The frequency and pattern of antibiotic resistance among Klebsiella spp. isolated from nosocomial infection in Khorramabad hospital

Document Type : Original Article


1 Master of sciences in Microbiology, Islamic Azad university Ashkezar branch, Ashkezar, Iran

2 Assistant professor, Infectious disease specialists, Lorestan university of Medical sciences, Khorramabad, Iran

3 Associate professor, Infectious disease specialists, Lorestan university of Medical sciences, Khorramabad, Iran

4 Ph.D. in Microbiology, Department of Biology, Islamic Azad university Ashkezar branch, Ashkezar, Iran


Introduction: Nosocomial infections are primarily caused by Klebsiella bacteria, which lead to an increase in healthcare costs and the mortality rate. Concerning the alarming increased antibiotic resistance of Klebsiella species, the purpose of this study was to compare the frequency and determine the antibiotic resistance pattern of Klebsiella species isolated from nosocomial infections using Kirby Bauer method.
Methods: This study was done on 80 specimens of Klebsiella isolates from 480 hospitalized patients in three different units of Khorramabad Shohadaye Ashayer hospital. After determining the bacterial species, antibiotic-resistance test of Klebsiella species was performed for 15 antibiotics using the disk diffusion method. The results were recorded based on Clinical and Laboratory Standards Institute (CLSI) standard guidelines.
Results: The frequency rates of Klebsiella species were determined as follows: Klebsiella pneumoniae (91%), Klebsiella oxytoca (5%), Klebsiella rhinoscleromatis (3%), and Klebsiella ozaenae (1%). The frequency of Klebsiella species on the basis of sources of infection and type of sample respectively were: urine (42%), lung and sputum (36%), wound (15%), blood (6%), and cerebro-spinal fluid (CSF) (1%). The resistance of all Klebsiella species to studied antibiotics were respectively as follows: ceftriaxone (92%), ciprofloxacin (82%), nitrofurantoin (80%), ofloxacin (75%), cefotaxime (70%), imipenem (67%), ticarcillin (66%), nalidixic acid (60%), gentamicin (52%), azithromycin (40%), cefepime (31%), polymyxin B (22%), colistin (17%), amikacin (7%), and meropenem (1%).
Conclusion: According to the obtained results, meropenem and amikacin with the lowest resistance are the most effective antibiotics against all Klebsiella strains, and although ceftriaxone antibiotic does not help in the treatment of Klebsiella infections, but it may cause antibiotic resistance.


1. Jain A, Singh K. Recent advances in the management of nosocomial infection. Journal of Medical Education and Research (JK Sciences) 2007; 9(1): 3-8.
2. Shaikh JM, Devrajani BR, Shah SZ, Akhund T, Bibi I. Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital. J Ayub Med Coll Abbottabad 2008; 20(4): 37-40.
3. Bereket W, Hemalatha K, Getenet B, Wondwossen T, Solomon A, Zeynudin A, et al. Update on bacterial nosocomial infections. Eur Rev Med Pharmacol Sci 2012; 16(8): 1039-44.
4. Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41(6): 848-54.
5. Ullah F, Malik SA, Ahmed J. Antimicrobial susceptibility pattern and ESBL prevalence in Klebsiella pneumoniae from urinary tract infections in the North-West of Pakistan. Afr J Microbiol Res 2009; 3(11): 676-80.
6. Siri GP, Sithebe NP, Ateba CN. Identification of Klebsiella species isolated from modimola dam (Mafikeng) north west province-south Africa. Afr J Microbiol Res 2011; 5(23): 3958-63.
7. Brooks GF. Enteric gram-negative rods (Enterobacteriaceae). In: Brooks GF, Butel GS, Morse SA, editors. Jawetz, Melnick, & Adelberg’s Medical Microbiology. 23th ed. USA: McGraw-Hill; 2004. p. 248-61.
8. Sikarwar AS, Batra HV. Challenge to health care: multidrug resistance in Klebsiella pneumoniae.
International Proceeding of Chemical, Biological and Enviromental Engineering 2012; 9: 130-4.
9. Donnenberg MS. Enterobacteriaceae. Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pennsylvania: Churchill Livingstone Elsevier; 2010. p. 218.
10. Karamoddini MK, Fazli-Bazzaz BS, Emamipour F, Ghannad MS, Jahanshahi AR, Saed N, et al. Antimicrobial efficacy of lytic bacteriophages against antibiotic-resistant Klebsiella species. Scientific World Journal 2011; 11: 1332-40.
11. Sikarwar AS, Batra HV. Prevalence of antimicrobial drug resistance of Klebsiella pneumoniae in India. International Journal of Bioscience, Biochemistry and Bioinfoormatics 2010; 1(3): 211-5.
12. Romanus II, Egwu OA, Ngozi AT, Chidiebube NA, Chika EP. Extended spectrum beta-lactamase(ESBL) mediated resistance to antibiotics among Klebsiella pneumoniae in Enugu Metropolis. Maced J Med Sci 2009; 2(3): 196-9.
13. Comandatore F, Sassera D, Ambretti S, Landini MP, Daffonchio D, Marone P, et al. Draft genome sequences of two multidrug resistant Klebsiella pneumoniae ST258 isolates resistant to colistin. Genome Announc 2013; 1(1): 1-2.
14. Chen H, Yuehua X, Shen W, Zhou H, Zhou L, Li Z. Epidemiology and resistance mechanisms to imipenem in Klebsiella pneumoniae: a multicenter study. Mol Med Rep 2013; 7(1): 21-5.
15. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and Pathogenicity Factors. Clin Microbiol Rev 1998; 11(4): 589-603.
16. Soltan Dalal MM, Miremadi SA, Sharify Yazdi MK, Rastegar Lari A, Rajabi Z, Yans SA. Antimicrobial resistance trends of Klebsiella spp. isolated from patients in Imam Khomeini hospital. Payavard Salamat Journal 2012; 6(4): 275-81. [In Persian]
17. Langarizadeh N, Ahangarzadeh Rezaee M, Aghazadeh M, Hasani A. Prevalence of multi-drug resistant (MDR) klebsiella pneumoniae among children and adults with urinary tract infection referred to Tabriz teaching hospitals. Quarterly Journal of Biological Sciences 2010; 4(1): 9-17. [In Persian]
18. Mohammadimehr M, Feizabadi MM, Bahadori A. Antibiotic resistance pattern of gram negative bacilli caused nosocomial infections in ICUs in Khanevadeh and Golestan hospital in Tehran -2007. Annals of Military And Health Sciences Research 2011; 8(4): 283-90. [In Persian]
19. Al-Shara M. A 5 year (2005-2009) review of antimicrobial susceptibility of clinical Klebsiella pneumoniae isolates from pediatric patients in Jordan. Al Ameen J Med Sci 2013; 6(4): 316-9.
20. Amin A, Ghumro P, Hussain S, Hameed A. Prevalence of antibiotic resistance among clinical isolates of Klebsiella pneumoniae isolated from a Tertiary Care Hospital in Pakistan. Malaysian Journal of Microbiology 2009; 5(2): 81-6.
21. Saeidynia F, Keihanian F, Saeidynia A. Antibiotic resistance in blood culture samples from patients referred to Razi Laboratory of Rasht, 2006-2011. Advances in Infectious Diseases 2014; 4: 165-72. [In Persian]
22. Shajari G, Khorshid AI, Moosavi G. Bacterial isolation and antibiotic resistance of nosocomial pneumonia in hospitalaized patients - Kashan Iran.Journal of Hormozgan University of Medical Sciences 2009; 13(3): 197-205. [In Persian]
23. Sarathbabu R, Ramani TV, Bhaskara rao K, Panda S. Antibiotic susceptibility pattern of Klebsiella pneumoniae isolated from sputum, urine and pus samples. Journal of Pharmacy and Biological Sciences 2012; 1(2): 04-09.
24. Olajide FA, Ameh JA, Simon MK. Antibiotic resistance and susceptibility pattern/profile of Staphylococcus aureus and Klebsiella species to popularly – used and readily available antibiotics in Zaria, Nigeria. Journal of Phytotherapy and Pharmacology 2012; 1(4): 16-21.