High Burden of blaKPC-2–Positive
Carbapenem-Resistant Klebsiella
pneumoniae among Inpatients in a Tertiary Care Hospital in Kathmandu
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 blaKPC-2 and blaVIM 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 blaKPC-2 and
blaVIM 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 blaKPC-2
(100%) and three (25%) additionally carrying blaVIM.
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.
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