High burden of blaKPC−2–positive carbapenemresistant Klebsiella pneumoniae among inpatients in a Tertiary Care Hospital in Kathmandu

High Burden of bla_KPC-2–Positive Carbapenem-Resistant Klebsiella pneumoniae among Inpatients in a Tertiary Care Hospital in Kathmandu

Shashi Gurung¹, Milan Kumar Upreti¹, Agrani Paudel², Khadga Bikram Angbuhang¹, Sanjit Shrestha³, Upendra Thapa Shrestha^{2 *}, Megha Raj Banjara^{2 *}

¹ GoldenGate International College, Department of Microbiology, Battisputali, Kathmandu, Nepal

² Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

³ Department of Pathology, Kirtipur Hospital, Kathmandu, Nepal

 

*Correspondance: Dr. Megha Raj Banjara, Professor; Dr. Upendra Thapa Shrestha, Assistant Professor, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu. Email:  megha.banjara@cdmi.tu.edu.np/upendra.thapashrestha@cdmi.tu.edu.np/

Abstract

Objective Klebsiella pneumoniae, a major nosocomial pathogen, is increasingly associated with multidrug resistance and carbapenem production, posing a significant therapeutic challenge on a global scale. The study aimed to determine the distribution, antimicrobial susceptibility pattern, and molecular identification of bla_KPC-2 and bla_VIM genes among carbapenem-resistant K. pneumoniae isolated from clinical specimens.

Methods Between January and June 2024, a hospital-based cross-sectional study was carried out at Kirtipur Hospital in Nepal. Standard microbiological protocols were adopted for the processing of 5002 clinical samples. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method following CLSI guidelines. The modified carbapenem inactivation method (mCIM) and the EDTA-modified carbapenem inactivation method (eCIM) were used to confirm carbapenemase production phenotypically, and the polymerase chain reaction (PCR) was used to detect the bla_KPC-2 and bla_VIM genes at the molecular level.

Results Of the total samples, 18.3% (917) showed bacterial growth, with K. pneumoniae accounting for 7.6% (n=70) of isolates, predominantly from wound/pus (35.7%), urine (32.8%), and blood (17.1%) specimens. High resistance was observed against imipenem (68.6%), ceftazidime (64.3%), and ceftriaxone (62.9%), whereas tigecycline and doxycycline remained the most effective ones. Twelve (30.8%) of the 39 carbapenem-resistant isolates were determined to be carbapenemases producers, all harboring bla_KPC-2 (100%) and three (25%) additionally carrying bla_VIM.

Conclusion The dominance of KPC-mediated resistance among the hospitalized patients, underscores the need for rigorous infection control, ongoing molecular surveillance, and prudent antimicrobial stewardship to stop the spread of high-risk K. pneumoniae strains in healthcare environments.

Keywords: Klebsiella pneumoniae, Carbapenem-resistant, bla_KPC-2, bla_VIM

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