Clinical Profile, Antimicrobial Resistance and Molecular Detection of ESBL, MBL and Other Carbapenemase Genes in Klebsiella Species-UTI Isolates from Chronic Kidney Disease Patients: A Cross-sectional Study

Introduction: Urinary Tract Infections (UTIs) are a common yet serious medical condition that can impact individuals of all ages and genders. UTIs in Chronic Kidney Disease (CKD) patients lead to a low quality of life, and the situation becomes worse when the pathogens exhibit antibiotic resistance due to Extended Spectrum Beta-Lactamases (ESBLs), Metallo-BetaLactamases (MBLs), and Carbapenemase genes. Aim: To to evaluate the clinical profile, antibiotic resistance, and frequency of resistance genes in Klebsiella pneumoniae isolates from urine samples of suspected UTIs in CKD patients. Materials and Methods: This cross-sectional study was conducted at Yenepoya Medical College Hospital in Mangalore, Karnataka, India, from January 2023 to January 2024. A total of 138 Klebsiella spp. isolates were collected and included in the study. Antimicrobial susceptibility was assessed using the Vitek2 method. The production of MBL, carbapenemase, and ESBL was confirmed by tests described in the Clinical and Laboratory Standards Institute (CLSI) 2023 document, and genes were detected using multiplex Polymerase Chain Reaction (PCR). Statistical analyses were expressed as percentages for all quantitative data, and categorical variables were compared using Fisher’s exact test, with a p-value of <0.001 considered significant. Results: Among the study participants, 79 (57.25%) were male, and approximately 84 (60.87%) were over 50 years of age. About 46 (33.33%) patients had a history of recurrent UTIs and stage 1 renal impairment. A total of 85 (61.59%) of Klebsiella spp. isolates exhibited Multidrug Resistance (MDR). The maximum resistance was observed against ceftazidime and cefepime, while lower resistance was noted for amikacin, gentamicin, piperacillin-tazobactam, and trimethoprim-sulfamethoxazole. Eighteen of the MDR isolates (72%) carried β-lactamase genes, such as bla-SHV and bla-CTX-M. Additionally, 33 (82.5%) had bla-KPC, 21 (52.5%) had bla-IMP, and OXA genes (58, 23, 51, and 48) were found in 2 (2.8%) isolates each. Conclusion: The present study emphasises the significance of the co-occurrence of ESBL and carbapenemase-encoding genes in K. pneumoniae isolates implicated in UTIs among CKD patients, which could pose challenges for effective treatment options.