Carbapenem-Resistant Klebsiella pneumoniae in Yemeni Patients: Prevalence, Phenotypes, and Resistance Profile to Last-Resort Antibiotics

Abstract

The spread of carbapenem-resistant Klebsiella pneumoniae (CRKp), which is one of the top pathogens in the WHO list of antibiotic-resistant bacteria, is a true threat to human life. This study aimed to determine the prevalence, carbapenemase phenotypes, and resistance to last-resort antibiotics of CRKp isolated from clinical specimens of inpatients and outpatients in 3 health-service facilities in Sana‘a-Yemen between December 2020 and November 2022. The carbapenemases produced by these isolates were phenotyped by mCIM and eCIM, and the susceptibility of the isolates to last-resort antibiotics was determined using the disk diffusion method. A total of 140 CRKp isolates were recovered in this study, mostly from urine specimens (35 %), from inpatients hospitalized in the gynecology ward (30%) and intensive care units (22.9 %). Differences in CRKp prevalence were insignificant between females and males and between age ranges but significant between urban and rural residents. Moreover, 75.7% of CRKp isolates were producers of metallo-β-lactamases and 81.4, 78.6 %, 17.1%, 15.7 %, and 7.1% of these isolates were resistant to aztreonam, ceftazidime+ avibactam, colistin, fosfomycin, and tigecycline, respectively. In conclusion, there is a considerable prevalence of CRKp isolates among Yemeni patients. These isolates are mostly metallo β-lactamase producers and have remarkable resistance to most lastresort antibiotics. Accordingly, there is a need to establish and employ urgent control and prevention measures to diminish the spread of CRKp and limit its emergent resistance to last-resort antibiotics in our community.