Authors:
Sofia Maraki Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece

Search for other papers by Sofia Maraki in
Current site
Google Scholar
PubMed
Close
https://orcid.org/0000-0003-0945-1732
,
Viktoria Eirini Mavromanolaki Department of Pediatrics, Agios Nikolaos General Hospital, Agios Nikolaos, 72100 Crete, Greece

Search for other papers by Viktoria Eirini Mavromanolaki in
Current site
Google Scholar
PubMed
Close
,
Dimitra Stafylaki Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece

Search for other papers by Dimitra Stafylaki in
Current site
Google Scholar
PubMed
Close
,
Evangelia Iliaki-Giannakoudaki Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece

Search for other papers by Evangelia Iliaki-Giannakoudaki in
Current site
Google Scholar
PubMed
Close
, and
Anna Kasimati Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Crete, Greece

Search for other papers by Anna Kasimati in
Current site
Google Scholar
PubMed
Close
Restricted access

Abstract

Klebsiella pneumoniae is one of the most prevalent bacteria causing urinary tract infections (UTIs). Its increasing resistance to a wide array of antibiotics limits available treatment options. This study investigated the characteristics and trends of antimicrobial resistance in K. pneumoniae isolated from UTIs in Crete, Greece, during 2017 and 2022. Among the 11,946 Enterobacteriaceae isolated from urine specimens, a total of 1,771 K. pneumoniae isolates were identified (14.8%), with an isolation frequency secondary to Escherichia coli (66.3%). K. pneumoniae isolates increased over the years, with a peak in the year 2022. Higher resistance rates were detected in ciprofloxacin (41%), trimethoprim/sulfamethoxazole (TMP/SMX) (38.1%) and nitrofurantoin (33.9%). Resistance to ciprofloxacin, amoxicillin/clavulanic acid, tigecycline, and TMP/SMX significantly increased from 33.7%, 24%, 6%, and 33.1%, respectively, over the years 2017–2019, to 47.8%, 34.2%, 14.3% and 42.8%, respectively, over the period 2020–2022. ESBL production and carbapenem resistance were decreased by 2.2% and 3.7%, respectively, over the two three-year periods (2017–2019 and 2020–2022). Among the 278 carbapenem-resistant K. pneumoniae (CRKP) isolates, 164 (59%), 66 (23.7%), 18 (6.5%) and 16 (5.8%) were positive for KPC, NDM, VIM and OXA-48 enzymes, respectively. Only 14 (5%) isolates harboured two carbapenemase genes, namely 10 (3.6%) both blaNDM and blaVIM, and 4 (1.4%) both blaKPC and blaNDM. Females, inpatients and the elderly were more frequently affected by CRKP. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) isolates were 32.6% and 7.7%, respectively. Continuous surveillance of local microbial prevalence and monitoring of antimicrobial resistance patterns provide critical information to guide the empiric therapy for UTIs and control the spread of MDR bacteria.

  • 1.

    Stamm WE, Norrby SR. Urinary tract infections: disease panorama and challenges. J Infect Dis (Suppl) 2001; 183: S1S4.

  • 2.

    Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol 2015; 13: 26984.

    • Search Google Scholar
    • Export Citation
  • 3.

    Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, economic costs. Am J Med 2002; 113: 513.

  • 4.

    Maslikowska JA, Walker SA, Elligsen M, Mittmann N, Palmay L, Daneman N, et al. Impact of infection with extended-spectrum β-lactamase-producing Escherichia coli or Klebsiella species on outcome and hospitalization costs. J Hosp Infect 2016; 92: 3341.

    • Search Google Scholar
    • Export Citation
  • 5.

    Vardakas KZ, Tansarli GS, Rafailidis PI, Falagas ME. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis. J Antimicrob Chemother 2012; 67: 2793803.

    • Search Google Scholar
    • Export Citation
  • 6.

    Tzouvelekis LS, Markogiannakis A, Psichogiou M, Tassios PT, Daikos GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 2012; 25: 682707.

    • Search Google Scholar
    • Export Citation
  • 7.

    Carattoli A. Plasmids and the spread of resistance. Int J Med Microbiol 2013; 303: 298304.

  • 8.

    Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2013; 13: 78596.

    • Search Google Scholar
    • Export Citation
  • 9.

    Centers for Disease Control and Prevention (CDC). Antimicrobial resistance threats report; 2019. Available from: https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf, Accessed 5 August 2022].

    • Search Google Scholar
    • Export Citation
  • 10.

    World Health Organization (WHO). Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics; 2017. Available from: http://www.who.int/medicines/publications/WHO-PPL-Short Summary_25Feb-ET_NM_WHO.pdf, Accessed 12 Dec 2021.

    • Search Google Scholar
    • Export Citation
  • 11.

    European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation for MICs and zone diameters: version 10.0, valid from 2020-01-01. EUCAST, Basel, Switzerland.

    • Search Google Scholar
    • Export Citation
  • 12.

    Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 32th ed. (M100-Ed32).

  • 13.

    Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 26881.

    • Search Google Scholar
    • Export Citation
  • 14.

    Poulou A, Grivakou E, Vrioni G, Koumaki V, Pittaras T, Pournaras S, et al. Modified CLSI extended-spectrum β-lactamase (ESBL) confirmatory test for phenotypic detection of ESBLs among Enterobacteriaceae producing various β-lactamases. J Clin Microbiol 2014; 52: 14839.

    • Search Google Scholar
    • Export Citation
  • 15.

    Tsakris A, Poulou A, Pournaras S, Voulgari E, Vrioni G, Themeli-Digalaki K, et al. A simple phenotypic method for the differentiation of metallo-beta-lactamases and class A KPC carbapenemases in Enterobacteriaceae clinical isolates. J Antimicrob Chemother 2010; 65: 166471.

    • Search Google Scholar
    • Export Citation
  • 16.

    Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis 2011; 70: 11923.

    • Search Google Scholar
    • Export Citation
  • 17.

    Czajkowski K, Broś-Konopielko M, Teliga-Czajkowska J. Urinary tract infection in women. Prz Menopauzalny 2021; 20: 407.

  • 18.

    Odoki M, Almustapha Aliero A, Tibyangye J, Nyabayo Maniga J, Wampande E, Drago Kato C, et al. Prevalence of bacterial urinary tract infections and associated factors among patients attending hospitals in Bushenyi District, Uganda. Int J Microbiol 2019; 2019: 4246780.

    • Search Google Scholar
    • Export Citation
  • 19.

    Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol 2019; 11: 1756287219832172.

    • Search Google Scholar
    • Export Citation
  • 20.

    Jalil MB, Al Atbee MYN. The prevalence of multiple drug resistance Escherichia coli and Klebsiella pneumoniae isolated from patients with urinary tract infections. J Clin Lab Anal 2022; 36: e24619.

    • Search Google Scholar
    • Export Citation
  • 21.

    Cortes-Penfield NW, Trautner BW, Jump RLP. Urinary tract infection and asympto-matic bacteriuria in older adults. Infect Dis Clin North Am 2017; 31: 67388.

    • Search Google Scholar
    • Export Citation
  • 22.

    Mohd Asri NA, Ahmad S, Mohamud R, Mohd Hanafi N, Mohd Zaidi NF, Irekeola AA, et al. Global Prevalence of nosocomial multidrug-resistant Klebsiella pneumoniae: a systematic review and meta-analysis. Antibiotics (Basel) 2021; 10: 1508.

    • Search Google Scholar
    • Export Citation
  • 23.

    Jalal NA, Al-Ghamdi AM, Momenah AM, Ashgar SS, Bantun F, Bahwerth FS, et al. Prevalence and antibiogram pattern of Klebsiella pneumoniae in a tertiary care hospital in Makkah, Saudi Arabia: an 11-year experience. Antibiotics (Basel) 2023; 12: 164.

    • Search Google Scholar
    • Export Citation
  • 24.

    Dhillon RH, Clark J. ESBLs: a clear and present danger? Crit Care Res Pract 2012; 2012: 625170.

  • 25.

    Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach D. A review of ten years of the study for monitoring antimicrobial resistance trends (SMART) from 2002 to 2011. Pharmaceuticals (Basel) 2013; 6: 133546.

    • Search Google Scholar
    • Export Citation
  • 26.

    Altamimi I, Binkhamis K, Alhumimidi A, Alabdulkarim IM, Almugren A, Alhemsi H, et al. Decline in ESBL production and carbapenem resistance in urinary tract infections among key bacterial species during the COVID-19 pandemic. Antibiotics (Basel) 2024; 13: 216.

    • Search Google Scholar
    • Export Citation
  • 27.

    Gutiérrez-Gutiérrez B, Rodríguez-Baño J. Current options for the treatment of infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect 2019; 25: 93242.

    • Search Google Scholar
    • Export Citation
  • 28.

    Karaiskos I, Galani I, Papoutsaki V, Galani L, Giamarellou H. Carbapenemase producing Klebsiella pneumoniae: implication on future therapeutic strategies. Expert Rev Anti Infect Ther 2022; 20: 5369.

    • Search Google Scholar
    • Export Citation
  • 29.

    Rodriguez-Gómez J, Pérez-Nadales E, Gutiérrez-Gutiérrez B, Machuca I, Martinez-Martinez L, Rivera F, et al. Prognosis of urinary tract infection caused by KPC-producing Klebsiella pneumoniae: the impact of inappropriate empirical treatment. J Infect 2019; 79: 24552.

    • Search Google Scholar
    • Export Citation
  • 30.

    Çölkesen F, Tarakçı A, Eroğlu E, Kacar F, Özdemir Armağan Ş, Can S, et al. Carbapenem-Resistant Klebsiella pneumoniae infection and its risk factors in older adult patients. Clin Interv Aging 2023; 18: 103745.

    • Search Google Scholar
    • Export Citation
  • 31.

    Mareș C, Petca RC, Petca A, Popescu RI, Jinga V. Does the COVID pandemic modify the antibiotic resistance of uropathogens in female patients? A New storm? Antibiot (Basel) 2022; 11: 376.

    • Search Google Scholar
    • Export Citation
  • 32.

    Miftode IL, Nastase EV, Miftode , Miftode EG, Iancu LS, Luncă C, et al. Insights into multidrug-resistant K. pneumoniae urinary tract infections: from susceptibility to mortality. Exp Ther Med 2021; 22: 1086.

    • Search Google Scholar
    • Export Citation
  • 33.

    Eshetie S, Unakal C, Gelaw A, Ayelign B, Endris M, Moges F. Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia. Antimicrob Resist Infect Control 2015; 4: 12.

    • Search Google Scholar
    • Export Citation
  • 34.

    Dromigny JA, Ndoye B, Macondo EA, Nabeth P, Siby T, Perrier-Gros-Claude JD. Increasing prevalence of antimicrobial resistance among Enterobacteriaceae uropathogens in Dakar, Senegal: a multicenter study. Diagn Microbiol Infect Dis 2003; 47: 595600.

    • Search Google Scholar
    • Export Citation
  • 35.

    Thakur SPN, Sharma M. Prevalence of multidrug resistant Enterobacteriaceae and extended spectrum β-lactamase producing Escherichia coli in urinary tract infection. Res J Pharm Biol Chem Sci 2013; 4: 1615.

    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand
The author instructions are available in PDF.
Please, download the file from HERE

 

Senior editors

Editor-in-Chief: Prof. Dóra Szabó (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Managing Editor: Dr. Béla Kocsis (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Co-editor: Dr. Andrea Horváth (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)

Editorial Board

  • Prof. Éva ÁDÁM (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Sebastian AMYES (Department of Medical Microbiology, University of Edinburgh, Edinburgh, UK.)
  • Dr. Katalin BURIÁN (Institute of Clinical Microbiology University of Szeged, Szeged, Hungary; Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary.)
  • Dr. Orsolya DOBAY (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Ildikó Rita DUNAY (Institute of Inflammation and Neurodegeneration, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany; Center for Behavioral Brain Sciences (CBBS), Magdeburg, Germany)
  • Prof. Levente EMŐDY(Department of Medical Microbiology and Immunology, University of Pécs, Pécs, Hungary.)
  • Prof. Anna ERDEI (Department of Immunology, Eötvös Loránd University, Budapest, Hungary, MTA-ELTE Immunology Research Group, Eötvös Loránd University, Budapest, Hungary.)
  • Prof. Éva Mária FENYŐ (Division of Medical Microbiology, University of Lund, Lund, Sweden)
  • Prof. László FODOR (Department of Microbiology and Infectious Diseases, University of Veterinary Medicine, Budapest, Hungary)
  • Prof. József KÓNYA (Department of Medical Microbiology, University of Debrecen, Debrecen, Hungary)
  • Prof. Yvette MÁNDI (Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary)
  • Prof. Károly MÁRIALIGETI (Department of Microbiology, Eötvös Loránd University, Budapest, Hungary)
  • Prof. János MINÁROVITS (Department of Oral Biology and Experimental Dental Research, University of Szeged, Szeged, Hungary)
  • Prof. Béla NAGY (Centre for Agricultural Research, Institute for Veterinary Medical Research, Budapest, Hungary.)
  • Prof. István NÁSZ (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Kristóf NÉKÁM (Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary.)
  • Dr. Eszter OSTORHÁZI (Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary)
  • Prof. Rozália PUSZTAI (Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary)
  • Prof. Peter L. RÁDY (Department of Dermatology, University of Texas, Houston, Texas, USA)
  • Prof. Éva RAJNAVÖLGYI (Department of Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary)
  • Prof. Ferenc ROZGONYI (Institute of Laboratory Medicine, Semmelweis University, Budapest, Hungary)
  • Prof. Joseph G. SINKOVICS (The Cancer Institute, St. Joseph’s Hospital, Tampa, Florida, USA)
  • Prof. Júlia SZEKERES (Department of Medical Biology, University of Pécs, Pécs, Hungary.)
  • Prof. Mária TAKÁCS (National Reference Laboratory for Viral Zoonoses, National Public Health Center, Budapest, Hungary.)
  • Prof. Edit URBÁN (Department of Medical Microbiology and Immunology University of Pécs, Pécs, Hungary; Institute of Translational Medicine, University of Pécs, Pécs, Hungary.)

 

Editorial Office:
Akadémiai Kiadó Zrt.
Budafoki út 187-187, A/3, H-1117 Budapest, Hungary

Editorial Correspondence:
Acta Microbiologica et Immunologica Hungarica
Institute of Medical Microbiology
Semmelweis University
P.O. Box 370
H-1445 Budapest, Hungary
Phone: + 36 1 459 1500 ext. 56101
Fax: (36 1) 210 2959
E-mail: amih@med.semmelweis-univ.hu

 Indexing and Abstracting Services:

  • Biological Abstracts
  • BIOSIS Previews
  • CAB Abstracts
  • CABELLS Journalytics
  • Chemical Abstracts
  • Global Health
  • Index Medicus
  • Index Veterinarius
  • Medline
  • Referativnyi Zhurnal
  • SCOPUS
  • Science Citation Index Expanded

2022  
Web of Science  
Total Cites
WoS
689
Journal Impact Factor 1.5
Rank by Impact Factor

Immunology (Q4)
Microbiology (Q4)

Impact Factor
without
Journal Self Cites
1.3
5 Year
Impact Factor
1.7
Journal Citation Indicator 0.34
Rank by Journal Citation Indicator

Immunology (Q4)
Microbiology (Q4)

Scimago  
Scimago
H-index
31
Scimago
Journal Rank
0.333
Scimago Quartile Score

Immunology and Microbiology (miscellaneous) (Q3)
Infectious Diseases (Q3)
Medicine (miscellaneous) (Q3)
Microbiology (medical) (Q3)

Scopus  
Scopus
Cite Score
2.8
Scopus
CIte Score Rank
General Immunology and Microbiology 29/53 (46th PCTL)
Infectious Diseases 186/304 (38th PCTL)
Microbiology 85/124 (31st PCTL)
Scopus
SNIP
0.484

2021  
Web of Science  
Total Cites
WoS
696
Journal Impact Factor 2,298
Rank by Impact Factor Immunology 141/161
Microbiology 118/136
Impact Factor
without
Journal Self Cites
2,143
5 Year
Impact Factor
1,925
Journal Citation Indicator 0,39
Rank by Journal Citation Indicator Immunology 146/177
Microbiology 129/157
Scimago  
Scimago
H-index
29
Scimago
Journal Rank
0,362
Scimago Quartile Score Immunology and Microbiology (miscellaneous) (Q3)
Medicine (miscellaneous) (Q3)
Scopus  
Scopus
Cite Score
3,6
Scopus
CIte Score Rank
General Immunology and Microbiology 26/56 (Q2)
Infectious Diseases 149/295 (Q3)
Microbiology (medical) 66/118 (Q3)
Scopus
SNIP
0,598

2020  
Total Cites 662
WoS
Journal
Impact Factor
2,048
Rank by Immunology 145/162(Q4)
Impact Factor Microbiology 118/137 (Q4)
Impact Factor 1,904
without
Journal Self Cites
5 Year 0,671
Impact Factor
Journal  0,38
Citation Indicator  
Rank by Journal  Immunology 146/174 (Q4)
Citation Indicator  Microbiology 120/142 (Q4)
Citable 42
Items
Total 40
Articles
Total 2
Reviews
Scimago 28
H-index
Scimago 0,439
Journal Rank
Scimago Immunology and Microbiology (miscellaneous) Q4
Quartile Score Medicine (miscellaneous) Q3
Scopus 438/167=2,6
Scite Score  
Scopus General Immunology and Microbiology 31/45 (Q3)
Scite Score Rank  
Scopus 0,760
SNIP
Days from  225
submission
to acceptance
Days from  118
acceptance
to publication
Acceptance 19%
Rate

2019  
Total Cites
WoS
485
Impact Factor 1,086
Impact Factor
without
Journal Self Cites
0,864
5 Year
Impact Factor
1,233
Immediacy
Index
0,286
Citable
Items
42
Total
Articles
40
Total
Reviews
2
Cited
Half-Life
5,8
Citing
Half-Life
7,7
Eigenfactor
Score
0,00059
Article Influence
Score
0,246
% Articles
in
Citable Items
95,24
Normalized
Eigenfactor
0,07317
Average
IF
Percentile
7,690
Scimago
H-index
27
Scimago
Journal Rank
0,352
Scopus
Scite Score
320/161=2
Scopus
Scite Score Rank
General Immunology and Microbiology 35/45 (Q4)
Scopus
SNIP
0,492
Acceptance
Rate
16%

 

Acta Microbiologica et Immunologica Hungarica
Publication Model Online only Hybrid
Submission Fee none
Article Processing Charge 1100 EUR/article
Regional discounts on country of the funding agency World Bank Lower-middle-income economies: 50%
World Bank Low-income economies: 100%
Further Discounts Editorial Board / Advisory Board members: 50%
Corresponding authors, affiliated to an EISZ member institution subscribing to the journal package of Akadémiai Kiadó: 100%
Subscription fee 2023 Online subsscription: 680 EUR / 832 USD
Print + online subscription: 760 EUR / 930 USD
Subscription Information Online subscribers are entitled access to all back issues published by Akadémiai Kiadó for each title for the duration of the subscription, as well as Online First content for the subscribed content.
Purchase per Title Individual articles are sold on the displayed price.

Acta Microbiologica et Immunologica Hungarica
Language English
Size A4
Year of
Foundation
1954
Volumes
per Year
1
Issues
per Year
4
Founder Magyar Tudományos Akadémia
Founder's
Address
H-1051 Budapest, Hungary, Széchenyi István tér 9.
Publisher Akadémiai Kiadó
Publisher's
Address
H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher
Chief Executive Officer, Akadémiai Kiadó
ISSN 1217-8950 (Print)
ISSN 1588-2640 (Online)

Monthly Content Usage

Abstract Views Full Text Views PDF Downloads
Dec 2023 0 0 0
Jan 2024 0 0 0
Feb 2024 0 0 0
Mar 2024 0 0 0
Apr 2024 0 0 0
May 2024 535 8 10
Jun 2024 438 3 5