Demographic Characteristics, Phenotypic and Genotypic Characterization of Antibiotic Resistant Klebsiella pneumoniae Isolated from Clinical Samples at The Nairobi Hospital, Kenya

Abstract

Antimicrobial resistance is a growing threat worldwide. The increasing number of β-lactamase producing K. pneumoniae leaves very few treatment options for clinicians and identification of these enzymes helps clinicians and microbiologists to rationalize the choice of antibiotics. The present study aimed to determine the demographic characteristics of patients from whom were collected K. pneumoniae isolates, antimicrobial susceptibility patterns of K. pneumoniae isolates, the presence of ESBL, Amp C and carbapenemase producing K. pneumoniae isolated from clinical samples at The Nairobi Hospital laboratory. The cross-sectional study was performed from May 2017 to April 2018 and included 272 positive clinical samples for K. pneumoniae tested with standard methods. Identification, antibiotic susceptibility pattern and detection of β-lactamases were done by automated VITEK 2 System. ESBL and Carbapenemase genes were detected by using PCR. Out of 272 K. pneumoniae isolates from various clinical samples, K. pneumoniae isolates was more collected in females as compared to males in almost age sets except at age group of 0-10 years. K. pneumoniae isolates were lower resistant to amikacin (18 %), gentamicin (21 %), nitrofurantoin (21 %), meropenem (21.7 %) and ciprofloxacin (25.4 %) compared to commonly used antibiotics. ESBL production was detected in 29.8 % (81 /272). The proportion of carbapenemase production was 7.0 % (19/272). The rate of ESBL and carbapenemase co-production was 5.1 % (14/272); ESBL and Amp C co-production 0.7 % (2/272); Amp C and carbapenemase 1.8 % (5/272) and ESBL/ AmpC/carbapenemase co-occurred in 2.6 % (7/272). In ESBL producing K. pneumoniae, the proportion of blaTEM, blaSHV and blaCTX-M was 5.77 %, 1.92 % and 2.88 % respectively; blaTEM /blaSHV /blaCTX-M (52.88 %), blaTEM/blaSHV (13.46 %), blaSHV/blaCTX-M (8.65 %), blaTEM /blaCTX-M (4.81 %) and blaTEM/blaSHV/blaCTX-M/blaOXA-48 (9.62 %). In carbapenemase producing K. pneumoniae, blaOXA-48 was the most dominant gene (62.2 %) and blaKPC genes (24.4 %) whereas blaVIM and blaIMP were not detected. The presence of β-lactamase enzymes singly or in combination were detected in this study. The findings obtained were essential for performing continuous monitoring of β lactamases, strict antibiotic policy in reducing K. pneumoniae resistance in hospital settings. Maintaining proper sanitation, antimicrobial policy and epidemiological surveys will help in controlling and preventing the spread of these resistant bugs in hospital environment.