SciELO - Scientific Electronic Library Online
 
vol.2 issue2Coronavirus (COVID-19): a new pandemicEffectiveness of the activities of supporters trained to prevent dementia author indexsubject indexarticles search 		Home Pagealphabetic serial listing  

My SciELO

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share

Iberoamerican Journal of Medicine

On-line version ISSN 2695-5075Print version ISSN 2695-5075

Iberoam J Med vol.2 n.2 Logroño May. 2020  Epub Feb 12, 2020

https://dx.doi.org/10.5281/zenodo.3698180 

Original Article

Antibiotic resistance pattern of Klebsiella pneumoniae in obtained samples from Ziaee Hospital of Ardakan, Yazd, Iran during 2016 to 2017

Jamshid Ayatollahi1  , Mohammad Sharifyazdi2  , Razieh Fadakarfard3  , Seyed Hossein Shahcheraghi4  shahcheraghih@gmail.com

1Infectious Diseases Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2Medical Student, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3Medical Student, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4Infectious Diseases Research Center, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Abstract

Background: In recent years, due to the inappropriate use of antibiotics, drug resistance has increased in gram negative bacilli, including Klebsiella pneumoniae. Drug resistance is associated with an increase in mortality and therapeutic costs. Therefore, determination of an antibiotic resistance pattern for choosing the appropriate treatment for infections caused by this bacterium seems necessary. This study was conducted to determine the antibiotic resistance pattern of Klebsiella pneumoniae species isolated from patients referring to Ziaee Hospital in Ardakan in 2016-2017.

Materials and Methods: For this descriptive-analytic study, all positive cultures of Klebsiella pneumoniae in patients referred to Ziaee Hospital in Ardakan during 2016 to 2017, were evaluated. Antibiotic resistance patterns of the samples were determined by the standard method of propagation of the disk from 12 different antibiotics and data analyzed by SPSS 21 software.

Results and discussions: The results of this study, which were performed on 75 samples, showed that 22 (29.3%) were male and 53 (70.7%) were female. Klebsiella's resistance to clarithromycin was 100%, but was 100% susceptible to amikacin. The percentage of Klebsiella's resistance to ampicillin was 78.3%, cefalotin 75%, cotrimoxazole 43.9%, ceftriaxone 32%, ciprofloxacin 30.9%, cefotaxime 24%, and ampicillin 20%. The highest sensitivity of Klebsiella pneumoniae for antibiotics was 100% for amikacin, 82.8% for meropenem and 82% for cefepime. Due to the high prevalence of resistance in Klebsiella samples, there is a need for strict measures in the administration of antibiotics. Antibiotic resistance can also be reduced by choosing the appropriate antibiotic for treatment and by taking antibiotic susceptibility tests.

Keywords Klebsiella; Resistance; Antibiotic

BACKGROUND

In recent years, antibiotics have been used to treat disease- causing bacteria. Antimicrobial resistance is a global threat to public health [1, 2, 3].

Enzymatic modification (b-lactamases), reduced permeability (selective blockage), increased membrane transport (efflux pumps), altered binding site (specific receptors) and metabolic bypass are the mechanisms of antibiotic resistance in bacteria [4, 5, 6].

The detection of multidrug resistance is, however, a primary step in effectively controlling antibiotic- resistant bacterial infections that can lead to clinical failure and additional antibiotic resistance [7, 8, 9].

The gram- negative organism of Klebsiella pneumoniae .K. pneumoniae) is one of the most important causes of nosocomial infections in developing countries and one of the eight most important causes in developed countries [10, 11, 12, 13]. Nosocomial infections caused by K. pneumoniae multi- antibiotic resistant have become an increasing public health concern. K. pneumoniae produces various pathogenic virulence factors, including capsular polysaccharide, lipopolysaccharide, fimbriae, siderophores and resistance [14, 15, 16].

Increased global infections by multidrug- resistant bacteria closely associated with limited drug treatments imply the failure of empirical treatments and strengthen the need for antibacterial therapies based on antimicrobial sensitivity tests [1, 17, 18]

Several studies have demonstrated outbreaks in hospitals due to K. pneumoniae resistant to cephalosporins, aminoglycosides and quinolones of third generation [10].

Therefore, this study aimed to investigate the antimicrobial susceptibility profile of Klebsiella pneumoniae isolates collected during the period of January 2016 till December 2017 at Ziaee Hospital in Ardakan.

MATERIALS AND METHODS

From January 2016 to December 2017 all positive cultures of Klebsiella pneumoniae in patients referred to Ziaee Hospital in Ardakan during 2016 and 2017, were evaluated. This study was approved by ethical committee of Yazd University of medical sciences with ID: IR.SSU.MEDICINE.REC.1395.278. It was result of thesis of general physician.

In this cross-sectional study, the samples were collected as census from all positive cultures of K. pneumoniae by a checklist that was previously provided by the researcher and confirmed by qualified specialists.

Samples were obtained in a sequential census of all positive cultures in terms of K. pneumoniae at the designated time period.

Data collection was carried out based on a questionnaire that was previously designed in terms of gender, age, the type of antibiotic (including: imipenem, meropenem, cefepim, ciprofloxacin, amikacin, ceftazidime, ceftriaxon, cefotaxime, ampicilin, cotrimoxazol, cefalotin and clarithromycin) and finally the type of sample (including: urine, blood, ulcer, sputum, pleural fluid, urethral discharge, eye secretions and fecal). Inclusion criteria were including all positive cultures for Klebsiella pneumoniae. The cases in which sample data was incomplete were excluded from study and were as exclusion criteria.

In this study, the disc diffusion sensitivity test was used to evaluate the sensitivity and resistance of K. pneumoniae to antibiotics. In the disc diffusion method, a certain amount of bacteria is set according to the existing standards in terms of the degree of dilution and has already been identified. Special culture media add to the same plates in terms of diameter, depth, etc., and discs the standardized antibiotic filter paper is placed on the plate surface. After the time it takes to grow the microbes, if the antibiotic is able to prevent the growth of the microorganism, it does not grow around the bacterial disk, and the bacteria to the antibody the biotype is more sensitive, these will be no larger growth halo.

Detection and differentiation of sensitive, semi-sensitive and resistant conditions from each other was performed based on the diameter of the around the colony as millimeters and according to the relevant table in laboratory. The data were collected, recorded in SPSS software (version 21) and analyzed by chi-Square test.

RESULTS AND DISCUSSIONS

Of 75 samples, 22 (29.3%) were related to men and 53 (70.7%) were for women. Of these, 60 patients (80%) were admitted and 15 patients (20%) were outpatient.

The samples were including urine specimens that were highest numbers with 64 (85.3%) and then, sputum 4 (5.3%), wound and blood each one 3 (4%) and finally secretions 1 (1.3%).

Klebsiella resistance was 100% for clarithromycin but about amikacin was susceptible in 100% of cases (Table 1).

Table 1. The frequency distribution of Klebsiella pneumoniae susceptibility based on the type of antibiotic 

N: Number of sample; * Significance susceptibility based on gender.

It should be noted that for all specimens, all antibiotic disks have not been used. For each sample, according to the type of specimen and physician's opinion, a certain number of disks were inserted. For example, clarithromycin was used in only 6 cases.

In women, the highest sensitivity was observed for amikacin (100%) and meropenem (88.2%). In the case of ciprofloxacin, there was a significant difference between the sexes (p=0.01). In men, resistance to cefalotin, ampicillin and clarithromycin antibiotics was 100%, but in women only resistance to clarithromycin was 100%. Overall, the resistance to all antibiotics examined in men was higher than women (Table 2).

Table 2. The frequency distribution of Klebsiella pneumoniae susceptibility based on gender 

N: Number of sample; * Significance susceptibility based on gender.

In total, the resistance to all antibiotics examined was in the hospitalized patients more than outpatient cases, but this difference was significant only for meropenem (p=0.001) and was probably due to a small number of outpatient cases (Table 3).

Table 3. The frequency distribution of Klebsiella pneumoniae susceptibility based on type of admission 

N: Number of sample; * Significance susceptibility based on gender.

Body secretions (Other than ulcers, blood, sputum, urine) were resistant to chlorthromycin and ampicillin (100%), and 100% sensitive to cotrimoxazole, cefotaxime and ceftriaxone. The frequency distribution of Klebsiella pneumoniae sensitivity based on of sample type has been listed in Table 4.

Table 4. The frequency distribution of Klebsiella pneumoniae susceptibility based on type of admission 

N: Number of sample; * Significance susceptibility based on gender.

A study assessed the 1805 Klebsiella pneumoniae isolates from the Hospital Universitário de Santa Maria, Brazil for antimicrobial susceptibility profile. Resistance to colistin (239.3%), ciprofloxacin (64%), and amikacin (21.4%) was found increased [1]. In the present study, the sensitivity rate was the highest against amikacin. Also the sensitivity rete to ciprofloxacin (67.6%) was more than mentioned study.

Another study showed that among the 168 K. pneumonia isolates studied, 72.0% were resistant to ceftazidime, almost 69% to cefotaxime and 67.2% to amikacin [10]. In our study the sensitivity was 100% against amikacin and there was no any resistance to it.

In a study that was performed on Klebsiella pneumoniae isolates from the hospitals in sari, Mazandaran, the highest resistance against cefotaxime (100%) and ceftazidim (100%) was observed among all isolates, while the highest susceptibility to gentamycin was observed (63%) [19]. But at present study, the highest sensitivity and resistance of Klebsiella pneumonia for antibiotics was related to amikacin and clarithromycin, respectively.

An investigation was conducted to investigate the prevalence of K. pneumoniae isolates and their antibiotic susceptibility pattern. The highest number of K. pneumoniae were resistant to ampicillin (75.6%) followed by, nitrofurontoin and cefuroxime almost 74% and least to chloramphenicol (13%) [20]. In the present study, the highest sensitivity was related to amikacin.

SUMMARY

The results of our study showed that the highest sensitivity of Klebsiella pneumoniae for antibiotics was to amikacin (100%). Also, Klebsiella's resistance to clarithromycin was 100%. The resistance to all antibiotics examined was in the hospitalized patients more than outpatient cases, but this difference was significant only for meropenem. Also, the resistance to all antibiotics examined in men was higher than women.

CONCLUSION

Currently, K. pneumoniae has reached high levels of endemicity in hospitals and is one of the main causes of nosocomial outbreaks. The results on our study show that Klebsiella's resistance to clarithromycin was 100%, but was 100% susceptible to amikacin. It needs to investigate in the more cities in our province for preventing resistant infections by organism.

REFERENCES

1. Lorenzoni VV, Rubert FdC, Rampelotto RF, Hörner R. Increased antimicrobial resistance in Klebsiella pneumoniae from a University Hospital in Rio Grande do Sul, Brazil. Rev Soc Bras Med Trop. 2018;51(5):676-9. doi: 10.1590/0037-8682-0362-2017. [ Links ]

2. Ruiz-Garbajosa P, Cantón R. Epidemiología de los bacilos gramnegativos multirresistentes. Rev Esp Quimioter. 2016;29(1):21-5. [ Links ]

3. Jo A, Ding T, Ahn J. Comparison of antibiotic resistance phenotypes in laboratory strains and clinical isolates of Staphylococcus aureus, Salmonella Typhimurium, and Klebsiella pneumoniae. Food Sci Biotechnol. 2017;26(6):1773-9. doi:10.1007/s10068-017-0191-2. [ Links ]

4. Khameneh B, Diab R, Ghazvini K, Bazzaz BSF. Breakthroughs in bacterial resistance mechanisms and the potential ways to combat them. Microb Pathog. 2016;95:32-42. doi: 10.1016/j.micpath.2016.02.009. [ Links ]

5. El-Sokkary RH, Ramadan RA, El-Shabrawy M, El-Korashi LA, Elhawary A, Embarak S, et al. Community acquired pneumonia among adult patients at an egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric anti.biotic therapy. Infect Drug Resist. 2018;11:2141. doi: 10.2147/IDR.S182777. [ Links ]

6. El-Mahdy R, El-Kannishy G, Salama H. Hypervirulent Klebsiella pneumoniae as a hospital-acquired pathogen in the intensive care unit in Mansoura, Egypt. Germs. 2018;8(3):140. doi: 10.18683/germs.2018.1141. [ Links ]

7. Tenover FC, Reller LB, Weinstein MP. Rapid detection and identification of bacterial pathogens using novel molecular technologies: infection control and beyond. Clinical infectious diseases 2007, 44(3):418-23. doi: 10.1086/510684. [ Links ]

8. Fluit AC, Visser MR, Schmitz F-J. Molecular detection of antimicrobial resistance. Clin Microbiol Rev. 2001;14(4):836-71. doi: 10.1128/CMR.14.4.836-871.2001. [ Links ]

9. Satter S, Mahbub H, Shamsuzzaman S. Antibiotic Resistance Pattern and Prevalence of Aminoglycoside-Modifying Enzymes in Escherichia Coli and Klebsiella species Isolated from a Tertiary Care Hospital in Bangladesh. Mymensingh Med J. 2018;27(3):561-6. [ Links ]

10. Alcántar-Curiel MD, Ledezma-Escalante CA, Jarillo-Quijada MD, Gayosso-Vázquez C, Morfín-Otero R, Rodríguez-Noriega E, et al. Association of Antibiotic Resistance, Cell Adherence, and Biofilm Production with the Endemicity of Nosocomial Klebsiella pneumoniae. BioMed Res Int. 2018;2018. doi: 10.1155/2018/7012958. [ Links ]

11. Veeraraghavan B, Jesudason MR, Prakasah JAJ, Anandan S, Sahni RD, Pragasam AK, et al. Antimicrobial susceptibility profiles of gram-negative bacteria causing infections collected across India during 2014–2016: Study for monitoring antimicrobial resistance trend report. Indian J Med Microbiol. 2018;36(1):32. doi: 10.4103/ijmm.IJMM_17_415. [ Links ]

12. Nepal R, Shrestha B, Joshi DM, Joshi RD, Shrestha S, Singh A. Antibiotic Susceptibility Pattern of Gram-negative Isolates of Lower Respiratory Tract Infection. J Nepal Health Res Counc. 2018;16(1):22-6. [ Links ]

13. Khan HA, Ahmad A, Mehboob R. Nosocomial infections and their control strategies. Asian Pac J Trop Biomed. 2015;5(7):509-14. [ Links ]

14. Alcantar-Curiel D, Tinoco JC, Gayosso C, Carlos A, Daza C, Perez-Prado MC, et al. Nosocomial bacteremia and urinary tract infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae with plasmids carrying both SHV-5 and TLA-1 genes. Clin Infect Dis. 2004;38(8):1067-74. doi: 10.1086/382354. [ Links ]

15. Kim J, Jo A, Chukeatirote E, Ahn J. Assessment of antibiotic resistance in Klebsiella pneumoniae exposed to sequential in vitro antibiotic treatments. Ann Clin Microbiol Antimicrob. 2016;15(1):60. doi: 10.1186/s12941-016-0173-x. [ Links ]

16. Mohammed MA, Alnour TM, Shakurfo OM, Aburass MM. Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya. Asian Pac J Trop Med. 2016;9(8):771-6. doi: 10.1016/j.apjtm.2016.06.011. [ Links ]

17. Singh NP, Rani M, Gupta K, Sagar T, Kaur IR. Changing trends in antimicrobial susceptibility pattern of bacterial isolates in a burn unit. Burns 2017;43(5):1083-7. doi: 10.1016/j.burns.2017.01.016. [ Links ]

18. Ullah F, Malik SA, Ahmed J. Antimicrobial susceptibility pattern and ESBL prevalence in Klebsiella pneumoniae from urinary tract infections in the North-West of Pakistan. Afr J Microbiol Res. 2009;3(11):676-80. [ Links ]

19. Ahanjan M, Naderi F, Solimanii A. Prevalence of Beta-lactamases Genes and Antibiotic Resistance Pattern of Klebsiella pneumoniae Isolated from Teaching Hospitals, Sari, Iran, 2014. J Mazandaran Univ Med Sci. 2017;27(149):79-87. [ Links ]

20. Manjula N, Math GC, Nagshetty K, Patil SA, Gaddad SM, Shivannavar CT. Antibiotic susceptibility pattern of ESβL producing Klebsiella pneumoniae isolated from urine samples of pregnant women in Karnataka. J Clin Diagn Res. 2014;8(10):DC08. doi: 10.7860/JCDR/2014/9594.5048. [ Links ]

Received: February 04, 2020; corrected: February 25, 2020; Accepted: March 05, 2020

shahcheraghih@gmail.com

© 2020 The Authors. Published by Iberoamerican Journal of Medicine

Creative Commons License This is an open access article under the CC BY license

 
Calle Piqueras, 98, Logroño, La Rioja, ES, 26006, 94 129 80 00