Carbapenemase Producing Multi Drug Resistant Klebsiella pneumoniae from a Referral Hospital in Nepal

Abstract

Background: This study aimed to assess the antimicrobial resistance rates of Acinetobacter species and Pseudomonas species isolated from clinical samples in an Antimicrobial Resistance (AMR) surveillance site in Gandaki Province, Nepal.
Methods: A retrospective analysis of data from an AMR surveillance site was extracted and analyzed, covering the time period from January 2020 to June 2024. A total of 575 Acinetobacter species and 687 Pseudomonas species were identified, with varying numbers tested for susceptibility against different antibiotics. Resistance rates were calculated for each pathogen-antibiotic combination.
Results: Resistance in Acinetobacter species was observed in 49.9% of isolates to amikacin and 42.7% to gentamicin, whereas Pseudomonas species showed resistance rates of 21.2% and 18.5%, respectively. Resistance to piperacillin–tazobactam was identified in 54.0% of Acinetobacter species and 24.6% of Pseudomonas species. Notably, 80.3% of Acinetobacter species and 62.6% of Pseudomonas species were resistant to ceftazidime, while carbapenem resistance was observed in 59.3% of Acinetobacter species and 14.8% of Pseudomonas species. Norfloxacin resistance was observed in 38.3% of Acinetobacter species and 43.5% of Pseudomonas species, whereas only 4.0% of Acinetobacter species and 11.4% of Pseudomonas species isolates were resistance to tigecycline. Resistance rates varied across sample types, with Acinetobacter species from respiratory samples and Pseudomonas species from urine samples exhibiting the highest resistance.
Conclusions: The study underscores alarming levels of antimicrobial resistance in Acinetobacter species and Pseudomonas species. Acinetobacter species demonstrated higher resistance to most antibiotics compared to Pseudomonas species. The variation in resistance patterns across sample types highlights the need of infection site and pathogen-specific antibiotic stewardship strategies.
Keywords: Acinetobacter species, AMR surveillance, antimicrobial resistance, Pseudomonas species