Authors: Sarita Nayak, Suman Singh, Soeb Jankhwala, Riddhi Pradhan
Background: Klebsiella peumoniae, a capsulated gram negative bacillus is responsible for causing life threatening infections in humans. Carbapenems are the drug of choice for serious infection caused by multidrug resistant Klebsiella pneumoniae. The emergence of carbapenem resistance has made it extremely difficult to treat such infections resulting in significant morbidity and mortality. Aims: To study the prevalence of carbapenem resistance using ertapenem as a marker and to detect Klebsiella pneumoniae Carbapenemase (KPC) producing Klebsiella pneumoniae as a mechanism of resistance. Material and Methods: The study included 102 patients from which Klebsiella pneumoniae isolated. Identification and antibiotic susceptibility testing of Klebsiella pneumoniae was performed on miniAPI (Analytical Profile Index, Semiautomated bacterial identification system) according to Clinical and Laboratory Standards Institute (CLSI) guidelines of 2011. The modified Hodge test was performed for detection of Carbapenemase production. Patient’s clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy and mortality were collected. Results: The prevalence of carbapenem resistance was found to be 30.41% with 16.6% KPC producing Klebsiella pneumoniae. The co-morbid conditions like immunocompromised state (p =0.042), prior antibiotics therapy (p=0.047), previous hospitalization (p =0.021), intensive care unit stay (p=0.047) and use of indwelling devices (p =0.013) were found to be significantly associated with carbapenem resistance. Adverse clinical outcomes (death or worsening) among patients infected with ertapenem resistant patients was found to be statistically significant than ertapenem sensitive strains (p =0.008). Conclusions: A high degree of carbapenem resistance in present study is alarming and poses therapeutic dilemmas for clinicians. Initiating timely and appropriate infection control measures along with a strictly implemented antibiotic stewardship program are necessary to prevent their spread.
Keywords: Klebsiella pneumoniae, carbapenem, KPC produces Klebsiella pneumoniae, Co morbid conditions