Frequency and antimicrobial susceptibility of Klebsiella species isolated from urine cultures at a tertiary healthcare facility of Lahore

Background: Klebsiella is found ubiquitously in nature and is a potential pathogen to infect different anatomic sites including urinary tract. Due to high resistance to antimicrobials it is considered as one of the most challenging pathogens. Aim: To study the frequency and antimicrobial sensitivity of Klebsiella species isolated from urine culture. Material and Method: The data of urine cultures results reported as Klebsiella species during 1st Jan to 31st Dec 2021 was collected through Electronic Medical Record system. Klebsiella species were recognized based on culture characteristics and biochemical tests with API-20E (bioMérieux) profile. Antibiotic susceptibility and extended spectrum beta-lactamase (ESBL) detection was performed by disc/combined disc diffusion using Kirby Bauer method. Results: Of 2438 urine samples submitted for culture during the study period, 746 (30.6%) showed significant growth of a known uropathogen. The frequency of Klebsiella was 14.75% which was second most common uropathogen after E. coli (57.37%). Other isolates reported were Enterococcus (12.87%), Candida (8.71%), Pseudomonas (2.68%), Staphylococcus (1.48%), Proteus (1.07%) and Citrobacter species (1.07%). The isolates showed high sensitivity to imipenem (87.3%) followed by meropenem (85.5%), amikacin (84.6%) and fosfomycin (81.5%). A reduced sensitivity was observed against gentamicin (68.2%), piperacillin-tazobactam (61.8%), nitrofurantoin (58.2%) and cefotaxime (50%), but the least sensitivity was seen for ciprofloxacin (40.9%), cotrimoxazole (36.4%), cefuroxime (20%) and ampicillin (10%). Of all isolates 37 (33.6%) were ESBL producers. Conclusion: Carbapenems, amikacin and possibly fosfomycin are the most efficient drugs for treating UTI due to Klebsiella species in our hospital setting. An on-going surveillance for ESBL producers as well as carbapenemase-producing Klebsiella pneumoniae (KPC) is needed.