Changing Trends in Antimicrobial Resistance Pattern in Klebsiella species Bacteremia in an Out-patient Hemodialysis Unit over 6 Years (2010–2015) in a Tertiary Care Hospital in Pakistan

Abstract

Klebsiella spp. is the commonest cause of bacteremia in dialysis patients from our center. A rising trend of antimicrobial resistance among Klebsiella has been reported from Pakistan. We studied the trends of antimicrobial resistance over the years in dialysis patients. Sindh Institute of Urology and Transplantation (SIUT) is a 700 bedded tertiary care hospital in Karachi, Pakistan. Around 500 patients are offered outpatient dialysis daily. We did a retrospective data analysis of all blood cultures with isolation of Klebsiella spp. for years 2010, 2012, 2014 and 2015. The resistance pattern of ceftriaxone, piperacillin-tazobactam, ciprofloxacin, trimethoprim-sulfamethoxazole, amikacin and imipenem were compared over the 6 years period. A total of 27,852 blood cultures were received during the study years, out of which 19,670 (70.6%) were positive for any microbial growth. Around 5,325 (27%) were Klebsiella spp. There was an increase in percentage of Klebsiella spp. bacteremia over the years, range from 19 to 35% (Figure 1). The antimicrobial sensitivity pattern changed significantly over years (Figure 2). Resistance was lowest against imipenem in 2010 around 1% which increased to 20%. There is a gradual rise in Klebsiella bacteremia in dialysis unit. Resistance to broad-spectrum antimicrobials has been increased significantly with a 20-fold increase in imipenem resistance over the last 6 years. We need a robust stewardship program for judicious use of antimicrobials and better infection control measures to contain increasing resistance. Frequency of Klebsiella spp. bacteremia in percentages in hemodialysis unit over 6 years Pattern of Klebsiella spp. bacteremia resistance in % over 6 years All authors: No reported disclosures.