# The Rising Menace: Carbapenem-Resistant Klebsiella pneumoniae in a Tertiary Care Center and Co-dominance of blaNDM, blaOXA-48 Along With the Emergence of blaVIM

## TL;DR

This study examines the spread of antibiotic-resistant Klebsiella pneumoniae in a hospital, finding that resistance genes like blaNDM and blaOXA-48 are common and pose a serious threat.

## Contribution

The study reports the co-dominance of blaNDM and blaOXA-48 genes and the emergence of blaVIM in CR-Kp isolates in a hospital setting.

## Key findings

- 64.52% of Klebsiella pneumoniae isolates were carbapenem-resistant.
- blaNDM was detected in 100% of tested CR-Kp isolates, and blaOXA-48 in 65%.
- CR-Kp isolates showed high resistance to fluoroquinolones, cephalosporins, and aminoglycosides.

## Abstract

Background and objective

Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a significant cause of hospital-acquired infections, with significant implications for patient outcomes due to limited treatment options and high mortality rates. This study aimed to determine the prevalence, phenotypic resistance patterns, and molecular characteristics of CR-Kp isolates.

Methods

This was a cross-sectional study conducted for a period of one year. A total of 186 non-duplicate Klebsiella pneumoniae (K. pneumoniae) isolates from various samples were subjected to antibiotic susceptibility testing. Phenotypic detection of carbapenemase production was performed using the modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and combined disc testing (CDT). Genotypic analysis using PCR was performed on 20 representative CR-Kp isolates to detect blaNDM, blaKPC, blaOXA-48, blaIMP, and blaVIM genes.

Results

Out of 186 K. pneumoniae isolates, 120 (64.52%) were carbapenem-resistant based on Kirby-Bauer disc diffusion method. Respiratory and bloodstream infections showed the highest CR-Kp prevalence. Phenotypic methods detected carbapenemase activity in 61.29% (combined disk test), 48.92% (mCIM), and 40.86% (MHT) in K. pneumoniae isolates. Genotypic testing revealed blaNDM in 100% and blaOXA-48 in 65% of the tested isolates, with blaVIM detected in one isolate. No blaKPC or blaIMP genes were identified. CR-Kp isolates exhibited high resistance to fluoroquinolones, cephalosporins, and aminoglycosides.

Conclusions

The high prevalence of blaNDM- and blaOXA-48-mediated carbapenem resistance in K. pneumoniae highlights a growing threat to antimicrobial efficacy. Routine molecular surveillance and stringent antibiotic stewardship initiatives are urgently needed to limit the spread of CR-Kp in hospital settings.