Frequency and Antimicrobial Susceptibility of Klebsiella Species Isolated from Urine Cultures at a Tertiary Healthcare Facility of Lahore

Abstract

Background and Objective: Klebsiella is found ubiquitously in nature and is a potential pathogen to infect

different anatomic sites including urinary tract. Due to high resistance to antimicrobials it is considered as

one of the most challenging pathogens. The study aimed to determine the frequency and antimicrobial

sensitivity of Klebsiella species isolated from urine.

Methods: The data of urine cultures conducted during 1st Sep 2021 to 31st Aug 2022 was collected through

Electronic Medical Record system. Uropathogens were recognized based on culture characteristics and

biochemical tests with API-20E (bioMérieux) profile. Antibiotic susceptibility and extended spectrum beta-

lactamase (ESBL) detection was performed by disc/combined disc diffusion using Kirby Bauer method.

Results: Of 2438 urine samples submitted for culture during the study period, 746 (30.6%) showed significant

growth of a known uropathogen. The frequency of Klebsiella was 14.75% which was second most common

uropathogen after E. coli (57.37%). Other isolates reported were Enterococcus (12.87%), Candida (8.71%),

Pseudomonas (2.68%), Staphylococcus (1.48%), Proteus (1.07%) and Citrobacter species (1.07%). The isolates

showed high sensitivity to imipenem (87.3%) followed by meropenem (85.5%), amikacin (84.6%) and

fosfomycin (81.5%). A reduced sensitivity was observed against gentamicin (68.2%), piperacillin-tazobactam

(61.8%), nitrofurantoin (58.2%) and cefotaxime (50%), but the least sensitivity was seen for ciprofloxacin

(40.9%), cotrimoxazole (36.4%), cefuroxime (20%) and ampicillin (10%). Of all isolates 37 (33.6%) were

ESBL producers.

Conclusion: Carbapenems, amikacin and possibly fosfomycin are the most efficient drugs for treating UTI

due to Klebsiella species in our hospital setting. An on-going surveillance for ESBL producers as well as

carbapenemase-producing Klebsiella pneumoniae (KPC) is needed.