CARBAPENEM RESISTANCE IN KLEBSIELLA PNEUMONIAE AT THE LAGOS UNIVERSITY TEACHING HOSPITAL

Abstract

Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging healthcare
associated pathogen.
Objective: To determine the prevalence of CRKP at the Lagos University Teaching Hospital
(LUTH) and identify associated risk factors.
Setting: LUTH is a 761-bed tertiary care teaching hospital.
Methods: Inpatients with clinical specimen that grew Klebsiella pneumoniae were identified from
the microbiology laboratory and followed up in the ward where clinical data were collected.
Antimicrobial susceptibility testing was done on the isolates using the modified Kirby Bauer method.
Carbapenemase production was confirmed by the modified Hodge test and screening for ESBL
production, by the double disk synergy test. CRKP were compared with non CRKP to identify risk
factors.
Results: Klebsiella pneumoniae was isolated from the clinical specimens of 153 in-patients.
Carbapenem resistant K. pneumoniae (CRKP) was isolated from 8 of the 153 patients giving a
prevalence of 5.2%. Only 4 CRKP isolates could be identified as carbapenemase producing by the
modified Hodge test. The independent risk factors for CRKP were the use of three or more
antibiotics during admission (p=0.03) and use of antibiotics before culture (p=0.003). The prevalence
of ESBL producing K. pneumoniae was 72.5% and the independent risk factors for ESBL producing
K. pneumoniae were previous hospital admission (p=0.002), ciprofloxacin resistance (<0.0001) and
gentamicin resistance (<0.0001).
Conclusion: Carbapenem resistant Klebsiella pneumoniae is emerging in LUTH even though
carbapenem use is low and ESBL producing K. pneumoniae are now endemic in the hospital.
Carbapenems are last line antibiotics reserved for treatment of severe gram negative sepsis and
emerging resistance in LUTH to these antibiotics will lead to limited treatment options. There is need
for good antibiotic policy and antibiotic stewardship. Strict infection control measures such as
improving hand hygiene practices have to be implemented to prevent spread of CRKP.