Characterization and Clinical Implications of Multidrug-Resistant Klebsiella pneumoniae in ICU Patients in India: A Comprehensive Review

Multidrug-resistant (MDR) Klebsiella pneumoniae has become a prominent cause of healthcare-associated infections, especially in Intensive Care Units (ICUs), constituting a major threat to patient outcomes and healthcare systems. This review examines the epidemiology, risk factors, mechanisms of antimicrobial resistance, virulence determinants, clinical manifestations, treatment approaches, infection control measures, and future perspectives of MDR K. pneumoniae, with particular emphasis on the Indian context. The rising incidence of carbapenem-resistant and hypervirulent strains has severely restricted available therapeutic choices, leading to higher mortality rates, prolonged hospital stays, and increased healthcare costs. Resistance is largely driven by mechanisms such as extended-spectrum β-lactamase (ESBL) and carbapenemase production, along with plasmid-mediated gene transfer, which facilitates rapid spread. Furthermore, virulence determinants such as capsule production, siderophore systems, and biofilm formation contribute to increased pathogenicity. Treatment remains difficult because of the scarcity of effective antibiotics, often requiring combination therapies and the investigation of novel treatment modalities. Reinforcing infection control practices, antimicrobial stewardship, and surveillance systems is crucial to curb the spread of MDR strains. Additionally, emerging approaches such as rapid diagnostic tools, genomic surveillance, and artificial intelligence-based predictive models offer potential for early detection and improved clinical outcomes.