Antimicrobial Resistance Profile of Klebsiella pneumoniae Clinical Isolates at a Tertiary Pulmonology-Critical Care Centre in Romania: A Five-Year Retrospective Study (2021–2026)
TL;DR
This cohort demonstrates severe AMR burden in this setting, consistent with the most concerning reports for K. pneumoniae in the literature, and underscores 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.
Abstract
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.