Klebsiella pneumoniae urinary tract infection: A multicentric study highlights significant regional variations in antimicrobial susceptibility across India

• Mapping of the antimicrobial susceptibility of Klebsiella pneumoniae in urinary tract infection was undertaken by 18 centers across India. • The national susceptibilities to nitrofurantoin, meropenem, and fosfomycin were 39%, 81%, and 89%, respectively. • The proportion of susceptibility of K. pneumoniae to different antimicrobials was directly linked to geographic region ( P <0.001). • South India had the highest mean susceptibility to trimethoprim/sulfamethoxazole, piperacillin/tazobactam, imipenem, and meropenem. • Humidity, and low and high temperatures ( P <0.05) had a statistically significant effect on the proportion of susceptible K. pneumoniae . Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics ( https://dashuti.com/ ), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product ( P <0.001), and humidity, and low and high temperatures ( P <0.05). Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.