Subash Paudel1, Pradeep
Kumar Shah1, Prashanna Adhikari1, Sanjay Singh
K.C.2, Upendra Thapa Shrestha3*
1Department of Microbiology,
Tri-Chandra Multiple Campus, Ghantaghar, Kathmandu
2Department of Pathology, Sahid
Gangalal National Heart Center, Bansbari, Kathmandu
3Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu
* Corresponding author: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kiritpur, Kathnamdu, Nepal. Email: upendrats@gmail.com
ABSTRACT
Background:
The accelerating rate of carbapenems resistance in Klebseilla pneumoniae
isolates has put the treatment option worrisome. The effective strategy to
ameliorate this alarming situation is possible through enhancing the
combination therapy and appropriate laboratory diagnosis. Hence, the study was focused
on identifying carbapenemase-producing K. pneumoniae and their antibiogram
pattern.
Methods:
A total of 944 clinical samples from patients attending Sahid Gangalal National
Heart Center were processed from September 2019 to March 2020 to identify the
possible bacterial pathogens following the standard microbiological procedures.
K. pneumonaie isolates were further subjected to antibiotic
susceptibility testing by the modified Kirby Bauer disc diffusion technique.
Phenotypic confirmation of carbapenemase production was done by the modified carbapenemase
inactivation method. The minimum inhibitory concentration of colistin was determined
by the broth microdilution method.
Results:
Of the total 944 samples, 15.47% (146) samples showed bacterial growth, among
which 23.97% (35) were K. pneumoniae. Out of 35 K. pneumoniae isolates,
45.71% (16) were multidrug-resistant followed by 42.86% (15) extensively drug-resistant.
Fourteen isolates of K. pneumoniae were carbapenemase producers among
which 20% (7) were serine carbapenemase
while 20% (7) showed metallo-β-lactamase production. All the carbapenemase-producing
K. pneumoniae were susceptible to colistin with <0.125µg/ml.
Carbapenemase activity showed statistically significant with multidrug resistance
(p=<0.05).
Conclusions:
An increasing resistance to the carbapenem drugs showed a great problem in the management
of K. pneumoniae infections among
immunocompromised patients especially cardiac patients however, colistin can be
still an ultimate choice of drug for disease management.
Keywords:
Klebsiella pneumoniae; Extreme Drug-Resistant; Carbapenemase; Broth
Micro Dilution; Colistin;
Citation: Paudel et al., 2021. Higher
rate of extreme drug-resistant Klebsiella pneumoniae infections among
cardiac patients attending a Tertiary Care Hospital in Kathmandu J Nepal Health Res Counc 2021 Oct-Dec; 19 (53): 661-8.
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