Carbapenem-Resistant Klebsiella pneumonia Isolated from Patients Admitted in Tertiary Care Hospital in Saudi Arabia

Background: Carbapenem-resistant klebsiella pneumoniae is an emerging threat worldwide causing high rates of morbidity and mortality

Aim: To evaluate the prevalence of carbapenem-resistant K. pneumonia (CRKP), associated risk factors, type of infections caused by CRKP and their antimicrobial susceptibility. To evaluate Carbapenemase Detection Set (D70C) as screening test for CRKP

Place and Duration of the Study: A cross sectional study and prospective cohort study was performed from June 2019 to February 2020 in intensive care unit and medical units of Al Quwayiyah General hospital.

Methodology: 541 samples were collected from different patient sources. Klebsiella pneumoniae strain was only selected identified to the species level and AST was done using the Vitek-2. Minimum inhibitory concentration (MIC) of meropenem and imipenem was carried out. A Carbapenemase Detection Set (D70C) was used as screening test for CRKP while Modified Hodge test and multiplex PCR as confirmatory tests.

Results: A total of 132 isolates were diagnosed as Enterobacteriaceae out of 541 patient samples.78 clinical isolates were klebsiella pneumoniae which were collected. Out of the 78 clinical isolates CRKP were 36 (46.2%) and CSKP were 42 (53.8%).) CRKP cases aged from (18-84 years) with the median patient age 59 year. Seventeen of 36 patients (47.2%) were males. the majority of the nosocomial CRKP infections were pneumonia 12 (33.3%) followed by urinary tract infection 9 (25%). The most common associated disease was diabetes (30%) followed by renal disease (27.8%). For invasive procedures, Urinary catheter was 27(75%) and 29(69%) followed by Mechanical ventilation 25(69.4%) and 22(52.4%) in CRKP and CSKP patients respectively. Reports of PCR for the 41 isolates which sent to regional laboratory for confirmation revealed that 36 isolates had carbapenemase genes; twenty eight (77.8%) K. pneumonia isolates positive for bla OXA-48 and 5 (13.9%) isolates were positive for blaNDM. in 2 (5.6%) bla KPC were detected, one isolate contained blaIMP. 5 isolates contain both blaOXA-48 and blaNDM. The sensitivity of MHT was analysed to be 91.7%. (95%Cl ratio 77.53% - 98.25%) and the specificity was 100% (95%Cl ratio 54.07% to 100%). The positive predictive value was 100% and the Negative predictive value was 66.7% ( 95%Cl ratio 40.36% to 85.53%). The sensitivity of Carbapenemase Detection Set (D70C) was 94.4% (81.34% to 99.32%) and the specificity was 80% (95%Cl ratio 28.36% to 99.49%). The positive predictive value was 97.1% (95%Cl ratio 85.46% to 99.49%).and the Negative predictive value was 66.7% (95%Cl ratio 32.67% to 89.18%).

Conclusion: CRKP prevalence was 46.2% among K. pneumoniae isolates in Al Quwayiya General Hospital. Using invasive procedures such as urinary catheters or mechanical ventilator and misuse of antibiotics were risk factors associated with CRKP indicating that infection control guidelines and effective preventive measures should be strictly applied. It is very important to monitor and report changes in antimicrobial-resistant isolates but Carbapenemase Detection Set (D70C) has low specificity makes it less reliable and need PCR confirmation.