribute to the transmission of resistant organisms. This study aimed to investigate environmental contamination with multidrug-resistant K. pneumoniae in pediatric wards at Benghazi Medical Center and to determine its antimicrobial susceptibility profile. A descriptive cross-sectional study was conducted using 166 environmental swab samples collected from high-touch surfaces and medical devices in pediatric departments between January 2024 and September 2025. Samples were cultured on blood agar and MacConkey agar, and bacterial isolates were identified using Gram staining and biochemical tests. Antimicrobial susceptibility was assessed using the Kirby-Bauer disk diffusion method. Bacterial growth was detected in 108/166 samples (65.1%), while 58/166 (34.9%) showed no growth. K. pneumoniae was the predominant isolate, detected in 67/166 (40.4%) of all samples and 67/108 (62.0%) of culture-positive samples. The medicine department showed the highest proportion of K. pneumoniae contamination (65.7%), followed by neurosurgery (10.4%), pediatric surgery (9.0%), and urology and orthopedic departments (7.5% each). The highest resistance was observed to amoxicillin/clavulanic acid (88.1%), followed by cefuroxime (71.6%), trimethoprim-sulfamethoxazole (62.7%), ceftazidime (58.2%), gentamicin (56.7%), and cefotaxime (52.2%). Colistin showed the highest susceptibility (95.5%). These findings demonstrate substantial environmental contamination by MDR K. pneumoniae and highlight the need for strengthened environmental cleaning, surveillance, infection-control practices, and antimicrobial stewardship in pediatric wards.