Predictors of mortality in acute pancreatitis complicated with multidrug-resistant Klebsiella pneumoniae infection

Abstract Background Multidrug-resistant (MDR) Klebsiella pneumoniae infections, from pancreatic infections to bloodstream infections, influence the mortality of patients with acute pancreatitis (AP) on the condition of limited antibiotic choices. The aim of this study was to investigate the predictor of mortality among AP patients complicated with MDR-K. pneumoniae infections. Methods Seventy-one AP patients who occurred MDR-K. pneumoniae infections from August 1st, 2016 to August 1st, 2020 were enrolled. MDR-K. pneumoniae was defined as the K. pneumoniae strain non-susceptible to at least one agent in three or more antimicrobial categories. MDR-K. pneumoniae isolates were confirmed by Vitek-2 system. Antibiotic susceptibility test was carried out using a micro broth dilution method. Clinical characteristics and drug-resistance rates were retrospectively reviewed, and the predictors of mortality were evaluated by univariate and multivariate analyses. Results The mortality rate of AP patients complicated with MDR-K. pneumoniae infections reached 46.5% (33 of 71), and pancreas (n = 53) was the most common site of MDR-K pneumoniae strains. The drug resistance rates of MDR-K. pneumoniae were high to 11 of 12 common antibiotics (more than 50.0%) except of tigecycline (23.9%). The predictor independently associated with mortality was septic shock (hazard ratio 2.959, 95% confidence intervals 1.396 – 6.272, P = 0.005). Conclusions More attention should be paid for pancreatic MDR-K. pneumoniae infections among AP patients The predictor for mortality of AP patients complicated with MDR-K. pneumoniae infection is septic shock. Therefore, further clinical investigations should focus on areas against septic shock.

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Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis

BMC Microbiology ◽

10.1186/s12866-021-02332-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shayan Chen ◽

Jiyu Shi ◽

Minghui Chen ◽

Jun Ma ◽

Zhaowei Zeng ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Drug Resistance ◽

Acute Pancreatitis ◽

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Gram Negative

Abstract Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.

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Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽

10.3390/antibiotics10010076 ◽

2021 ◽

Vol 10 (1) ◽

pp. 76

Author(s):

Matthaios Papadimitriou-Olivgeris ◽

Christina Bartzavali ◽

Alexandra Georgakopoulou ◽

Fevronia Kolonitsiou ◽

Chrisavgi Papamichail ◽

...

Keyword(s):

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill ◽

Critically Ill Patients ◽

Primary Outcome ◽

Bloodstream Infections ◽

Microdilution Method ◽

Broth Microdilution Method ◽

Carbapenemase Gene ◽

Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

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Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

10.21203/rs.3.rs-658252/v1 ◽

2021 ◽

Author(s):

Yuzhen Qiu ◽

Wen Xu ◽

Yunqi Dai ◽

Ruoming Tan ◽

Jialin Liu ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Klebsiella Pneumoniae ◽

Critically Ill Patients ◽

Bloodstream Infections ◽

Polymyxin B ◽

Mortality Rates ◽

Carbapenem Resistant ◽

All Cause Mortality ◽

Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

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Clinical outcomes and prognostic factors in bloodstream infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae among patients with malignancy: a meta-analysis

10.21203/rs.2.24466/v1 ◽

2020 ◽

Author(s):

Ai-Min Jiang ◽

Na Liu ◽

Rui Zhao ◽

Hao-Ran Zheng ◽

Xue Chen ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Clinical Outcomes ◽

Hematological Malignancy ◽

Meta Analysis ◽

Bloodstream Infections ◽

Icu Admission ◽

Predictors Of Mortality ◽

Oncological Patients ◽

Subgroup Analyses

Abstract Background The colonization of Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in bloodstream infections (BSIs) has been increased dramatically worldwide, and it was associated with worse clinical outcomes in patients with malignancy. We performed the meta-analysis to investigate the prognosis and risk factors in BSIs caused by ESBL-PE in oncological patients. Methods PubMed and EMBASE were searched for related studies. All-cause mortality was considered as the primary outcome. Subgroup analyses, meta-regression analyses, and sensitivity analysis were used to investigate heterogeneity and reliability in results. Results 6729 patients from 25 studies were eligible. Six studies enrolled oncological patients with BSIs caused by ESBL-PE only, while 19 studies both enrolled ESBL-PE and non-ESBL-PE infections. The results showed that BSIs caused by ESBL-PE in patients with malignancy was associated with higher mortality than non-ESBL-PE infections (RR = 2.21, 95% CI: 1.60–3.06, P < 0.001), with a significant between-study heterogeneity (I2 = 78.3%, P < 0.001). Subgroup analyses showed that children (RR = 2.80, 95% CI: 2.29–3.43, P < 0.001) and hematological malignancy (RR =3.20, 95% CI: 2.54–4.03, P < 0.001) were associated with a higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality. Conclusions Our study identified that BSIs caused by ESBL-PE in patients with malignancy was associated with worse clinical outcomes compared with non-ESBL-PE infections. Furthermore, children and hematological malignancy were associated with higher mortality. Severe sepsis/ septic shock, pneumonia, and ICU admission were the most common predictors of mortality.

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A67 Bloodstream infections by carbapenem-resistant Klebsiella pneumoniae subsp. pneumoniae: Bayesian phylogenetic analysis of whole genomes

Virus Evolution ◽

10.1093/ve/vez002.066 ◽

2019 ◽

Vol 5 (Supplement_1) ◽

Author(s):

Eleonora Cella ◽

Davide Leoni ◽

Walter Mirandola ◽

Carla Fontana ◽

Loredana Sarmati ◽

...

Keyword(s):

Phylogenetic Analysis ◽

Klebsiella Pneumoniae ◽

Infection Control ◽

Minimum Spanning Tree ◽

Hospital Setting ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Epidemiological Surveillance ◽

Health Concern ◽

Hospital Infection Control

Abstract Bloodstream infection (BSI) caused by carbapenemase-producing Enterobacteriaceae (CPE) is a major public health concern, particularly in the hospital setting. The rapid detection of resistance patterns is of paramount importance for establishing the proper antibiotic regime. In addition, in countries where CPE are endemic, it is also important to evaluate genetic relationship among the isolates in order to trace pathogen circulation and to improve the infection control programs. This study is an application of a rapid blood culture (BC) workflow consisting of fast reporting of Gram stain results, rapid pathogen identification (using MALDI TOF technology), and a molecular assay for the detection of the major genes conferring resistance, all of them performed directly from positive BCs. The application of phylogenetic and phylodynamic analyses to bacterial whole-genome sequencing (WGS) data have become essential in the epidemiological surveillance of multidrug-resistant nosocomial pathogens. We analyzed 40 strains of Klebsiella pneumoniae subsp. pneumoniae (KP) carrying blaKPC (KP-KPC), randomly selected among 147 CPE identified from BCs collected from consecutive patients from 2013 to 2016. The number of BSIs-related CPE were 23, 31, 43, and 50 in 2013, 2014, 2015, and 2016, respectively. Among 147 CPE isolates, 143 were KP and four were Escherichia coli (EC). The gene blaKPC was detected in 117 strains of KP and in four strains of EC. Other carbapenemase genes, such as blaVIM and blaOXA-48, were detected in four and nine different isolates of KP, respectively. Moreover, 13 KP strains carried two resistance genes: twelve vehicled blaKPC plus blaVIM and one blaKPC plus blaOXA-48. Phylogenetic analysis of bacterial WGS data was used to investigate the evolution and spatial dispersion of KP in support of hospital infection control. The maximum likelihood tree showed two main clades statistically supported, with statistical support for several subclusters within as well. The minimum spanning tree showed mixing between sequences from different years and wards with only few specific groups. Bayesian analyses are ongoing, as the aid of Bayesian genomic epidemiology in combination with active microbial surveillance is highly informative regarding the development of effective infection prevention in healthcare settings or constant strain reintroduction.

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Enterokokken mit speziellen Resistenzen – Epidemiologie, Hygiene und Therapie

DMW - Deutsche Medizinische Wochenschrift ◽

10.1055/a-0655-6454 ◽

2019 ◽

Vol 144 (08) ◽

pp. 553-560 ◽

Cited By ~ 1

Author(s):

Alexander Mischnik ◽

Guido Werner ◽

Jennifer Bender ◽

Nico Mutters

Keyword(s):

Scientific Evidence ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Vancomycin Resistant Enterococci ◽

Resistance Patterns ◽

Single Intervention ◽

Vancomycin Resistant ◽

Meta Analyses ◽

Resistance Rates ◽

Insight Into

AbstractEnterococci with special resistance patterns (mainly vancomycin-resistant enterococci) play an important role in everyday clinical practice. Rising resistance rates to linezolid, daptomycin or tigecycline are also increasingly reported. Therapeutically, linezolid and daptomycin are the most important substances mainly in infections due to vancomycin-resistant enterococci. Several systematic meta-analyses of bloodstream infections showed discrepant results in the comparison of mortality of linezolid and daptomycin-treated bacteraemias. The containment of enterococci with special resistance patterns is currently receiving great attention. The key hygienic issue in all recommendations for dealing with multidrug-resistant enterococci can be summarized very simply: current scientific evidence is often inconsistent and studies that have clearly tested a single intervention for efficacy are lacking. The present work gives an insight into the current epidemiology and therapeutic strategies. Furthermore, the recently published German KRINKO recommendations are presented.

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Epidemiology and microbiology of Gram-negative bloodstream infections in a tertiary-care hospital in Beijing, China: a 9 -year retrospective study

10.21203/rs.3.rs-22214/v1 ◽

2020 ◽

Author(s):

Zhixin Liang ◽

Qiang Zhu ◽

Minghui Zhu ◽

Chunyan Li ◽

Lina Li ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Acinetobacter Baumannii ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Bloodstream Infections ◽

Care Hospital ◽

Gram Negative ◽

Resistance Rates ◽

Beijing China

Abstract Background Gram-negative bacterial bloodstream infections (BSIs) are serious diseases associated with high morbidity and mortality. The following study examines the incidence, clinical characteristics and microbiological features, drug resistance situations and mortality associated with gram-negative BSIs at a large Chinese tertiary-care hospital in Beijing, China. Methods A retrospective cohort study of patients with gram-negative BSIs was performed between January 1, 2010, and December 31, 2018, at the Chinese People's Liberation Army General Hospital. The patients’ data were collected and included in the reviewing electronic medical records. Results A total of 6867 episodes of gram-negative BSIs occurred among 3199 patients over 9 years, and there were 3032 significant BSI episodes 77% of these cases were healthcare-associated, while 23% were community-associated. The overall incidence of gram-negative BSIs fluctuated from 2.30 to 2.55 episodes per 1000 admissions over 9 years. Malignancy was the most common comorbidity and indwelling central intravenous catheter was the most common predisposing factor for gram-negative BSI. Escherichia coli were the major pathogen (34.3%), followed by Klebsiella pneumoniae (23.3%) and other bacterial pathogens (9.9%). The resistance rates of Escherichia coli and Klebsiella pneumoniae to penicillins were more than 90%. and the resistance rates of Acinetobacter baumannii to the most antibiotic were more than 70% include the Carbapenem. The resistance of ESBLs-producing Escherichia coli to the most antibiotic was higher than non-ESBLs producing Escherichia coli but to Carbapenems(0.7% VS 5.1%). The rates of Carbapenems resistance of ESBLs-producing Klebsiella pneumoniae and non-ESBLs producing Klebsiella pneumoniae were 32.8% and 8.1%. The rates of Carbapenems resistance of Enterobacter cloacae and Pseudomonas aeruginosa were 1.4% and 27.8% respectively. Between 2010 and 2018, the overall mortality of gram-negative BSIs decreased from 11.41–9.05%(X2 = 6.95, P = 0.434). Moreover, the mortality in the ICU decreased from 27.03–14.93%(X2 = 9.61, P = 0.212), while in the general ward fluctuated from 8.85–8.13% that without obvious decrease change(X2 = 9.29, P = 0.232). Conclusions The mortality of gram-negative BSIs have showed downward trends. carbapenem antibiotics is still consider the best treatment for patients with Gram-negative BSIs except Acinetobacter baumannii.

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The Molecular Epidemiology of Resistance to Antibiotics among Klebsiella pneumoniae Isolates in Azerbaijan, Iran

Journal of Tropical Medicine ◽

10.1155/2021/9195184 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Mehdi Kashefieh ◽

Hassan Hosainzadegan ◽

Shabnam Baghbanijavid ◽

Reza Ghotaslou

Keyword(s):

Drug Resistance ◽

Klebsiella Pneumoniae ◽

Molecular Epidemiology ◽

Resistance Genes ◽

Susceptibility Testing ◽

Multidrug Resistant ◽

Aminoglycoside Resistance ◽

State Hospitals ◽

Aminoglycoside Resistance Genes ◽

Hospital Acquired

Introduction. Klebsiella pneumoniae (K. pneumoniae) is one of the leading causes of hospital-acquired and community-acquired infections in the world. This study was conducted to investigate the molecular epidemiology of drug resistance in clinical isolates of K. pneumoniae in Azerbaijan, Iran. Materials and Methods. A total of 100 nonduplicated isolates were obtained from the different wards of Azerbaijan state hospitals, Iran, from 2019 to 2020. Antibiotic susceptibility testing was done. The DNA was extracted, and the PCR for evaluation of the resistance genes was carried out. Results. The highest antibiotic resistance was shown to ampicillin (96%), and the highest susceptibility was shown to tigecycline (9%), and 85% of isolates were multidrug resistant. The most frequent ESBL gene in the tested isolates was blaSHV-1 in 58%, followed by blaCTXM-15 (55%) and blaSHV-11(42%). The qepA, oqxB, and oqxA genes were found to be 95%, 87.5%, and 70%, respectively. We detected tetB in 42%, tetA in 32%, tetD in 21%, and tetC in 16%. Seventy isolates were resistant to co-trimoxazole, and the rate of resistance genes was sul1 in 71%, followed by sul2 (43%), dfr (29%), and sul3 (7%). The most common aminoglycoside resistance genes were ant3Ia, aac6Ib, aph3Ib, and APHs in 44%, 32%, 32%, and 31.4%, respectively. The most frequent resistance gene to fosfomycin was fosA (40%) and fosX (40%) followed by fosC (20%). Conclusion. The results of this study indicate the high frequency of drug resistance among K. pneumoniae isolated from hospitals of Azerbaijan state. The present study shows the presence of high levels of drug-resistant genes in various antibiotics, which are usually used in the treatment of infections due to K. pneumoniae.

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Molecular Characterization of invasive Enterobacteriaceae from Pediatric Patients in Central and Northwestern Nigeria

10.1101/2020.02.21.959338 ◽

2020 ◽

Author(s):

Carissa Duru ◽

Grace M Olanipekun ◽

Vivian Odili ◽

Nicholas J Kocmich ◽

Amy Rezac ◽

...

Keyword(s):

Resistance Genes ◽

Treatment Options ◽

Bloodstream Infections ◽

Multidrug Resistant ◽

Diffusion Method ◽

Esbl Production ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum ◽

High Prevalence ◽

Resistance Rates

AbstractBackgroundBacteremia is a leading cause of death in developing countries but etiologic evaluation is infrequent and empiric antibiotics are not evidence-based. Very little is known about the types of extended-spectrum β-lactamases (ESBL) in pediatric bacteremia patients in Nigeria. We evaluated the patterns of ESBL resistance in children enrolled into surveillance for community acquired bacteremic syndromes across health facilities in Central and Northwestern Nigeria.MethodBlood culture from suspected cases of sepsis from children age less than 5 years were processed using automated Bactec® incubator System from Sept 2008-Dec 2016. Enterobacteriacea were identified to the species level using Analytical Profile Index (API20E®) identification strip and antibiotic susceptibility profile was determined by the disc diffusion method. The multidrug resistant strains were then screened and confirmed for extended spectrum beta lactamase (ESBL) production by the combination disc method as recommended by Clinical and Laboratory Standard Institute (CLSI). Real time PCR was used to elucidate the genes responsible for ESBL production characterize the resistance genesResultOf 21,000 children screened from Sept 2008-Dec 2016, 2,625(12.5%) were culture-positive. A total of 413 Enterobacteriaceae available for analysis were screened for ESBL. ESBL production was detected in 160/413(38.7%), comprising Klebsiella pneumoniae 105/160(65.6%), Enterobacter cloacae 21/160(13.1%), Escherichia coli 22/160(13.8%), Serratia species 4/160(2.5%), Pantoea species 7/160(4.4%) and Citrobacter species 1/160(0.6%). Of the 160 ESBL-producing isolates, high resistance rates were observed among ESBL-positive isolates for Ceftriaxone (92.3%), Aztreonam (96.8%), Cefpodoxime (96.25%), Cefotaxime (98.75%) and sulphamethoxazole-trimethoprim (90%), while 87.5 %, 90.63%, and 91.87% of the isolates were susceptible to Imipenem, Amikacin and Meropenem respectively. Frequently detected resistance genes were blaTEM 83.75%) (134/160), and, blaCTX-M 83.12% (133/160) followed by blaSHV genes 66.25% (106/160). Co-existence of blaCTX-M, blaTEM and blaSHV was seen in 94/160 (58.8%), blaCTX-M and blaTEM in 118/160 (73.8%), blaTEM and blaSHV in 97/160 (60.6%) and blaCTX-M and blaSHV in 100/160 (62.5%) of isolates tested.ConclusionOur results indicate a high prevalence of ESBL resistance to commonly used antibiotics in Enterobacteriaceae isolates from bloodstream infections in children in this study. Careful choice of antibiotic treatment options and further studies to evaluate transmission dynamics of resistance genes could help in the reduction of ESBL resistance in these settings.

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EVALUATION OF EFFLUX PUMP ACTIVITY AND BIOFILM FORMATION IN MULTIDRUG RESISTANT KLEBSIELLA PNEUMONIAE ISOLATES IN TANTA, EGYPT

International Research Journal of Pharmacy ◽

10.7897/2230-8407.1203123 ◽

2021 ◽

Vol 12 (3) ◽

pp. 1-5

Author(s):

Tarek El-Said El-Banna ◽

Fatma Ibrahim Sonbol ◽

Heba M El-Dawy ◽

Lamiaa A Al-Madboly

Keyword(s):

Drug Resistance ◽

Klebsiella Pneumoniae ◽

Biofilm Formation ◽

Efflux Pump ◽

Treatment Options ◽

Multidrug Resistant ◽

High Morbidity ◽

Biochemical Tests ◽

Antibiotic Resistance Profile ◽

Pump Activity

Nosocomial and community acquired infections that caused by multidrug-resistant (MDR) Klebsiella pneumoniae isolates are widespread recently resulting in high morbidity and mortality due to limited number of treatment options with effective antibiotics. The aim of this study is to evaluate the antibiotic resistance profile, biofilm formation and efflux pump activity of MDR K. pneumoniae isolates collected from different hospitals in Tanta, Egypt. A total of 70 K. pneumoniae isolates characterized by standard biochemical tests and confirmed by MALDI-TOF/MS were screened for antibiotic susceptibility, efflux pump activity and biofilm formation. Isolates displayed high resistance to penicillins, cephalosporins, trimethoprim-sulfamethoxazole and the majority of tested fluoro/-quinolones and decreased resistance to imipenem, amikacin, chloramphenicol, tigecycline and colistin. Out of 70 K. pneumoniae isolates, 2 isolates exhibited Pan Drug-Resistance (PDR) profile while 57 (81.4%) and 11 (15.7%) exhibited MDR and Extensively drug-resistance (XDR) profiles, respectively. Sixty-four (91.4%) isolates exhibited efflux pump activity while all tested isolates had the ability to form biofilm with varied degrees as 40 (57.1%), 26 (37.1%), and 4 (5.7%) isolates were strong, moderate and weak biofilm producers, respectively. Also, a strong relation between efflux pump activity and biofilm formation per isolate was detected. In conclusion, Multidrug resistance, biofilm formation and efflux pump capabilities in K. pneumoniae have serious public health implications in the management and control of infections caused by this bacterium. Therefore, a multifaceted approach and precise planning are recommended in controlling these infections

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