Klebsiella pneumoniae is a gram negative, encapsulated, non-motile lactose fermenting, facultative anaerobic bacteria belonging to family Entero-bacteriaceae [1, 2]. It is one of the most common causative agents of hospital and community acquired infections. It is usually associated with pneumonia, septicaemia, urinary tract infection but can also cause various other pyogenic infections [3].

Klebsiella pneumoniae is resistant to a wide range of antibiotics. It is intrinsically resistant to ampicillin [4]. A steady increase in Extended Spectrum Beta Lactamase (ESBL) producing Klebsiella pneumoniae and its co-resistance to other antimicrobial agents like quinolones and aminoglycoside antibioticshas been observed over past years. These organisms acquire resistance via different pathways mediated by plasmids, transposons, and gene cassettes in integronsetc [5,6]. Carbapenemsare are preferred to treat the infections caused by multi drug resistant (MDR) isolates of Klebsiella pneumoniae but recently carbapenem-resistant Klebsiella pneumoniae has been reported (CRKP) [7]. These multi drug resistant organisms (MDROs) poses a serious threat in terms of morbidity and mortality associated with them.

Emergence of resistance of Klebsiella to previously sensitive antibiotics is greatly due to non judicious use of antimicrobial agents [8]. This study was therefore undertaken to update our knowledge on recent trends in resistance patterns among Klebsiella pneumoniae isolates obtained from various clinical samples of the patients suffering from infections. This will help clinicians in a rational selection of antimicrobial agents and thus help in better patient management.

The study was carried out after taking ethical approval from the ethical committee of the institution.

Study design & data collection: It was a prospective study carried out from January 2019 to July 2019. Data collection included information about, age & sex of the patients and a brief clinical history of illness.

Settings: The study was carried out in the Department of Microbiology, S.G.R.D Institute of

41-60 years followed by those above 60 years of age (table 2). Maximum number of isolates were obtained from pus samples (table 3).

Table-1: Gender wise distribution n=194

Odds Ratio: 2.078; CI: 1.755-2.450; p <0.001; highly significant

Table-2: Age wise distribution n=194.

Table-3: Isolation rate of Klebsiella pneumoniae from various clinical samples n=194

Table-4: Antibiogram of Klebsiella pneumoniae n=194.

Most of the isolates obtained were multi-drug resistant and ESBL and Carbapenamase producers. 100% isolates showed resistance to Ampicillin (table 4).

Unfortunately, in the present study high resistance to tegicycline is seen leaving only colistin as treatment option which also shows 16% resistance. Resistance to colistin has also been reported, with a 17% resistance rate in Taiwan [21] and also in our previous study on pus isolates [22].

The present study also reveals that, there is a predominance of males (58%) over females (42%) (p <0.001) w.r.t. isolation of Klebsiella pneumonia also the infection was observed to be more common in age group 41-60 years. (Table 1&2). This has been documented by other studies also [23]. The highest percentage of Klebsiella pneumonia were isolated were from pus (27.8%) followed by urine (22%), blood (8%) and sputum (8%) (Table 3) which is also In concordance with other studies [24].

Limitation- This study was conducted in only one tertiary care teaching hospital so the situation may differ in other parts of the countries. A multi centric study should be conducted to have a more reliable data.

To conclude, high resistance of Klebsiella pneumonia to commonly used antibiotics is the major reasons for high morbidity and mortality associated with its infections in hospitalised patients. Therefore a regular surveillance of antibiotic susceptibility pattern is needed to prevent indiscriminate use of antibiotics which is a major cause of emergence of drug resistance among pathogens.

The data obtained from the present study can be used to determine trends in antimicrobial resistance of Klebsiella pneumonia, an important nosocomial pathogen and to formulate local antibiotic policy. This will assist clinicians in the rational selection of antibiotic therapy for effective management of patients.

Dr. Manmeet Kaur Gill: Research Question framing, Literature search, Study design, Research work, Data collection and data analysis, Manuscript preparation

Anureet Kaur Gill: Assisted in Data compilation