Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

Abstract

Background Early detection and proper management of maternal sepsis caused by multidrug-resistant K. pneumoniae can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia. Methods A prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated on the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of < 0.05 was statistically significant. Results Of the 5613 total women suspected of having maternal sepsis, 609 (10.8%) were found to be infected with K. pneumoniae. Among them, 31.5% of K. pneumoniae isolates produced carbapenemase, while 93.0% were ESBL-producing strains. 93.9% of the strains were MDR, 24.3% were XDR, and 10.9% were PDR strains. 100% isolates were resistant to 3rd generation cephalosporins. However, they exhibited susceptibility to amikacin (83.6%), tigecycline (70.9%), and carbapenem (68.5%). Combined therapy using carbapenem with either amikacin or tigecycline, has shown positive outcomes against carbapenem-resistant strains. Regarding sepsis risk factors, septic abortion[AOR = 5.3;95%CI:2.2–14.4]; extended hospitalization[AOR = 3.7; 95%CI: 1.6–19.4]; dilatation and curettage[AOR = 2.2;95%CI:1.3–13.4]; caesarean wound infection [AOR = 4.1,95%CI:2.0–9.2]; indwelling catheterization[AOR = 2.1, 95%CI: 1.4–6.2]; ICU admission[AOR = 4.3;95%CI:2.4–11.2]; post abortion[AOR = 9.8,95%CI:5.7–16.3]; and recurrent UTI[AOR = 3.3, 95%CI: 1.6–13.2] were significantly associated with maternal sepsis caused by K. pneumoniae. Conclusions Maternal sepsis caused by carbapenemase-/ESBL-producing K. pneumoniae leads to severe maternal morbidity that may result in disability or mortality. Therefore, improving awareness, early diagnosis, person-centered care, IPC measures, integrated surveillance, and efficient antimicrobial stewardship are crucial for preventing maternal sepsis.