Carbapenem Resistant Klebsiella pneumoniae Cases from India: An Overview of Current Knowledge
Abstract:
Carbapenem-resistant
Klebsiella pneumoniae (CRKP) is a significant public health concern in India.
Our current review attempts a qualitative summary of observational studies
published in the last ten years. The key resistance mechanisms identified
include carbapenemase enzymes like New Delhi Metallo-beta-lactamase (NDM-1),
Oxacillinase-48 (OXA-48), and Klebsiella pneumoniae carbapenemase (KPC), as
well as non-enzymatic factors such as efflux pump overexpression and
alterations in outer membrane porins (OmpK35, OmpK36). Horizontal gene transfer
via plasmids and transposons was also observed to accelerate the dissemination
of resistance genes. Carbapenem resistance rates in India have surged from 9%
in 2008 to approximately 60% by 2024. Environmental contamination from
untreated industrial and hospital waste, along with antibiotic overuse, also
significantly contributed to the increased spread of CRKp strains and is
associated with mortality rates of around 68%. Challenges in the diagnosis of
CRKp cases arise from limitations of phenotypic methods and the non-availability
of genotypic techniques such as PCR and whole-genome sequencing in
resource-constrained settings. Treatment options against CRKp are limited,
often relying on last-resort antibiotics like polymyxins and tigecycline, which
also have significant side effects and face rising resistance. Emerging
therapies, including novel β-lactam/β-lactamase inhibitor combinations and
agents like cefiderocol, show a promising option but require further
validation. Therefore, an urgent, integrated approach is recommended to combat rising
CRKp infections in India, which involves enhancing surveillance systems,
strengthening antimicrobial stewardship programs, improving infection control
practices within healthcare facilities, and promoting public education on the
risks of antibiotic misuse.
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