Phenotypic profile of multi-drug-resistant Klebsiella spp. isolated from urinary tract and wound infections in Togo

Antimicrobial resistance (AMR) is a growing global health threat, particularly in sub-Saharan Africa. Klebsiella spp., as opportunistic pathogens, are commonly associated with urinary tract and wound infections, with an increasing prevalence of MDR and ESBL-producing strains. This study aimed to characterize the phenotypic antimicrobial resistance patterns of Klebsiella spp. isolates in Togo and to evaluate the extent of multidrug resistance using the multiple antibiotic resistance (MAR) index. A multicenter cross-sectional study was conducted between October 2024 and June 2025, including 409 clinical isolates obtained from urine and wound samples across major healthcare facilities nationwide. Identification was performed using standard microbiological methods, complemented by API 20E and VITEK 2 systems where required. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and interpreted according to the Clinical and Laboratory Standards Institute (CLSI) M100 (2024) guidelines. ESBL production was assessed using the Double-Disk Synergy Test (DDST), and MAR index were calculated. Urinary isolates accounted for 80.2% of cases, with a slight female predominance (51.6%). Klebsiella pneumoniae subsp. pneumoniae was the most prevalent species (76.5%), followed by Klebsiella oxytoca (15.1%). Overall, 92.4% of isolates were MDR and 7.6% XDR. High resistance rates were observed for cephalosporins (85.8%), fluoroquinolones (81.4%), and sulfonamides (79.7%), while carbapenems and amikacin remained largely susceptible (< 6%). ESBL production was identified in 38.1% of isolates. The mean MAR index (0.258 ± 0.123) exceeded the critical threshold in most cases. These findings highlight a high AMR burden and the urgent need for strengthened surveillance and antimicrobial stewardship in Togo.