DETECTION OF CARBAPENEM ANTIBIOTIC RESISTANCE IN KLEBSIELLA PNEUMONIA IN DUHOK CITY/KURDISTAN REGION/IRAQ
Background: The emergence of Klebsiella pneumoniae carbapenemase (KPC) is regarded as a major concern worldwide. The aims were to detect carbapenem resistant in K. pneumoniae and to assess their antimicrobial susceptibility results.
Methods: K. pneumoniae strains were identified by conventional method first then confirmed by Vitek-2 automated machine. Antimicrobial sensitivity tests were performed by both Kirby-Bauer method and Vitek-2 automated machine.
Results: Out of 281 strains of K. pneumoniae, there were 131 strains co-producing carbapenemase, extended spectrum β lactamase (ESβL) and Amp C-type β-lactamase. 84 strains were ESβL producer only and 66 strains were sensitive to all antibiotics except ampicillin. The highest expression rate were among samples of blood and CSF (72.15% and 71.43% respectively) followed by wound 64%, sputum 37.5%, urine 32.17% and were least for vaginal swabs 17.65%. The highest number of this expression was among the age group 15-44 years, followed by the age of under 1 year. Overall, the resistance prevalence was high for: ampicillin, amoxicillin/clavulunate, cephalosporins, aztreonam, cefepime, trimethprim and Tetracycline (> 90% up to 100%), aminoglycosides (>85%), emipenem and meropenem (87.9% and 72.5% respectively), colistin (62.6%), ciprofloxacin, nitrofurantoim and cefoxitin (59.5%) and fosfomycin (28.2%).
Conclusion: This study describes the emergence of carbapenemase, Amp C and ESβL-producing K. pneumoniae. High percentage of K. pneumoniae detected among isolates in Duhok city. They were highly resistant to β-lactams, carbapenems and aminoglycosides. However, their sensitivities to fosfomycin, ciprofloxacin and colistin were higher than other used antibiotics. Active surveillance and testing for susceptibility to colistin, ciprofloxacin and fosfomycin should be implementing because resistance to these antibiotics are also on the increase worldwide.
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