Antibiotic resistance and biofilm formation in Klebsiella spp. isolates from Intensive Care Units in the Brazilian Amazon.

Abstract

Klebsiella spp. is an opportunistic pathogen which poses a significant threat to public health, especially due to antimicrobial resistance and biofilm formation. This study aimed to determine the antibiotic resistance profile, biofilm formation and β-lactamases production in Klebsiella spp. strains from clinical samples obtained from hospitalized patients, health professionals and hospital environment of intensive care units (ICUs) in Brazilian Amazon. The strains were obtained from clinical samples in different hospitals and identified using molecular techniques. The antimicrobial susceptibility was investigated via disk diffusion and microdilution. Biofilm formation was evaluated using a microtiter plate assay, while the extended-spectrum β-lactamases (ESBL) and carbapenemases production was assessed via disk approximation tests and combined disk tests, respectively. A total of 226 Klebsiella spp. strains were identified, with 141 coming from patients hospitalized in ICUs, 54 from healthcare workers, and 31 from hospital structures. Collection sites that showed the highest frequencies of isolated bacteria were the armpit (43,3%), oral cavity (42.6%), nasal cavity (70.4%), beds (54.8%) and mechanical ventilation (19.4%). Klebsiella spp. isolates from hospitalized patients and hospital ICU environments showed a high frequency of resistance (>50%) to the antibiotics, cefuroxime, cefotaxime, ceftriaxone, ciprofloxacin and aztreonam, and greater sensitivity (>70%) to carbapenems, amikacin and polymyxin B. Samples obtained from hospital structures (74.2%) and patients (51.8%) exhibited a high rate of multidrug resistant (MDR) isolates. In addition, 29% of Klebsiella isolates were found to produce ESBL and 15.5% carbapenemases. Biofilm formation was observed in 58.4% (132/226) of the isolates, with percentages of 64.5% (91/141) in hospitalized patients, 51.6% (16/31) on hospital structures, and 46.3% (25/54) among healthcare professionals. These results indicated a high percentage of antibiotics resistance and MDR in isolates from hospital structures and patients, which also showed ability to produce biofilms, ESBL and carbapenemases. Our findings reinforce the need to monitor resistance and adopt measures aimed at preventing the spread of MDR bacteria in ICUs.