ABSTRACT

Introduction: Globally, antimicrobial resistance is a foremost public health challenge, particularly in developing countries. Multiple antibiotic resistance (MAR) index is helpful in analyzing health risk, as well as to check the extent of antibiotic resistance.
Methodology: About four hundred (400) clinical isolates of members of the of the family Enterobacterales were isolated from urine specimens of inpatients and outpatients submitted for routine culture and susceptibility testing at the Medical Microbiology Laboratory, Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto. Isolates were identified using colonial morphology and standard biochemical test. Antimicrobial susceptibility testing was conducted using modified Kirby bauer disc diffusion method. The quinolone resistance genes ware detected using Polymerase Chain Reaction.
Result: The isolates were recovered from adult patients with age range between 18-75 years. Majority of the patients were females (60%). The prevalence of Klebsiella pneumoniae was 8.75%. and the antibiotic susceptibility profile of Klebsiella pneumoniae were classified as either “resistant”, “intermediate” or “susceptible.” It exhibited high levels of resistance to certain antibiotics. Ampicillin showed the highest resistance rate at 26(74.3%), followed closely by Amoxicillin-clavulanate and Ceftriaxone 24(68.6%), Ciprofloxacin 22(62.9%), Gentamicin 20(57.1%), Ceftazidime 19(54.3%), and Levofloxacin 20(55.1%). Amikacin appeared to be the most sensitive drug at 21(60%); then followed by Meropenem at 19(54.3%). The MAR of the isolate ranges from 0.29 for Meropenem to 0.74 for Penicillin G. quinolone resistance genes were detected in 4(11.4%) of the Ciprofloxacin resistance isolates.
Conclusion: The irrational use of antimicrobials is certainly a complex and multifactorial problem in developing countries, and a proper understanding of the problem is necessary for effective control policies.

KEYWORDS

Klebsiella pneumoniae, multiple antimicrobial index, antibiotics, antimicrobial resistance, medical microbiology.

REFERENCES

1) Mandell, Douglas and B. Enterobacteriaceae. In: Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone,: An Imprint of Elsevier.; 2009.
2) Ronald A. The etiology of urinary tract infection: traditional and emerging pathogens. Am J Med. 2002;113. 
3) Caneiras C, Lito L, Melo-cristino J, Duarte A. Community- and Hospital-Acquired Klebsiella pneumoniae Urinary Tract Infections in Portugal : Virulence and Antibiotic Resistance. :1–14.
4) Auta A, Hadi MA, Oga E, Adewuyi EO, Abdu-Aguye SN, Adeloye D et al. Global access to antibiotics without prescription in community pharmacies: A systematic review and meta-analysis. J Infect [Internet]. 2019;78(1):8–18.
5) World Health Organization (WHO). Antimicrobial resistance: Does stopping a course of antibiotics early lead to antibiotic resistance?. 2020.
6) Nigeria CB of. Exchange rates.
7) Riaz S, Faisal M, Hasnain S. Antibiotic susceptibility pattern and multiple antibiotic resistances ( MAR ) calculation of extended spectrum β – lactamase ( ESBL ) producing Escherichia coli and Klebsiella species in Pakistan. 2011;10(33):6325–31.
8) Journal A, Clinical OF. MULTIPLE ANTIBIOTIC RESISTANCE ( MAR ) INDICES OF PSEUDOMONAS AND KLEBSIELLA SPECIES ISOLATES IN LAGOS UNIVERSITY TEACHING HOSPITAL. 2013;14(3):164–8.
9) Joseph A.A, Odimayo M.S Olokoba Lb Olokoba AB PG. Multiple Antibiotic Resistance Index of EscherichiaColi Isolates in a Tertiary Hospital in. Med J Zambia. 2017;44(4):225–32.
10) 3 غش 1، فت 1، عبمن 2 ،فم. No Titleتعیین تاثیر مصرف بی کربنات سدیم بر عملکرد بی هوازی مردان غیر ورزشکار.
11) CLSI. M100 Performance Standards for Antimicrobial Susceptibility Testing. 33rd ed. USA; 2023.
12) PH K. Multiple antibiotic resistance indexing of Escherichia coli to identify high-risk sources of fecal contamination of foods. Appl Env Microbiol. 1983;46(1):165–7.
13) Cattoir V, Poirel L, Rotimi V, Soussy C james, Nordmann P. Multiplex PCR for detection of plasmid-mediated quinolone resistance qnr genes in ESBL-producing enterobacterial isolates. 2007;(June):394–7.
14) Ayandele AA, Oladipo EK, Oyebisi O, Kaka MO. Prevalence of multi-antibiotic resistant escherichia coli and klebsiella species obtained from a tertiary medical institution in Oyo State, Nigeria. Qatar Med J. 2020;2020(1):1–6.
15) Polse RF, Qarani SM, Assafi MS, Sabaly NJ. Incidence and Antibiotic Sensitivity of Klebsiella pneumonia Isolated from Urinary Tract Infection Patients in Zakho Emergency Hospital / Iraq نیباصملا ىضرم لا نم ةلوزعملا ةیوئرلا لایس ب ی لکلا ةموثرجل ةیویحلا تاداضملل ةیساسح لا و ةباصلإا ىدم قا رعلا / وخ. 2020;2020:257–68.
16) Kaye KS, Gupta V, Mulgirigama A, Joshi A V, Ye G, Oman NES, et al. Prevalence , regional distribution , and trends of antimicrobial resistance among female outpatients with urine Klebsiella spp . isolates : a multicenter evaluation in the United States between 2011 and 2019. Antimicrob Resist Infect Control [Internet]. 2024;1–9. Available from: https://doi.org/10.1186/s13756-024-01372-x
17) Yandai FH, Ndoutamia G, Nadlaou B, Barro N. Prevalence and resistance profile of Escherichia coli and Klebsiella pneumoniae isolated from urinary tract infections in N ’ Djamena , Tchad. 2019;13(August):2065–73.
18) Umar U, Anagor S, Aliyu A, Suleiman AI. Hypermucoviscosity in Clinical Isolates of Klebsiella pneumoniae Correlates with High Multiple Antibiotic Resistance ( MAR ) Index. 2016;(September):97–103.
19) Navon-Venezia, S.; Kondratyeva, K.; Carattoli A. Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol Rev. 2017;41:252–275.
20) Bayode MT, Olalemi AO, Oladejo BO. Multiple antibiotic resistant index and detection of qnrS and qnrB genes in bacterial consortium of urine samples from clinical settings. 2021;11(1):45–56.
21) Moumouni A, Diagbouga S, Nadembèga C, Dabiré A, Salah F, Obiri Yeboah D, et al. Quinolone Resistance (qnr) genes in Fecal Carriage of Extended Spectrum beta-Lactamases producing Enterobacteria isolated from Children in Niger. Curr Res Microbiol Biotechnol [Internet]. 2017;5(1):953–7. Available from:
https://www.researchgate.net/publication/312531240
22) Diagbouga S1, 2*, Salah F D2, Sadji A Y3, Dabire A M2, Nadembega C2, Kere A B3, Soubeiga S T2, Ouattara A K2, Zohoncon T2, Belemgnegre M2, Karou S4 and SJ. Detection of High Prevalence of TEM/SHV/CTX-M Genes in ESBL Producing and Multidrug Resistant Klebsiella pneumoniae and Klebsiella oxytoca. JBR J Clin Diagnosis Res. 2016;04(01).
23) Partridge SR, Kwong SM, Firth N, Jensen SO. Mobile genetic elements associated with antimicrobial resistance. Clin Microbiol Rev. 2018;31(4):1–61.
24) Madni O, Amoako DG, Abia ALK, Rout J, Essack SY. Genomic investigation of carbapenem-resistant klebsiella pneumonia colonization in an intensive care unit in south africa. Genes (Basel). 2021;12(7).