STUDYON CHANGE IN THE TREND OF ANTIBIOTIC SUSCEPTIBILITY PATTERN OF KLEBSIELLA PNEUMONIAE ISOLATES FROM VARIOUS CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL

in both community and health-caresettings.It became a challenge to the Disease) physicians to treat Klebsiella infections due to increasing resistance to various antibiotics which led to significant morbidity and mortality. This study was done to know the change in the trend of antibiotic susceptibility pattern of K. pneumoniae for a period of 2 years and to identify Extended Spectrum β-lactamase and AmpCβ-lactamase producing organisms. This is a collaboration of Microbiologists and clinicians is also necessary fortheeffective management of infectious diseases.


…………………………………………………………………………………………………….... Introduction:-
Klebsiella pneumoniae belongs to the family Enterobacteriaceae. It is a Gram-negative encapsulated bacterium that grows in the mucosal surfaces of humans and soil, vegetation and water. In humans, K.pneumoniae colonizes the oropharynx and gastrointestinal tract, from where it can easily enter the circulation and other tissues, causes infections such as bacteremia, septicemia, surgical site infections, urinary tract infections, hospital-acquired pneumonia and ventilator-associated pneumonia.K.pneumoniae can form biofilms. It became a challenge to the ID (Infectious Disease) physicians to treat Klebsiella infections due to increasing resistance to various antibiotics which led to significant morbidity and mortality.One major drug resistance mechanism of K. pneumoniae is through the production of β-lactamases like Extended-Spectrum β-Lactamases (ESBLs) and/or AmpC β-lactamases or both.K. pneumoniae is often resistant to severalclasses of non-β-lactam antibiotics.Intensive and prolonged use of antibiotics is another reason for the emergence and spread of highly resistant nosocomial infections.

Methods:-
Blood, pus and urine specimens were received from both Out-patients and In-patients from different wards of Government General Hospital, Vijayawada for a period of 2 years from August 2019 -July 2021 which was divided into 2 periods. Period 1 is from August 2019 to July 2020. Period 2 is from August 2020 to July 2021. The samples were inoculated onfresh Nutrient agar, 5% sheep Blood agar and MacConkey's agar.The plates were incubated aerobically at 37⁰ C for 24 hrs.The organisms were identified phenotypically by cultural characteristics, Gram's stain, Motility and standard biochemical tests as per CLSI guidelines.Antibiotic susceptibility testing of the isolated bacteria was done by Modified Kirby-Bauer Disc Diffusion method on Muller Hinton's agar with proper standardization using ATCC control strains.
Phenotypic screening of ESBL producing Klebsiella isolates was doneusing cefotaxime (30µg)disks and confirmation was done using ceftazidime (30µg) disk and clavulanate (10µg) on Mueller-Hinton agar. A difference of more than or equal to 5 mm between the zone diameters of Ceftazidime disks and Ceftazidime/ clavulanate disks was taken to be phenotypic confirmation of ESBL production.
AmpCβ-lactamase producing isolates were detected using 30µg cefoxitin disks on inoculatedMuller Hinton's agar. Isolates producing zone diameters less than 18 mm were confirmed as AmpC β-lactamase producers.

Results:-
Out of 3021 samples received during period 1, 1442 were pus samples, 594 were blood samples, 985 were urine samples. The no. of Klebsiella pneumoniae isolates from the pus, blood and urine samples were 139, 67 and 48 respectively during period 1, which accounts for a total of 254.
Out of 3558 samples received during period 2, 1778 were pus samples, 612 were blood samples, 1168 were urine samples. The no. of Klebsiella pneumoniae isolates from the pus, blood and urine samples were 175, 82 and 63 respectively during period 2,which accounts for a total of 320.

Discussion:-
The present study shows the antibiotic resistance pattern of Klebsiella pneumoniae over a period of 2 years.

Conclusion:-
There is an increase in the antibiotic resistance during period 2 when compared with period 1. Intensive and prolonged use of antibiotics is likely the main underlying factor in the transmission of antibiotic-resistant nosocomial infections. so it is very important to monitor and optimize antibiotic use through antibiotic stewardship programmes. The collaboration of Microbiologists and clinicians is also necessary for the effective management of infectious diseases.