Resistance mechanisms, control strategies and outbreak management in Klebsiella pneumoniae

Klebsiella ( K. ) pneumoniae is a major reason of multidrug-resistant infections worldwide. The Enterobacterales that produce β-lactamases represent significant sources of infections within healthcare environments. This prevalence can be attributed to the challenges they pose in treatment, their high potential for transmission, and their substantial economic and personal impact. Recent studies highlight the emergence of multidrug-resistant K. pneumoniae strains which show resistance to colistin, a lastline antibiotic, arising from mutational inactivation of the mgrB regulatory gene. The bacteria of greatest clinical relevance are those with resistance to third and fourth generation cephalosporins, extended spectrum β-lactamases and ampicillin-cephalosporin. Carbapenems represent a category of antibiotics that remain one of the limited options for addressing infections caused by multi-drug resistant pathogens. Typically, these antibiotics are reserved as a final solution when other therapies prove ineffective. Nevertheless, the rising prevalence of carbapenem-resistant bacteria presents a considerable obstacle to their efficacy. Continuous monitoring and the advancement of alternative therapeutic strategies are essential to tackle the escalating challenge of antibiotic resistance. However, the rise of carbapenem-resistant Enterobacterales poses significant health challenges. Notably, K. pneumoniae , a pan-resistant bacterium, is associated with high morbidity rates, particularly in public health settings. This study reviews the various aspects of antibacterial resistance, focusing on the genes present in the genome of K. pneumoniae and the mechanisms through which it develops resistance. Through the analysis of these factors, we intend to highlight the escalating threat posed by antibiotic resistance and the urgent requirement for effective measures to counteract it. Surveillance and diagnostics are vital for controlling outbreaks as they enable early detection of diseases, allowing for timely interventions to prevent further spread. Accurate laboratory diagnostics are essential for confirming cases and informing public health responses, thereby ensuring the effective allocation of resources during an outbreak. In this work, we have carried out a review on the antibacterial resistance antibiotics, genes found in its genome, as well as the resistance mechanisms involved. Finally, we focus on the main outbreaks causing hospital acquired infections during the last few years.