Carbapenem-Resistant Klebsiella pneumoniae in Clinical Specimens at the University Teaching Hospital of Butare, Rwanda: Antimicrobial Resistance Profiles and Carbapenemase Genes.

Abstract

Klebsiella pneumoniae, a leading cause of health care-associated infections, increasingly exhibits multidrug-resistant phenotypes, including resistance to carbapenems, the last-resort antimicrobials, and thus compromises treatment options. However, there is a paucity of data on antimicrobial profiles and carbapenemase gene distribution in K. pneumoniae in Rwanda. A cross-sectional study was conducted from February 1 to June 30, 2025, at the University Teaching Hospital of Butare. One-hundred-fifty isolates were analyzed using traditional bacteriological identification with the API 20E system. Antimicrobial susceptibility was assessed by the modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute 2024 guidelines, and carbapenemase genes were detected through conventional polymerase chain reaction. Data were analyzed using descriptive and inferential statistical methods, and a P-value less than 0.05 was considered statistically significant. As a result, Klebsiella isolates exhibited high resistance rates to trimethoprim-sulfamethoxazole (78%), cefuroxime (71.3%), cefixime (72%), and ceftriaxone (66.7%). Moderate resistance to ciprofloxacin (30%) and amoxicillin-clavulanate (42.7%) was observed. In contrast, lower resistance to amikacin (9.3%), imipenem (12%), meropenem (13.3%), and ertapenem (14%) was observed. Of the Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates, 8 (38.1%) tested positive for the blaNDM gene, whereas none harbored the blaKPC gene. This study found a high resistance rate in K. pneumoniae to a widely used antibiotic and confirms the presence of blaNDM, highlighting the need for antimicrobial stewardship and strengthened local surveillance.