Iranian Journal of Public Health 2018. 47(3):317-326.

Prevalence of Drug-resistant Klebsiella pneumoniae in Iran: A Review Article
Mohsen HEIDARY, Mohammad Javad NASIRI, Hossein DABIRI, Samira TARASHI



Background: The infections caused by drug resistant strains of Klebsiella pneumoniae are becoming an important health problem worldwide. There are several reports on antimicrobial resistant status of K. pneumoniae in Iran. However, a comprehensive analysis on drug-resistant K. pneumoniae from different parts of Iran has not yet been performed.

Methods: The searches were done according to several English and Persian databases including PubMed, Scopus, Iranmedex, and SID to identify studies addressing antibiotic resistant K. pneumoniae in Iran from Jan 1998 to Nov 2014. Comprehensive Meta-Analysis (V2.2, Biostat) software was used to analyze the data.

Results: The incidence rate of imipenem and ceftazidime resistance in K. pneumoniae isolates was 3.2% (95% confidence interval [CI], 1.5-6.5) and 55.7% (95% CI, 46.9-64.1), respectively. The highest rate of resistance in isolates of K. pneumoniae was seen against ampicillin (82.2%), aztreonam (55.4%) and nitrofurantoin (54.5%).

Conclusion: There is a relatively high prevalence of drug resistant K. pneumoniae isolates in Iran. Thus, a high degree of awareness among physicians and microbiologists, active infection control committee, appropriate antimicrobial therapy, improvement of hygiene condition and monitoring of drug resistant isolates are urgently needed in order to better control the emergence and spread of drug-resistant K. pneumoniae isolates in hospital settings.




Klebsiella pneumoniae, Drug resistance, Iran

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Pages JM, Lavigne JP, Leflon Guibout V et al (2009). Efflux pump, the masked side of ß-Lactam resistance in Klebsiella pneumoniae clinical isolates. PLoS One, 4(3):e4817.

Heidary M, Goudarzi H, Hashemi A et al (2016). The prevalence of genes that encode quinolone resistance in Klebsiella pneumoniae strains isolated from hospitalized patients during 2013-2014. Arch Pediatr Infect Dis, (In press).

Heidary M, Bahramian A, Goudarzi H et al (2016). To study the association between AcrAB and Qep A efflux pumps and ciprofloxacin resistance among Escherichia coli and Klebsiella pneumoniae clinical strains. Arak Med Univ J, 19(4):1-0.

World Health Organization (2014). Antimicrobial resistance: global report on surveillance.

Vardakas KZ, Matthaiou DK, Falagas ME et al (2015). Characteristics, risk factors and outcomes of carbapenem resistant Klebsiella pneumoniae infections in the intensive care unit. J Infect, 70(6):592-9.

Maatallah M, Vading M, Kabir MH et al (2014). Klebsiella variicola is a frequent cause of bloodstream infection in the Stockholm area, and associated with higher mortality compared to K. pneumoniae. PLoS One, 9(11):e113539.

Mouloudi E, Massa E, Piperidou M et al (2014). Tigecycline for treatment of carbapenem-resistant Klebsiella pneumoniae infections after liver transplantation in the intensive care unit: a 3-year study. Transplant Proc, 46(9):3219-21.

Siddiqui NU, Qamar FN, Jurair H, Haque A (2014). Multi-drug resistant gram negative infections and use of intravenous polymyxin B in critically ill children of developing country: retrospective cohort study. BMC Infect Dis, 14:626.

Matsumura Y, Tanaka M, Yamamoto M et al (2015). High prevalence of carbapenem resistance among plasmid-mediated AmpC β-lactamase-producing Klebsiella pneumoniae during outbreaks in liver transplantation units. Int J Antimicrob Agents, 45(1):33-40.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med, 151(4):264-9.

Nasiri MJ, Dabiri H, Darban-Sarokhalil D et al (2014). Prevalence of drug-resistant tuberculosis in Iran: Systematic review and meta-analysis. Am J Infect Control, 42(11):1212-8.

Feizabadi MM, Etemadi G, Rahmati M et al (2007). Antibiotic resistance patterns and genetic analysis of Klebsiella pneumoniae isolates from the respiratory tract. Tanaffos, 6(3):20-25.

Etemadi G, Sadeghian S, Amirkhani A et al (2005). Drug resistance patterns and prevalence of extended spectrum betalactamase producers among isolates of Klebsiella pneumonia cultured from patients at Tehran hospitals during 2003-2004. Tehran Univ Med J, 63(7):543-50.

Nematzadeh S, Shahcheraghi F, Feizabadi MM et al (2011). Molecular characterization of CTX-M β-lactamases among Klebsiella pneumoniae isolated from patients at Tehran hospitals. Indian J Med Microbiol, 29(3):254-7.

Mohammadimehr M, Feizabadi M, Bahadori A (2011). Antibiotic resistance pattern of gram negative bacilli caused nosocomial infections in ICUs in khanevadeh and golestan hospital in Tehran-2007. J Army Univ, 8(4):283-90.

Aminzadeh Z, Kashi MS, Sha’bani M (2008). Bacteriuria by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Iran J Kidney Dis, 2(4):197-200.

Mohammadimehr M, Feizabadi MM, Bahadori O et al (2009). Study of prevalence of gram- negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007. Iran J Med Microbiol, 3(2):47-54.

Feizabadi MM, Delfani S, Raji N et al (2010). Distribution of bla TEM, bla SHV, bla CTX-M genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad Hospital, Tehran, Iran. Microb Drug Resist, 16(1):49-53.

Moghaddam MM, Barjini KA, Ramandi MF, Amani J (2014). Investigation of the antibacterial activity of a short cationic peptide against multidrug-resistant Klebsiella pneumoniae and Salmonella typhimurium strains and its cytotoxicity on eukaryotic cells. World J Microbiol Biotechnol, 30(5):1533-40.

Shahcheraghi F, Nobari S, Rahmati Ghezelgeh F et al (2013). First report of New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae in Iran. Microb Drug Resist, 19(1):30-6.

Hashemi A, Fallah F, Erfanimanesh S et al (2014). Detection of β-lactamases and outer membrane porins among Klebsiella pneumoniae strains isolated in Iran. Scientifica, 2014:726179.

Rajabi Z, Akbari N, Mardane J, Soltan DM (2012). Antibiotic susceptibility of the strains isolated from blood and urinary tract infections in neonatal intensive care units of Imam Hossein Hospital. Microb Biotechnol, 4(12):53-9.

Jalalpoor S, Mobasherizadeh S (2011). Frequency of ESBLs in Escherichia coli and Klebsella pneumoniae strains isolated from hospitalized and out-patients with urinary tract infection in selective centers in Esfahan (2009-2010). Razi J Med Sci, 18(85):7-16.

Soltani R, Ehsanpoor M, Khorvash F, Shokri D (2014). Antimicrobial susceptibility pattern of extended-spectrum β-lactamase-producing bacteria causing nosocomial urinary tract in-fections in an Iranian referral teaching hospital. J Res Pharm Pract, 3(1):6-11.

Jalalpoor S (2011). Antibiotic resistant pattern in ESBLs producer Klebsiella pneumoniae strains isolated of hospitalized and out patients acquired urinary tract infection. J Isfahan Med Sch, 29(142): 695-705.

Karami M, Amirmozafari N, Doudi M (2013). Effects of silver nanoparticles on ESBL-producing Klebsiellae. Qom Univ Med Sci J, 7(3):28-34.

Archin T, Afzalian E, Kargar M, Ghasemi Y (2014). Molecular identification of SHV, TEM, CTX-M β-lactamases genes and antibiotics resistance pattern of K.peneumoniae isolates collected from ICU patients of Namazi Hospital, Shiraz, Iran. Armaghane Danesh, 18(10): 816-25.

Pirouzi A, Jafari M, Kargar M et al R (2012). Molecular detection of simultaneous occurrence of antibiotic-and heavy metal-resistance in Klebsiella pneumoniae isolated from urinary tract infection. J Isfahan Med Sch, 30(186): 1-12

Ghasemi Y, Archin T, Kargar M, Mohkam M (2013). A simple multiplex PCR for assessing prevalence of extended-spectrum β-lactamases producing Klebsiella pneumoniae in intensive care units of a referral hospital in Shiraz, Iran. Asian Pac J Trop Med, 6(9):703-8.

Mobasher Kare Jeddi A, Nahaei M et al (2009). Molecular study of extended-spectrum beta-lactamase (SHVtype) in Esherichia coli and Klebsiella pneumonia isolated from medical centers of Tabriz. Iran J Med Microbiol, 2(3-4):9-17.

Langari ZM, Ahangarzade RM, Aghazade M, Hasani A (2010). Comparison the prevalence of multidrug-resistant Klebsiella pneumoniae in adults and children with urinary tract infection. J Animal Physiol Develop, 4(1): 9-17.

Irajian G, Jazayeri Moghadas A (2010). Frequency of extended-spectrum beta lactamase positive and multidrug resistance pattern in Gram-negative urinary isolates, Semnan, Iran. Jundishapur J Microbiol, 3(3):107-13.

Moghadas AJ (2009). Prevalence of extended-spectrum beta lactamase positive and multidrug resistance pattern of Escherichia coli and Klebsiella pneumoniae isolates, Semnan, Iran. Iran J Microbiol, 1(1):49-53.

Mansouri S, Neyestanaki DK, Shokoohi M et al (2014). Characterization of AmpC, CTX-M and MBLs types of β-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli producing extended spectrum β-lactamases in Kerman, Iran. Jundishapur J Microbiol, 7(2): e8756.

Rahbar M, Gra Agaji R, Hashemi S (2005). Nosocomial blood stream infections in Imam Khomeini Hospital, Urmia, Islamic Republic of Iran, 1999-2001. East Mediterr Health J, 11(3):478-84.

Hashemizadeh FS, Zamanzad B, Jahandideh S et al (2013). Identification of KPC-producing Klebsiella pneumoniae in clinical samples in Iran. Yafteh, 15(1):105-14.

Mashouf RY, Alijani P, Saidijam M et al (2013). Study of antibiotic resistance pattern and phenotypic detection of ESBLs in Klebsiella pneumoniae strains isolated from clinical samples and determination of minimum inhibitory concentrations of imipenem and ceftazidim antibiotics. Sci J Hamadan Univ Med Sci, 20(4): 295-302.

Mashouf RY, Babalhavaeji H, Yousef J (2009). Urinary tract infections: bacteriology and antibiotic resistance patterns. Indian Pediatr, 46(7):617-20.

Van der Steen M, Leenstra T, Kluytmans JA et al (2015). Trends in expanded-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae among dutch clinical isolates, from 2008 to 2012. PLoS One,10(9):e0138088.

Ji S, Lv F, Du X et al (2015). Cefepime com-bined with amoxicillin/clavulanic acid: a new choice for the KPC-producing K. pneumoniae infection. Int J Infect Dis, 38:108-14.

Joseph NM, Bhanupriya B, Shewade DG, Harish BN (2015). Relationship between antimicrobial consumption and the incidence of antimicrobial resistance in Escherichia coli and Klebsiella pneumoniae isolates. J Clin Diagn Res, 9(2):DC08-12.

Zhang Y, Ma Y, Ye L et al (2014). Prevalence and antimicrobial susceptibility of hypervirulent Klebsiella pneumoniae isolates in China. Clin Infect Dis, 58(10):1493-94.


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