Carbapenemase Producing Klebsiella species from Hospitalised Patients at Three Referral Hospitals in Yaounde; Cameroon

Abstract

Background: Carbapenemases are the most potent beta-lactamases capable of hydrolysing all beta-lactam drugs. Data scarcity on laboratory evidence of carbapenemase producers obstructs infection prevention and effective control measures. This study aimed to detect and phenotypically characterize Klebsiella species resistant to carbapenems. Method: A total of eighty-seven (87) Klebsiella spp. isolates were collected from three Yaounde-based tertiary hospitals over a period of twelve months (February 2019 to January 2020). The isolates were identified on API 20E and antimicrobial susceptibility testing was done according to the Kirby Bauer disc diffusion method. Carbapenem resistance was detected based on reduction in inhibition zone diameter of meropenem less than 28mm and resistance phenotypes determined by the combination disc synergy test. Results: Four Klebsiella species were identified namely: Klebsiella pneumoniae 62/87 (71.3%), K. oxytoca 11/87 (12.6%), K. ozaenae 7/87 (8%), K. rhinoscleromatis 7/87 (8%). Klebsiella pneumoniae was most resistant to carbapenems with a considerably high number of multidrug resistant isolates 39/56 (69.6%). Patients from the 0-9 years age group were most represented 29/87 (33.3%). Carbapenemases belonging to Ambler classes A, B and D were detected as follows: KPC 2/87 (2.3%), MBL 2/87(2.3%), OXA-48 4/87 (4.6%). All four Klebsiella species were producers of KPC carbapenemase 12/87 (13.8%) and Extended Spectrum β-lactamase 68/87 (78.2%) enzymes. Conclusion: These results revealed that more than half of Klebsiella species analysed were multidrug resistant and about a quarter in hospitalized patients at the referral hospitals were mostly KPC carbapenemase producers. This raises concerns over the need to control and confine the spread of these isolates of clinical and epidemiological importance for effective infection prevention and control.