# Antimicrobial Resistance in Sepsis Cases Due to Escherichia coli and Klebsiella pneumoniae: Pre-Pandemic Insights from a Single Center in Southwestern Romania

## TL;DR

This study examines antibiotic resistance in E. coli and K. pneumoniae causing sepsis in Romania, finding high resistance to ampicillin and varying resistance to other antibiotics.

## Contribution

The study provides a detailed resistance profile of E. coli and K. pneumoniae in sepsis cases from a single center in Romania, comparing resistance levels to broader data.

## Key findings

- E. coli showed high resistance to ampicillin (64.6%), reduced to 41.8% with sulbactam.
- K. pneumoniae exhibited higher resistance to 3rd generation cephalosporins (20.7–22.5%) and carbapenems (13.7–19.5%) compared to E. coli.
- Resistance levels for both bacteria were generally lower than continental and national data, except for ampicillin and carbapenems.

## Abstract

Sepsis is an uncontrolled reaction of the body to an infection, and if not effectively treated, it can progress to septic shock, multiple organ failure, and ultimately, death. Objective: To determine the resistance profile of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains isolated in sepsis cases diagnosed at the Infectious Diseases Clinic in Craiova, Romania. Methods: The bacteria responsible for sepsis cases were identified using the Vitek 2 Systems version 06.01, which was then employed to assess their antimicrobial susceptibility (Global CLSI and Phenotypic 2017). Results: We have identified 989 patients diagnosed with bacterial sepsis. Among these, 953 cases were caused by Gram-negative rods, with 415 attributed to E. coli and 278 to K. pneumoniae. High levels of resistance to ampicillin were recorded for E. coli strains isolated in sepsis cases (64.6%); adding sulbactam lowers the level of resistance to 41.8%. Resistance to 3rd generation cephalosporins varied between 7.47 and 14.6% and another 3.41 to 11.1% are dose-dependent susceptibility strains. Resistance to carbapenems (i.e., ertapenem, meropenem) is low—2.18–2.42%. More than 95% of the tested K. pneumoniae strains were resistant to ampicillin and adding sulbactam as a β-lactamase inhibitor only halves that level. Resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%; resistance levels for K. pneumoniae were notably higher than those for E. coli. Over 95% of K. pneumoniae strains showed resistance to ampicillin, and resistance to 3rd generation cephalosporins varied between 20.7% and 22.5%. Additionally, K. pneumoniae exhibited higher resistance to carbapenems (13.7–19.5%) compared to E. coli (2.18–2.42%). Conclusions: Antimicrobial resistance levels are generally lower than continental and national data, except for ampicillin and carbapenems (meropenem and ertapenem). K. pneumoniae strains are significantly more resistant than E. coli strains.