Detection of multidrug resistance in klebsiella species by phenotypic and genotypic methods in a tertiary care hospital

BACKGROUND: Infections caused by multidrug-resistant microorganisms have become a major threat for the human health. Especially nosocomial infections when hospitalized give problems with antibiotics susceptibility, because the hospital environment gives a constant selective pressure that favours resistance. Nosocomial infections are often caused by multidrug-resistant Gram-negative microorganisms. One of these Gram-negative bacteria is Klebsiella species, which is naturally found in the gut microbiota of both humans and animals. Klebsiella species is a Gram negative opportunistic nosocomial pathogen and is known to cause community acquired infections. Klebsiella is known to produce bacterial pneumonia, urinary tract infection, wound infections, blood stream infections and infections in the intensive care unit. This study is aimed to know the resistant pattern of multi drug resistant klebsiella species in various clinical samples received in microbiological labarotary in Rajiv Gandhi government general hospital. AIMS: To detect the Multidrug resistant Klebsiella species among various clinical specimens and to determine its resistance pattern by phenotypic and genotypic methods. MATERIALS AND METHODS: A total of 200 clinically significant, consecutive, non-duplicate isolates of Klebsiella spp. were included in this study. The isolates were tested by bacteriological culture, biochemical identification and antibiotic susceptibility testing. ESBL, AmpCbetalactamase (AmpC), etallobetalactamase (MBL), and Klebsiella pneumoniae carbapenemase (KPC) producers were screened and confirmed by phenotypic methods based on guidelines given in CLSI 2016and EUCAST 2016. Molecular characterisation were analysed for bla KPC gene by RT-PCR. RESULTS: 200 Multidrug resistant Klebsiella strains were isolated mainly from Intensive care unit (29%) followed by Orthopaedic ward (16.5%).Among these 200 Multidrug resistant Klebsiella isolates, Klebsiella pneumoniae subsp aerogenes (48%) was the most common species isolated followed by Klebsiella oxytoca(46%) and Klebsiella pneumonia subsp pneumoniae(6%). Among these 200 isolates 119(59.5%) showed ESBL production,16(8%) showed Metallobetalactamases, 13(6.5%)showed AmpC production and 12(6%) showed KPC production and 25(12.5%) were enzyme co producers. All resistance mechanisms were most common in Klebsiella pneumoniae and Metallobeta lactamase production were more common in Klebsiella oxytoca. CONCLUSION: In view of controlling these resistant strains of Klebsiella isolates, early and simultaneous detection of these resistance pattern(ESBL, AMPC, MBL and KPC) and strict adherence to antibiotic policies by curtailing injudicious use of antibiotics and implementation of antimicrobial Stewardship would prevent the emergence and the cross transmission of multidrug resistant organisms.