Susceptibility to antimicrobial preparations of Klebsiella pneumoniae strains isolated from patients in a multidisciplinary hospital

Introduction. The extraordinary genetic potential of microorganisms has benefited from human overuse antibiotics to develop multiple resistance mechanisms. The large size and heterogeneity of the Russian population, the presence of territories with significant differences in demographic, cultural, and socio-economic indicators, the features of the management and availability of medical care are significant factors influencing the spread of resistance genes to antibacterial therapy of some strains of microorganisms.

Materials and methods. Susceptibility to twenty one antimicrobial agents of one hundred twenty eight Klebsiella pneumoniae isolates, isolated from various loci of patients in a multidisciplinary hospital, including 16% of strains from the lower respiratory tract, 44% from wounds and wound discharge, and 40% from urine, was assessed.

Results. Among isolates from urine, 20% of isolates were found to have the multidrug resistance (MDR) phenotype, 42% had the extreme resistance phenotype (XDR). Among the isolates of Kl. pneumoniae from purulent wounds, 18% had the MDR phenotype, and 43% had the XDR phenotype. Among the isolates of Kl. Рneumoniae from the lower respiratory tract, 37% had the MDR phenotype, 40% had the XDR phenotype. There are no pan-resistant strains in all groups.

The presence of genes for metallo-beta-lactamase (VIM, IMP, NDM groups) and serine carbapenemase (bovine and OXA-48) in molecular genetic study by real-time PCR of isolated Kl. pneumoniae was found in 73.4% of cases.

The results of determining the sensitivity of the isolates revealed a low activity of amoxicillin / clavulanic acid, III and IV generation cephalosporins (ceftazidime, cefotaxime, cefepime). 86.7% of isolates are resistant to drugs of the aminoglycoside group (amikacin), and 100% to gentamicin. Of the group of carbapenems, meropenem showed the highest activity — 26.6%, about 7% were sensitive to ertapenem. From the group of fluoroquinolones, sensitivity ranged from 20 to 30%. The highest activity of all drugs was shown by ticarcillin/clavulanate — 33.3%.

Limitations. The criteria for inclusion in the group of examination and selection of biomaterial were the presence of previous massive antibacterial therapy in the anamnesis, the presence of catheters, drains, etc.

Conclusions. There was established a high proportion of strains Kl. pneumoniae with the phenotype of multiple antibiotic resistance.

Compliance with ethical standards. The examination of patients corresponded to the ethical standards of the Bioethical Committee of the Ufa Research Institute of Occupational Medicine and Human Ecology, developed in accordance with the Helsinki Declaration of the World Association “Ethical Principles of Practice in the Russian Federation”, approved by Order No. 266 of the Ministry of Health of the Russian Federation dated 06/19/2003. All the examined persons signed an informed consent to participate in the survey. Conclusion of the Bioethical Commission of the Ufa Research Institute of Occupational Medicine and Human Ecology (BEC protocol from 03.04.2023 No. 01-04).

Contribution:
Gizatullina L.G. — research concept and design, research execution, text writing;
Bakirov A.B. — concept and design of the study;
Masyagutova L.M. — writing the text;
Kudakaeva R.H. — writing the text;
Muzafarova A.R. — selection of literature, writing of the text.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Conflict of interest. The authors declare no conflict of interest.

Acknowledgement. The study had no sponsorship.

Received: May 19, 2023 / Accepted: September 26, 2023 / Published: October 30, 2023