Tossing the coin of ESBL: 50% prevalence of ESBL-producing Klebsiella pneumoniae isolated from bloodstream infections of patients with features of sepsis at a national referral and teaching hospital of a low-income setting.

Abstract

Background. Klebsiella pneumoniae is part of the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp) group of MDR pathogens. It is the second leading cause of nosocomial bloodstream infections, and it has a propensity to be drug resistant. Therefore, it was aimed to determine the antibiotic resistance patterns of K. pneumoniae isolated from blood cultures of patients with features of sepsis at Mulago National Referral Hospital, Uganda. Methods The cross-sectional study on patients with features of sepsis utilised K. pneumoniae (N= 30) isolated from positive blood culture specimens. The antibiotic resistance profile was determined by the Clinical and Laboratory Standards Institute’s Kirby Bauer disk diffusion method, which was used to classify the isolates as susceptible, intermediate, and resistant. K. pneumoniae isolates that were resistant to third generation cephalosporins were subjected to extended spectrum b-lactamase (ESBL) screening and confirmation using the double-disk synergy test using cefotaxime, ceftazidime, ceftriaxone, cefotaxime-clavulanic acid, and ceftazidime-clavulanic acid. The results were analysed for frequencies. Results. K. pneumoniae isolates showed minimum resistance to imipenem 13% (4/30) followed by amikacin 17% (5/30). There was intermediate resistance to gentamycin 60% (18/30). However, K. pneumoniae showed the highest resistance to piperacillin; 100% (30/30) followed by sulphamethoxazole-trimethoprim and cefepime both showing a percentage of 97% (29/30). Up to 16/30 (53.3%) of K. pneumoniae were positive for ESBL production while 14/30 (46.7%) were negative. Conclusion. There was a high prevalence of antibiotic resistant ESBL-producing K pneumoniae isolates from bloodstream infection of patients with features of sepsis in Uganda’s Mulago National Referral Hospital.