High prevalence of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a tertiary care hospital in Tehran, Iran

Abstract

Background: Extended-spectrum beta (β)-lactamase (ESBL)-producing enterobacteria are major emerging pathogens in nosocomial infections.

Methodology: The combination disk synergy test was used to evaluate 202 consecutive non-repeated Klebsiella pneumoniae (K. pneumonia) strains for ESBL production.  The strains were isolated from various clinical specimens of hospitalized patients over the period from July 2005 to March 2007. Their antibiotic susceptibility pattern was also determined by the disk diffusion method.  Demographic and medical data of the patients were recorded using a questionnaire.

Results: One hundred and fifty-seven (77.7%) of the isolates were confirmed as ESBL-producers. By univariate analysis, young age, stay in intensive care unit (ICU)/medical wards, recent stay in ICU, and number of days of ICU stay were found to be risk factors for acquisition of resistant bacteria (χ2 and Mann-Whitney U tests, P < 0.05). However, binary logistic multivariate regression analysis confirmed that stay in ICU [Odds ratio (OR) 6.09, 95% confidence interval (CI) 2.36-15.72; P < 0.001] or medical wards [OR 3.72, 95% CI 1.42-9.75; P = 0.007] were significantly associated with ESBL production. Imipenem, ofloxacin, cefoxitin and norfloxacin (against urinary isolates) were found to be highly active against ESBL-producing isolates in vitro (100%, 75.2%, 69.4% and 66.7% susceptibility, respectively). In addition to most β-lactams, they showed co-resistance with other antibiotics such as ciprofloxacin, aminoglycosides, trimethoprim/sulfamethoxazole and tetracycline.

Conclusion: Our results showed a high prevalence of ESBL-producing K. pneumoniae in our hospital setting. As the available treatment options are limited, antibiotic control policies together with the implementation of infection control measures remain of high importance.