Dynamics of antibiotic resistance of Klebsiella pneumoniae clinical isolates from patients with secondary bacterial infection during COVID-19 for the period 2019–2021

Gram-negative bacteria (GAB) continue to lead in terms of antibiotic resistance among the causative agents of opportunistic infections. K. pneumoniae occupies a special placeamong GOBs, causing secondary bacterial infections with a high frequency in patients with COVID-19.

Objective. To study the dynamics of sensitivity/resistance to antibiotics of K. pneumoniae clinical isolates isolated from biological material in patients with secondary bacterial infection with COVID-19.

Materials and methods. In terms of sensitivity/resistance, 535 clinical isolates of K. pneumoniae isolated from patients with COVID-19 in various regions of the Republic of Belarus in the period 2019–2021 were studied.

Results. The proportion of clinical isolates of K. pneumoniae resistant to antibiotics against the background increased in 2021 compared to 2019 and was for carbapenems in 2019 ertapenem – 46,4 ± 3,35 %, imipenem – 35,8 ± 3,19 % and meropenem – 39,6 ± 3,28 % and in 2021 ertapenem 66,7 ± 4,74 % (p = 0,000603), imipenem 54,4 ± 4,66 % (p = 0,001253) and meropenem 54,5 ± 4,49 % (p = 0,008182). K. pneumoniae showed a high frequency of resistance to colistin: against the background of COVID-19 in 2019 – 95,0 ± 4,87 %, in 2020 – 100,0 ± 0,0 % (p = 0,311608), in 2021 – 55,3 ± 7,25 % (p = 0,000046).

Conclusion. Among clinical isolates of K. pneumoniae, widespread resistance to most antibiotics was observed, as well as an increase in resistance to carbapenems.

1. Shamina, O. V., SamoilovaE. A., NovikovaI. E., LazarevaA. V. Klebsiella pneumoniae: microbiological characterization, antibiotic resistance and virulence // Russian pediatric journal. – 2020. – № 23(3). – P. 191–197. – DOI: 10.18821/1560-9561-2020-23-3-191-197.

2. Paczosa, M. K., Mecsas J. Klebsiella pneumoniae: Going on the Offense with a Strong Defense // Microbiol. Mol. Biol. Rev. – 2016. – Vol. 80. – Р. 629–661. – DOI: 10.1128/MMBR.00078-15.

3. Voulgari, E., Poulou A., Koumaki V., Tsakris A. Carbapenemase producing Enterobacteriaceae: now that the storm is finally here, how will timely detectionhelp us fightback? FutureMicrobiol. – 2013. – Vol. 8(1). – P. 27–39. – DOI:10.2217/fmb.12.130.

4. Martin, R. M., Bachman M. A. Colonization, Infection, and the Accessory Genome of Klebsiella pneumoniae // Front Cell Infect. Microbiol. – 2018. – № 8. – P. 4. – DOI: 10.3389/fcimb.2018.00004.

5. Yang, Li, Dan Li et. al. The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae et al. // Children’s Medical Center in Eastern China; Infect Drug Resist. – 2021. – Vol. 14. – P. 3737–3752. – DOI: 10.2147/IDR.S323353.

6. Tapalsky, D. V., Zhavoronok S. V., Carbapenemases of gram-negative bacteria: distribution and methods of detection // Medical Journal. – 2012. – № 2. – P. 10–14.

7. Sukhorukova, M. V., Eidelstein M. V. Antibiotic resistance of nosocomial strains of Enterobacteriaceae in Russian hospitals: results of the multicenter epidemiological study “MARATHON” 2013–2014 // Clinical Microbiology and Antimicrobial Chemotherapy. – 2017. – Vol. 19(1). – P. 49–56.

8. Kozlova, N. S., Barantsevich N. E., Barantsevich E. P. Antibiotic susceptibility of Klebsiella pneumoniae strains isolated in a multidisciplinary hospital // Infection and immunity. – 2018. – Vol. 8, № 1. – P. 79–84.

9. Shamina, O. V., Kryzhanovskaya O. A. et al. Resistance of carbapenem-resistant strains of Klebsiella pneumoniae to colistin: molecular mechanisms and bacterial fitness // Bulletin of the RSMU. – 2020. – № 3. – P. 11–18.

10. Li, Z., Cao Y., Yi L. et al. Emergent polymyxin resistance: end of an era // Open Forum Infect. Dis. – 2019. – Vol. 6, № 10. – Article ID ofz368. – DOI: https://doi.org/10.1093/ofid/ofz368.

11. Anisko, L. A. The problem of using antibacterial drugs in the era of COVID-19 infection // Journal “Laboratory Diagnostics. Eastern Europe”. – 2022. – Vol. 11, № 1. – P. 22–29.