Determinants of Antimicrobial Resistance in Klebsiella Pneumoniae

Salbia Abbas; Irtaza Hussain; Tayyaba Durrani; Alam Zeb khan; Muhammad Tahir; Aqsa Shahid; Amna Rehman; Mian Muhammad Salman; Abira Fatima; Hafiz Muhammad Umer Farooq

doi:10.54112/bcsrj.v7i5.2305

Authors

Salbia Abbas Department of Ecology, Chinese Academy of Sciences, China
Irtaza Hussain Department of Pathobiology, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, Punjab, Pakistan
Tayyaba Durrani Department of Zoology, The Government Sadiq College Women University, Bahawalpur, Punjab, Pakistan
Alam Zeb khan Department of Clinical Sciences, Faculty of Veterinary and Animal Sciences, Gomal University, D. I. Khan, Khyber Pakhtunkhwa, Pakistan
Muhammad Tahir Faculty of Science, The University of Veterinary and Animal Sciences (UVAS), Swat, Khyber Pakhtunkhwa, Pakistan
Aqsa Shahid University of Wah, Quaid Avenue, Wah Cantt, Punjab, Pakistan
Amna Rehman The department of Parasitology and Microbiology, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Punjab, Pakistan
Mian Muhammad Salman Department of Pathobiology, College of Veterinary Sciences and Animal Husbandry, Abdul Wali Khan University, Mardan, Khyber Pakhtunkhwa, Pakistan
Abira Fatima Department of Microbiology, The University of Veterinary and Animal Sciences (UVAS), Lahore, Punjab, Pakistan
Hafiz Muhammad Umer Farooq Department of Biosciences, Faculty of Veterinary Sciences, Bahauddin Zakariya University, Multan, Punjab, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i5.2305

Keywords:

Anti-Bacterial Agents; Carbapenemases; Cross-Sectional Studies; Drug Resistance, Bacterial; Drug Resistance, Multiple, Bacterial; Extended-Spectrum beta-Lactamases; Klebsiella pneumoniae

Abstract

Klebsiella pneumoniae is an important hospital-associated pathogen with increasing multidrug resistance and limited therapeutic options. The rising frequency of ESBL and carbapenemase-producing strains has made its treatment more challenging. Objective: To identify the key determinants of antimicrobial resistance among clinical isolates of Klebsiella pneumoniae. Methods: This cross-sectional study was conducted at tertiary care hospitals from June 2025 to December 2025. A total of 150 Klebsiella pneumoniae isolates were obtained from urine, blood, sputum, wound swabs, and tracheal aspirates. Demographic, clinical, and hospital-related risk factors, including ICU admission, mechanical ventilation, catheterization, hospitalization, surgery, and previous antibiotic use, were recorded. Antimicrobial susceptibility testing was performed against commonly used antibiotics, and phenotypic detection of ESBL and carbapenemase production was carried out. Data were analyzed using SPSS. Descriptive statistics, chi-square test, independent-samples t-test, and binary logistic regression were applied, with p < 0.05 considered statistically significant. Results: High resistance rates were observed against ceftriaxone and ceftazidime, while colistin showed the lowest resistance. Overall, 68/150 (45.3%) isolates were multidrug-resistant. ESBL production was detected in 66/150 (44.0%) isolates, whereas carbapenemase production was found in 33/150 (22.0%). Multidrug resistance was significantly associated with ICU admission, mechanical ventilation, catheterization, prolonged hospital stay, previous hospitalization, and prior antibiotic use (p < 0.05). On multivariate logistic regression, ESBL production, carbapenemase production, previous antibiotic exposure, and prolonged hospitalization were independent predictors of MDR Klebsiella pneumoniae. Conclusion: A substantial proportion of clinical Klebsiella pneumoniae isolates showed multidrug resistance, with ESBL and carbapenemase production contributing significantly to resistance burden. Previous antibiotic exposure and prolonged hospitalization were important modifiable predictors, highlighting the need for strict antimicrobial stewardship, infection control practices, and continuous surveillance.

Downloads

Download data is not yet available.

121

References

1. Tang KWK, Millar BC, Moore JE. Antimicrobial resistance (AMR). Br J Biomed Sci. 2023;80:11387. DOI: https://doi.org/10.3389/bjbs.2023.11387

2. Shay LE, Freifeld AG. The current state of infectious disease: a clinical perspective on antimicrobial resistance. Lippincott’s Prim Care Pract. 1999;3(1):1-15; quiz 16.

3. Sona PH, Attavar PC, Rasmi TR, Kotian MS, Delna NS. Emergence of high-level antibiotic resistance in Klebsiella pneumoniae: a narrative review. South Asian J Res Microbiol. 2024;18(2):1-8. DOI: https://doi.org/10.9734/sajrm/2024/v18i2343

4. Sekowska A, Janicka G, Klyszejko C, Wojda M, Wroblewski M, Szymankiewicz M. Resistance of Klebsiella pneumoniae strains producing and not producing ESBL (extended-spectrum beta-lactamase) type enzymes to selected non-beta-lactam antibiotics. Med Sci Monit. 2002;8(3).

5. Durdu B, Koc MM, Hakyemez IN, Akkoyunlu Y, Daskaya H, Gultepe BS, et al. Risk factors affecting patterns of antibiotic resistance and treatment efficacy in extreme drug resistance in intensive care unit-acquired Klebsiella pneumoniae infections: a 5-year analysis. Med Sci Monit. 2019;25:174-183. DOI: https://doi.org/10.12659/MSM.911338

6. Aiesh BM, Mousa N, Jomaa R, Zouneh Y, Abuhalima D, Saifi M, et al. Epidemiology, resistance profiles, and risk factors of multidrug-resistant Klebsiella pneumoniae: experience from a low- and middle-income country. BMC Infect Dis. 2025;25:1421. DOI: https://doi.org/10.1186/s12879-025-11926-y

7. Sanchez GV, Master RN, Clark RB, Fyyaz M, Duvvuri P, Ekta G, et al. Klebsiella pneumoniae antimicrobial drug resistance, United States, 1998-2010. Emerg Infect Dis. 2013;19(1):133-136. DOI: https://doi.org/10.3201/eid1901.120310

8. Shankar GA, Hampi K. Antimicrobial resistance in Klebsiella pneumoniae: a comparative analysis of resistance mechanisms and clinical outcomes. Int J Sci Technol. 2025;16(3). DOI: https://doi.org/10.71097/IJSAT.v16.i3.7263

9. Peters DM Jr, Winter JB, Droege CA, Ernst NE, Liao S. Comparison of ceftriaxone and antipseudomonal β-lactam antibiotics utilized for potential AmpC β-lactamase-producing organisms. Hosp Pharm. 2021;56(5):560-568. DOI: https://doi.org/10.1177/0018578720931463

10. Leshaba TMS, Mmatli M, Mbelle NM, Sekyere JO. Evaluation of six commercial and noncommercial colistin resistance diagnostics. Microbiologyopen. 2025;14(4). DOI: https://doi.org/10.1002/mbo3.70029

11. Silva MS da, Prado JCS, Oliveira MWM de, Quelemes PV, Barbosa FCB. Current global occurrence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in hospitalized patients: a literature review. Arch Curr Res Int. 2024;24(5):113-123. DOI: https://doi.org/10.9734/acri/2024/v24i5689

12. Fazeli H, Kamali Dolatabadi R, Taraghian A, Nasr Isfahani B, Moghim S, Norouzi M. Carbapenem resistance pattern of multiple drug-resistant and extended-spectrum beta-lactamase-positive Klebsiella pneumoniae in Isfahan. Int J Enteric Pathog. 2014;2(4). DOI: https://doi.org/10.17795/ijep21495

13. Tulloch L, Qin X, Rutledge J. Carbapenem-resistant strain of Klebsiella pneumoniae harboring one copy of the serine carbapenemase KPC-2 and two copies of a TEM-type extended-spectrum β-lactamase gene. J Investig Med. 2007;55(1). DOI: https://doi.org/10.1097/00042871-200701010-00291

14. Choiński M, Wasiewicz-Ciach P, Marzec MT, Kuczyński P, Marszałek A, Wydra-Rojek A, et al. The issue of antibiotic-resistant bacterial infections in intensive care units (ICUs): epidemiology, risk factors and prevention. Literature review. Qual Sport. 2024;20:53946. DOI: https://doi.org/10.12775/QS.2024.20.53946

15. Koren J, Hubenakova Z, Drahovska H, Ozaee E, Markuskova B, Lichvarikova A. Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase-producing Enterobacteriaceae (CPE) and their antimicrobial resistance. Bratisl Lek Listy. 2019;120(12):935-940. DOI: https://doi.org/10.4149/BLL_2019_157

16. Woodworth KR, Walters MS, Weiner LM, Edwards J, Brown AC, Huang JY, et al. Vital signs: containment of novel multidrug-resistant organisms and resistance mechanisms—United States, 2006-2017. MMWR Morb Mortal Wkly Rep. 2018;67(13):396-401. DOI: https://doi.org/10.15585/mmwr.mm6713e1