Antibiotic Susceptibility of Klebsiella pneumoniae Isolated from Various Clinical Samples from a Tertiary Care, Chennai, India

Kiran Madhusudhan and Bindu D^*

^*Correspondence: Bindu D, Department of Microbiology, Sree Balaji Medical College and Hospital, India, Email:

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Introduction

Klebsiella pneumoniae (K. pneumoniae) is opportunistic gram negative pathogen belonging to Enterobacteriaceae, which causes various infections ranging from Urinary tract infections, bacteremia, wound infections and pneumonia. It causes both hospital-acquired and community-acquired infections [1]. It carries various genes both in chromosome and plasmid that contributes to the antibiotic resistance. Its resistance profile has increased over the past 20 years leading to Multidrug resistant (MDR) and extremely drug resistant organism (XDR). Resistance to the antibiotics is due to the irrational use which has produced ESBLs and Carbapenamases producing K. pneumoniae. Hence the study was aimed to determine the trend of antibiotic profile of K. pneumoniae among the patients attending our tertiary care centre.

Materials and Methods

This is a retrospective study conducted in the Department of Microbiology in a tertiary care, Chennai from January 2022 to May 2022. A total of 573 clinical samples including pus, blood, wound swab, tissue, Bronchoalveolar lavage (BAL), bile, urine, pleural fluid, endotracheal aspirates and blood were collected from different departments (General surgery, General medicine, Obstetrics and Gynaecology, Orthopedics, dermatology, urology, Nephrology, Intensive Care unit (ICU), ) of Sree Balaji Medical College Hospital. Urine, Pus/wound swab, endotracheal aspirate, sputum, BAL, bile, pleural fluid, tissue were inoculated in Nutrient agar, Blood agar and Mac Conkey agar, For Blood primary inoculation in BacT/Alert followed by subculture in Blood agar and Mac Conkey agar. The colonies were isolated and identified by standard test like Gram staining, Catalase, oxidase, Indole, citrate, urease, Triple sugar agar and Mannitol motility agar.

The isolated K. pneumoniae was inoculated in Muller Hinton agar plates following Clinical and Laboratory Standard Institute (CLSI) guidelines [2]. Escherichia coli ATCC 25922 was used as quality control strain.

Results

Among the 573 culture samples from different department, 325 samples were culture positive. 104 (32%) K. pneumoniae were isolated. 56.3% were isolated from male patients and 43.7% were from females. K. pneumoniae was isolated more from Pus/wound sample followed by Urine, sputum as shown in the Table 1. The isolation of K. pneumoniae was (33.5%) highest in 50-60 years age group as shown in Table 2. The isolation was 64.1% in hospitalized patients than outpatients (Table 3). The isolation of K. pneumoniae was high from General surgery department followed by General medicine (Table 4).

Table 1: Prevalence of K. pneumoniae in various samples.

Table 2: Isolation of K. pneumoniae in different age group.

Table 3: Frequency of K. pneumoniae in different samples.

Table 4: Isolation of Klebsiella pneumoniae in different wards.

Antibiotic susceptibility of K. pneumoniae

The susceptibility pattern of K. pneumoniae isolates is shown in the Figure1. Thse K. pneumoniae isolates were least resistant to piperacillin-tazobactam (29.1%), Imipenam (33.3%), Meropenam (24.2%), Ciprofloxacin (33%), Gentamicin (33%). All the isolates were resistant to ampicillin. About 46.6% of the isolates were ESBL producers.

Figure 1. AMP-Ampicillin, CZ-Cefozolin, CXM-Cefuroxime, AMC-Amoxycillin, PIT-Piperacillin, CAZ-ceftazidime, CAC-Ceftazidime/ Clavulanic acid, CEC-Cefotaxime/Clavulanic acid, CTX-Cefotaxime, IPM-Imipenem, MRP-Meropenem, GEN-Gentamicin, TOBTobramicin, COT-Cotrimoxazole, CIP-Ciprofloxacin.

Discussion

Klebsiella pneumoniae is one of major species in Enterobacteiceae family casing infections in both immunocompetent and immunocompromised patients. It causes infections in elderly people which are shown in our study. The total number of Klebsiella isolates from various clinical samples in this study is 104 (32 %). It is similar to the isolation rate seen in the studies [3-5].

In this study, Klebsiella species were isolated more from males compared to females. This study is similar to the work conducted by Anu sharma, et al. [6] (males 57% and females 42%).

In our study the prevalence of K. pneumoniae was more in age group 51-60, followed by 60-70 age group which is similar to study by Sharanya, et al. [6] Susethira, et al. [7] but in contrast to the study by In this study, K. pneumoniae were isolated more from inpatients and from surgery wards, which is similar to study by Anu sharma, et al. [6] which showed that these infections are nosc.

Conclusion

In this present study, K. pneumoniae was isolated from Pus followed by urine similar to study by Anu sharma, et al. 46.7% were found to be ESBL producers.

In this K. pneumoniae was the predominant isolate from various samples. IT was isolated more from inpatients and from surgical wards. In this study, multidrug resistant isolates were found. Hence the it is important formulate antibiotic stedwardship programme. Constant mointoring of the infection control policies is necessary to combat the antibiotic resistance.

References

1. Gorrie CL, Mirčeta M, Wick RR, et al. Gastrointestinal carriage is a major reservoir of Klebsiella pneumoniae infection in intensive care patients. Clin Infect Dis 2017; 65:208-215.

Indexed at, Google Scholar, Cross Ref

2. Humphries R, Bobenchik AM, Hindler JA, et al. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100. J Clin Microbiol 2021; 59:e00213-221.

Indexed at, Google Scholar, Cross Ref

3. Shilpakar A, Ansari M, Rai KR, et al. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing gram-negative isolates from clinical samples in a tertiary care hospital of Nepal. Trop Med Health 2021; 49:23.

Indexed at, Google Scholar, Cross Ref

4. Vivas R, Dolabella SS, Barbosa AAT, et al. Prevalence of Klebsiella pneumoniae carbapenemase—and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option. Rev Soc Bras Med Trop 2020; 53:e20200064.

Indexed at, Google Scholar, Cross Ref

5. Pyakurel S, Ansari M, Kattel S, et al. Prevalence of carbapenemase-producing Klebsiella pneumoniae at a tertiary care hospital in Kathmandu, Nepal. Tropical Med Health 2021; 49:1-8.

Indexed at, Google Scholar, Cross Ref

6. Krishnasamy L, Saikumar C, Kumaramanickavel G. Aerobic bacterial pathogens causing vaginitis in patients attending a tertiary care hospital and their antibiotic susceptibility pattern. J Pure Appl Microbiol 2019; 13:1169-1174.

Indexed at, Google Scholar, Cross Ref

7. Susethira AR, Uma A. Prevalence of Klebsiella bacteriuria and antimicrobial susceptibility in a tertiary care hospital, Tiruchirapalli, India. Int J Pharma and Clin Res 2016; 8:538-542.

Indexed at, Google Scholar

8. Sharanya K, Cugati S, Saikumar C. Prevalence and Antibiotic susceptibility pattern among Klebsiella isolates from patients attending a tertiary care hospital. Indian J Microbiol Res 2018; 5:208-212.

Google Scholar, Cross Ref