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Paper Title: Resistance Profile of Klebsiella pneumoniae Isolates from a Tertiary Hospital in South-South Nigeria.

Authors: Igunma A.J., Robinson N.I., Wariso K.T.

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Klebsiella pneumoniae is notoriously drug resistant, possessing hundreds of antimicrobial resistance genes. It is also capable of transferring these genes to other gram-negative bacteria, especially in settings with suboptimal infection prevention and control practice, thereby propagating antimicrobial resistance within the environment. This study aimed at detecting the presence and distribution of resistant Klebsiella pneumoniae isolates in our institution.

Two hundred and twenty-five (225) Klebsiella pneumoniae isolates were recruited from samples received from patients admitted to various wards in the hospital. Antimicrobial susceptibility was done using the modified Kirby Bauer technique. Isolates non-susceptible to third generation cephalosporin and carbapenems were screened for extended-spectrum beta-lactamase (ESBL) and carbapenemase production using the double-disk synergy method and modified carbapenem inactivation method respectively, multidrug-resistant (MDR) isolates were also identified. The distribution of resistant isolates across various wards were determined based on information in accompanying laboratory request forms.

Average resistance rates to cephalosporins and carbapenems were 32% and 7.8% respectively with cefuroxime showing highest resistance (39.1%) among cephalosporins and ertapenem (8.4%) among carbapenems. Resistance to ciprofloxacin was 34.7% while 24.0% and 14.7% of isolates showed resistance to gentamicin and amikacin, respectively. While 12 (5.3%) isolates were multidrug resistant, 65 (28%) and 14 (6.2%) isolates produced ESBL and carbapenemase enzymes, respectively. 41 (63.1%) of the ESBL producing and 7 (50%) carbapenemase producing isolates were recovered from urine specimens. The isolates possessing ESBL and carbapenemase genes were mostly recovered from specimens from surgical wards, while the MDR organisms were on the other hand seen the most in specimens recovered from medical wards.

Although the general resistance rate of Klebsiella pneumoniae to last-line antibiotics was low in the study compared to many reports in-country and across the world, the rate of ESBL expression is worrisome. This is a cause for concern as both resistance mechanisms have similar predisposing factors. As a result, widespread difficult-to-treat infections are imminent if adequate measures such as optimal infection prevention and control practices and rational antibiotics use are not put in place.

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