Resistance to third generation cephalosporins in Klebsiella pneumoniae: a five years multicentric Tunisian study (1999–2003)

Abstract number: 1134_04_211

Boutiba-Ben Boubaker I., Saidani M., Mahjoubi F., Smaoui H., Achour W., Ben Hassen A., Kéchrid A., Hammami A., Ben Redjeb S.

Objective:  

The massive use of third generation cephalosporins (3rdGC) was subsequently followed by a marked increase in their resistance incidence. Klebsiella pneumoniae is the most common Gram negative bacteria exhibiting this resistance pattern. In order to assess the impact of resistance to 3rdGC, a multicentric study was carried out over a five years period (1999–2003), in 4 teaching hospitals.

Methods:  

Isolates were identified by Api 20E system and their antimicrobial susceptibility was determined by the disc- diffusion method in Mueller–Hinton agar with regular quality control. Data analysis was done using the Whonet 4 software

Results:  

Over the 6378 strains of K. pneumoniae collected, 34.1% were resistant to 3rd GC. Their annual rate has increased from 26.4% in 1999 to 38.9% in 2003 without difference between hospitals except for paediatric hospital in 1999 (65.2%). These isolates were recovered mainly from paediatrics (38.2%), Medicine (18.2%), urology (12.4%), intensive care units (11.7%) and surgery (10.2%). They were more frequently isolated from urines (49.7%), blood cultures (23.3%), and pus (13.3%). Associated resistance rates were as follows: 18.4% to cefoxitin, 88.3% to gentamicin, 62.5% to amikacin, 43.4% to chloramphenicol, 80.3% to trimethoprim–sulfamethoxazol and 40.6% to ciprofloxacin. All isolates were susceptible to imipenem.

Conclusion:  

The alarming rate of K. pneumoniae resistant to 3rdGC needs the implementation of infection control measures, hand washing and rational use of antibiotics.