The dominance of KPC-mediated resistance among the hospitalized patients, underscores the need for rigorous infection control, ongoing molecular surveillance, and prudent antimicrobial stewardship to stop the spread of high-risk K. pneumoniae strains in healthcare environments.
Abstract
Objective
Klebsiella pneumoniae, a major nosocomial pathogen, is increasingly associated with multidrug resistance and carbapenem production, posing a significant therapeutic challenge on a global scale. The study aimed to determine the distribution, antimicrobial susceptibility pattern, and molecular identification of blaKPC-2 and blaVIM genes among carbapenem-resistant K. pneumoniae isolated from clinical specimens.
Methods
Between January and June 2024, a hospital-based cross-sectional study was carried out at Kirtipur Hospital in Nepal. Standard microbiological protocols were adopted for the processing of 5002 clinical samples. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method following CLSI guidelines. The modified carbapenem inactivation method (mCIM) and the EDTA-modified carbapenem inactivation method (eCIM) were used to confirm carbapenemase production phenotypically, and the polymerase chain reaction (PCR) was used to detect the blaKPC-2 and blaVIM genes at the molecular level.
Results
Of the total samples, 18.3% (917) showed bacterial growth, with K. pneumoniae accounting for 7.6% (n = 70) of isolates, predominantly from wound/pus (35.7%), urine (32.8%), and blood (17.1%) specimens. High resistance was observed against imipenem (68.6%), ceftazidime (64.3%), and ceftriaxone (62.9%), whereas tigecycline and doxycycline remained the most effective ones. Twelve (30.8%) of the 39 carbapenem-resistant isolates were determined to be carbapenemases producers, all harboring blaKPC-2 (100%) and three (25%) additionally carrying blaVIM.
Conclusion
The dominance of KPC-mediated resistance among the hospitalized patients, underscores the need for rigorous infection control, ongoing molecular surveillance, and prudent antimicrobial stewardship to stop the spread of high-risk K. pneumoniae strains in healthcare environments.
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.
I. Nzabanterura, Samson Adewale Oyebadejo, Djibril Mbarushimana et al.· American Journal of Tropical...· 0 citations
This study substantiates an escalated incidence of carbapenem-resistant, MDR A. baumannii in post-surgical infections in Pakistan, highlighting the exigency for strengthened antimicrobial stewardship and infection control strategies in the hospitals of the region.
Sana Gul, Nawab Ali, M. Qasim et al.· Antibiotics· 0 citations
Background: Klebsiella pneumoniae is a major cause of hospital- and community-acquired infections worldwide. It produces extended-spectrum beta-lactamases (ESBLs), which are associated with multidrug resistance and limit therapeutic options for treating infections, thereby posing a serious global threat.
Aim: This study aimed to detect the blaTEM, blaSHV, and blaCTX-M genes associated with multidrug and beta-lactam resistance in K. pneumoniae isolates from clinical specimens obtained at Jos University Teaching Hospital (JUTH), Plateau State, Nigeria.
Methods: A total of 39 confirmed K. pneumoniae isolates were obtained from 344 clinical samples. The antimicrobial susceptibility patterns of the isolates were determined using the Kirby-Bauer disc diffusion method, and the phenotypic production of extended-spectrum beta-lactamases (ESBLs) was assessed using the Modified Double-Disc Synergy Test (MDDST). The three resistance genes were detected using polymerase chain reaction (PCR).
Results: Thirty-two (82.1%) of the K. pneumoniae isolates were ESBL producers and were multidrug-resistant. The isolates showed high resistance to cefotaxime (76.9%), ceftazidime (69.2%), and cefepime (66.7%), but low resistance to imipenem and meropenem (7.7% and 5.1%, respectively). Twenty-four (85.7%) isolates were blaTEM-positive, and 10 (35.7%) were blaSHV-positive; the amplicon sizes were 972 bp and 868 bp, respectively. None of the isolates carried blaCTX-M.
Conclusion: The findings of this study indicate that imipenem, meropenem, and ertapenem had the greatest activity against the K. pneumoniae isolates. The beta-lactamase-encoding resistance genes blaTEM and blaSHV were detected in the K. pneumoniae isolates. Antibiotic-use policies and regular surveillance of antimicrobial susceptibility patterns may help reduce indiscriminate antibiotic use, which contributes to the emergence of drug resistance among pathogens.
I. Jesse, A. Emeka, A. Mohammed et al.· International Journal of TRO...· 0 citations
The objective of the study is to determine the prevalence of antibiotic-resistant bacteria and characterize major ESBL and carbapenemase resistance genes in HWW from Bhubaneswar, Odisha, India.
Wastewater samples were collected quarterly from six tertiary-care hospitals between May 2022 and February 2023. A total of 164 bacterial isolates were recovered and identified by conventional microbiological methods. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method. Thirty-eight multidrug-resistant isolates representing different bacterial species, hospital sites, and resistance profiles were selected for molecular analysis. Genomic DNA was extracted by the salting-out method, and polymerase chain reaction was used to detect
blaTEM, blaCTX-M, blaSHV, blaOXA, blaKPC
, and
blaNDM
genes.
Categorical data were summarized using frequencies and percentages.
Among the 164 isolates,
Klebsiella pneumoniae
(62%) was the predominant species, followed by
Escherichia coli
(25%),
Pseudomonas aeruginosa
(10%), and
Enterococcus
spp. (3%). High resistance rates were observed against cefuroxime (100%), piperacillin/tazobactam (99%), ofloxacin (99%), norfloxacin (98%), and nitrofurantoin (97%). Molecular analysis showed that blaTEM (34%) was the most prevalent gene, followed by blaCTX-M (26%), blaOXA (18%), and blaSHV (13%), whereas blaKPC and blaNDM were not detected.
HWW in eastern Odisha harbors multidrug-resistant bacteria and ESBL-associated resistance genes, emphasizing the need for continuous environmental surveillance and improved wastewater management.
Asima Das, Sunita Kabi, Lipika Jena et al.· Journal of Laboratory Physic...· 0 citations
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: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is among the pathogens contributing most to the global burden of antimicrobial resistance, and its pooled prevalence in Indonesia reaches 43%. Carbapenem resistance and carbapenemase production are not equivalent, and only the enzymatic route is transmissible and therapeutically decisive. Molecular confirmation is unavailable in most Indonesian laboratories, so an accurate low-cost phenotypic assay is needed.
Objective: To compare the simplified carbapenem inactivation method (sCIM) with the Modified Hodge Test (MHT) for detecting carbapenemase production in carbapenem-resistant P. aeruginosa.
Methods: This cross-sectional diagnostic-accuracy study evaluated 30 meropenem- and imipenem-resistant clinical isolates archived at Dr. Soetomo General Academic Hospital, Surabaya, using PCR for blaIMP, blaGES, blaOXA, blaNDM, blaKPC and blaVIM as the reference standard.
Result: A carbapenemase gene was detected in 13/30 isolates (43.3%): blaIMP in 9, blaGES in 3 and blaOXA in 1. sCIM achieved 92.31% sensitivity (95% confidence interval 64.0-99.8), 100.00% specificity (80.5-100.0), 96.7% accuracy and near-perfect agreement with PCR (kappa 0.932). MHT achieved 46.15% sensitivity (19.2-74.9), 88.24% specificity (63.6-98.5) and fair agreement (kappa 0.360). The paired exact McNemar test confirmed the sensitivity advantage of sCIM (p = 0.031), and bootstrapping showed a 26.6-percentage-point difference in overall accuracy (95% confidence interval 10.0-43.3). MHT detected no blaGES-positive isolate and only 6/9 blaIMP-positive isolates; sCIM detected all of both, while neither assay detected the single poorly expressed blaOXA isolate.
Conclusion: sCIM is an accurate, rapid and inexpensive assay that should replace MHT in Indonesian laboratories and feed directly into stewardship and infection-control decisions.
Fara Nayo Faramarisa, Kristiawan Basuki Rahmat, Berliana Nisfa Laily et al.· Open Access Indonesian Journ...· 0 citations
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