DOI: https://doi.org/10.14710/jbtr.v12i1.29019

Comparison Clinical Outcomes of Sepsis Caused by Multidrug-Resistant (MDR) and Non-MDR Klebsiella pneumoniae

1Department of Internal Medicine, Division of Tropical and Infectious Disease, Faculty of Medicine, Dr. M. Djamil Central General Hospital, Universitas Andalas, Indonesia

2Department of Internal Medicine, Division of Tropical and Infectious Disease, Faculty of Medicine, Universitas Andalas, Indonesia

3Department of Internal Medicine, Division of Tropical and Infectious Disease, Dr. M. Djamil General Hospital, Indonesia

4 Department of Microbiology, Faculty of Medicine, Universitas Andalas, Indonesia

5 Department of Internal Medicine, Faculty of Medicine, Universitas Andalas, Indonesia

View all affiliations
Received: 14 Aug 2025; Revised: 5 Mar 2026; Accepted: 17 Mar 2026; Available online: 29 Apr 2026; Published: 30 Apr 2026.
Open Access Copyright (c) 2026 Journal of Biomedicine and Translational Research
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Klebsiella pneumoniae is a common pathogen causing sepsis and is associated with high morbidity and mortality. The emergence of multidrug-resistant organisms (MDROs), particularly extended-spectrum β-lactamase-producing K. pneumoniae (ESBL-KP) and carbapenem-resistant K. pneumoniae (CRKP), has limited antimicrobial therapy options and may worsen clinical outcomes such as mortality and length of hospital stay (LOS). 

Objective: This study aims to compare the clinical characteristics and outcomes of sepsis caused by multidrug-resistant K. pneumoniae and non-resistant strains, focusing on mortality and LOS.

Methods: An observational analytical study with a cohort design was conducted at Dr. M. Djamil General Hospital in Padang from October 2024 to January 2025. Subjects diagnosed with sepsis due to pneumonia and confirmed positive for K. pneumoniae through blood or respiratory cultures were included using consecutive sampling. Isolates were categorized into MDR (ESBL-KP and CRKP) and non-MDR. Clinical data were analyzed descriptively to described subject characteristics, while bivariate analysis (chi-square and independent t-test) evaluated associations between resistance profiles and outcomes, focusing on mortality and LOS (p < 0.05). 

Results: Of the 70 subjects, 39 (55.7%) had confirmed infection with MDR strains and 31 (44.3%) with non-MDR.Mortality was highest in the CRKP (56.5%), followed by non-MDR (38.7%) and ESBL-KP (25.0%). Statistical analysis revealed a notable association between the resistance profiles of K. pneumoniae and mortality (p < 0.001 for both CRKP and ESBL-KP vs non-MDR). However, there were no statistically significant differences in mean hospital LOS across the groups (CRKP: 16.30 ± 9.81 days; ESBL-KP: 13.63 ± 9.77 days; non-MDR: 16.06 ± 9.49 days; all p > 0.05). 

Conclusion: Sepsis caused by multidrug-resistant K. pneumoniae, including both ESBL and CRKP, is significantly associated with increased mortality. Early identification and appropriate antimicrobial management are essential to improve subject outcomes.

 

Note: This article has supplementary file(s).

Fulltext View|Download |  Research Instrument
Untitled
Subject
Type Research Instrument
  Download (76KB)    Indexing metadata
 Research Instrument
Copyright Transfer Agreement (CTA)
Subject
Type Research Instrument
  Download (1MB)    Indexing metadata
Email colleagues
Keywords: Klebsiella pneumoniae, multidrug-resistant organism, ESBL-KP, CRKP, sepsis outcomes.

Article Metrics:

Article Info
Section: Original Research Articles
Language : EN
  1. Monteiro AdSS, Silva MdO, Galvão VS, Bomfim AP, de Araújo LG, Silva CMP, et al. High proportions of multidrug-resistant Klebsiella pneumoniae isolates in community-acquired infections, Brazil. Sci Rep. 2025 Mar 20;15(1):9698. DOI: 10.1038/s41598-025-92549-w
  2. Karnwal A, Jassim AY, Mohammed AA, Al-Tawaha ARMS, Selvaraj M, Malik T. Addressing the global challenge of bacterial drug resistance: insights, strategies, and future directions. Front Microbiol. 2025 Feb 24;16:1517772. DOI: 10.3389/fmicb.2025.1517772
  3. World Health Organization. WHO bacterial priority pathogens list, 2024: bacterial pathogens of public health importance to guide research, development and strategies to prevent and control antimicrobial resistance. Geneva: WHO; 2024. p. 1–56. Available from: https://www.who.int/publications/i/item/9789240093461
  4. Kong H, Liu Y, Yang L, Chen Q, Li Y, Hu Z, et al. Seven-year change of prevalence, clinical risk factors, and mortality of patients with carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a Chinese teaching hospital: a case–case–control study. Front Microbiol. 2025;16:1531984. DOI: 10.3389/fmicb.2025.1531984
  5. Fadrian F, Linosefa L, Ridhwan FM, Hasnah H, Ayuni AS. Multidrug-resistant organisms and determinant factors in sepsis patients. Iran J Med Microbiol. 2023;17(5):596-605. DOI: 10.30699/ijmm.17.5.596
  6. Diop M, Bassoum O, Ndong A, Wone F, Ghogomu Tamouh A, Ndoye M, et al. Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis. BMC Infect Dis. 2025;25:390. DOI: 10.1186/s12879-025-10335-x
  7. Asokan S, Jacob T, Jacob J, AlSosowaa AA, Cherian T, Peijnenburg WJGM, et al. Klebsiella pneumoniae: a growing threat in the era of antimicrobial resistance. Microbe (Netherlands). 2025;7(1):100167. DOI: 10.1016/j.microb.2024.100167
  8. Haitsma Mulier JLG, Falcone M, Tiseo G, Azzini AM, Scardellato R, Franceschini E, et al. Postoperative risk of infection with Klebsiella in adults: a retrospective case–control study. J Hosp Infect. 2025 Aug 1;162:26-35. DOI: 10.1016/j.jhin.2025.06.001
  9. Chen YP, Tasi XW, Chang K, Cao X Di, Chen JR, Liao CS. Multi-drug resistant organisms infection impact on patients' length of stay in respiratory care ward. Antibiotics. 2021 May 1;10(5):532. DOI: 10.3390/antibiotics10050532
  10. Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-resistant sepsis: a critical healthcare challenge. Antibiotics. 2024;13(11):1073. DOI: 10.3390/antibiotics13111073
  11. Kilinc M. Antibiotic resistance and mortality in ICU patients: a retrospective analysis of first culture growth results. Antibiotics. 2025 Mar;14(3):290. DOI: 10.3390/antibiotics14030290
  12. Van Giang T, Anh NK, Phuong NQ, Dat LT, Van Duyet L. Clinical, antibiotic resistance features, and treatment outcomes of Vietnamese patients with community-acquired sepsis caused by Klebsiella pneumoniae. IJID Reg. 2025 Mar 1;14:81-7. DOI: 10.1016/j.ijregi.2025.02.002
  13. Fadrian F, Linosefa L, Ahmad A, Simanjuntak RB, Aisy R. Multidrug-resistant organism and antibiotic sensitivity patterns before, during, and after the coronavirus disease 2019 pandemic in the Dr. M. Djamil Central General Hospital, Padang, Indonesia. Biomed Biotechnol Res J. 2024;8(3):279-90. DOI: 10.4103/bbrj.bbrj_143_24
  14. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016 Feb 23;315(8):801-10. DOI: 10.1001/jama.2016.0287
  15. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016 Sep 1;63(5):e61-111. DOI: 10.1093/cid/ciw353
  16. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67. DOI: 10.1164/rccm.201908-1581ST
  17. Csiki-Fejer E, Traczewski M, Procop GW, Davis TE, Hackel M, Dwivedi HP, et al. Multicenter clinical performance evaluation of omadacycline susceptibility testing of Enterobacterales on VITEK 2 systems. J Clin Microbiol. 2023 Jun 20;61(6):e00039-23. DOI: 10.1128/jcm.00039-23
  18. Lin X, Li C, Zhang S, Yang X, Jiang M. The global and regional prevalence of hospital-acquired carbapenem-resistant Klebsiella pneumoniae infection: a systematic review and meta-analysis. Open Forum Infect Dis. 2024 Feb 1;11(2):ofae048. DOI: 10.1093/ofid/ofae048
  19. Kadariswantiningsih IN, Rampengan DD, Ramadhan RN, Idrisova A, Idrisov B, Empitu MA. Antibiotic resistance in Indonesia: a systematic review and meta-analysis of extended-spectrum beta-lactamase-producing bacteria (2008–2024). Trop Med Int Health. 2025;30(2):246-59. DOI: 10.1111/tmi.14082
  20. Falahi S, Abdoli A, Kenarkoohi A. Immune aging, immunosenescence, and inflammaging: implications for vaccine response in older adults. Health Sci Rep. 2025 Jul 23;8(7):e2236. DOI: 10.1002/hsr2.2236
  21. Ibarz M, Haas LEM, Ceccato A, Artigas A. The critically ill older patient with sepsis: a narrative review. Ann Intensive Care. 2024 Jan 10;14(1):6. DOI: 10.1186/s13613-023-01233-7
  22. Shields CA, Wang X, Cornelius DC. Sex differences in cardiovascular response to sepsis. Am J Physiol Cell Physiol. 2023 Feb 1;324(2):C458-66. DOI: 10.1152/ajpcell.00315.2022
  23. Ciapponi A, Bardach A, Sandoval MM, Palermo MC, Navarro E, Espinal C, et al. Systematic review and meta-analysis of deaths attributable to antimicrobial resistance, Latin America. Emerg Infect Dis. 2023 Nov;29(11):2222-35. DOI: 10.3201/eid2911.230753
  24. Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019 Jun 19;32(3):e00001-19. DOI: 10.1128/CMR.00001-19
  25. Addissouky TA, Sayed IE, Ali MMA, Wang Y. Towards personalized care: unraveling the genomic and molecular basis of sepsis-induced respiratory complications. Arch Clin Toxicol (Middlet). 2024 Apr 2;6(1):4-15. DOI: 10.29328/journal.act.1001038
  26. Dyah Widyaningsih P, Made Mertaniasih N. The risk factors of multidrug-resistant organisms in hospitalized patients with community-acquired pneumonia in Dr. Soetomo Hospital Surabaya, Indonesia. Acta Med Indones. 2021;53(4):380-7. PMID: 34999265
  27. Wang X, Liu Y, Ding Y, Li M, Gao Y, Li T. Disease spectrum of patients with hospital-acquired multidrug-resistant organism infections in the intensive care unit: a retrospective study. Front Microbiol. 2025 May 19;16:1350098. DOI: 10.3389/fmicb.2025.1350098
  28. Garvey M. Hospital-acquired sepsis, disease prevalence, and recent advances in sepsis mitigation. Pathogens. 2024;13(5):421. DOI: 10.3390/pathogens13050421
  29. Slocker-Barrio M, López-Herce-Cid J, Bustinza-Arriortúa A, Fresán-Ruiz E, Jordán-García I, de Carlos-Vicente JC, et al. Increase in incidence rates and risk factors for multidrug resistant bacteria in septic children: a nationwide Spanish cohort study (2013–2019). Antibiotics. 2023 Nov 14;12(11):1626. DOI: 10.3390/antibiotics12111626
  30. Alsehemi AF, Alharbi EA, Alammash BB, Alrais AI, Elbadawy HM, Alahmadi YM. Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital: a retrospective study. Saudi Pharm J. 2023 Jun 1;31(6):1084-93. DOI: 10.1016/j.jsps.2023.04.019
  31. Fadrian F, Decroli E, Ahmad A, Kam A, Muharramah DH, Pradana G, et al. In-hospital mortality and its determinant factors among patients with sepsis. Univ Med. 2025 Feb 18;44(1):3-15. DOI: 10.18051/UnivMed.2025.v44.003-015
  32. Farasatinasab M, La'li A, Zibafard A, Khaleghian M, Nasiripour S, Alizadeh Otaghvar H, et al. Evaluation of surgical antibiotic prophylaxis guideline adherence: a cross-sectional study of two Iranian teaching hospitals. Arch Clin Infect Dis. 2024 Dec 30;20(2):e143826. DOI: 10.5812/archcid-143826
  33. Dhole S, Mahakalkar C, Kshirsagar S, Bhargava A. Antibiotic prophylaxis in surgery: current insights and future directions for surgical site infection prevention. Cureus. 2023 Oct 28;15(10):e38043. DOI: 10.7759/cureus.38043
  34. Ellingson KD, Noble BN, Buser GL, Snyder GM, McGregor JC, Rock C, et al. Interfacility transfer communication of multidrug-resistant organism colonization or infection status: practices and barriers in the acute-care setting. Infect Control Hosp Epidemiol. 2022 Apr;43(4):448-53. DOI: 10.1017/ice.2021.108
  35. Piotrowska MJ, Sakowski K, Lonc A, Tahir H, Kretzschmar ME. Impact of inter-hospital transfers on the prevalence of resistant pathogens in a hospital–community system. Epidemics. 2020 Dec 1;33:100414. DOI: 10.1016/j.epidem.2020.100414
  36. Li D, Huang X, Rao H, Yu H, Long S, Li Y, et al. Klebsiella pneumoniae bacteremia mortality: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2023 Apr 20;13:1122333. DOI: 10.3389/fcimb.2023.1122333
  37. Chen YC, Tsai IT, Lai CH, Lin KH, Hsu YC. Risk factors and outcomes of community-acquired carbapenem-resistant Klebsiella pneumoniae infection in elderly patients. Antibiotics. 2024 Mar 20;13(3):282. DOI: 10.3390/antibiotics13030282
  38. Han R, Shi Q, Wu S, Yin D, Peng M, Dong D, et al. Dissemination of carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) among carbapenem-resistant Enterobacteriaceae isolated from adult and children patients in China. Front Cell Infect Microbiol. 2020 Jul 3;10:314. DOI: 10.3389/fcimb.2020.00314
  39. Lazar DS, Nica M, Dascalu A, Oprisan C, Albu O, Codreanu DR, et al. Carbapenem-resistant NDM and OXA-48-like producing K. pneumoniae: from menacing superbug to a mundane bacteria; a retrospective study in a Romanian tertiary hospital. Antibiotics. 2024 May 12;13(5):435. DOI: 10.3390/antibiotics13050435
  40. Capsoni N, Bellone P, Aliberti S, Sotgiu G, Pavanello D, Visintin B, et al. Prevalence, risk factors and outcomes of patients coming from the community with sepsis due to multidrug resistant bacteria. Multidiscip Respir Med. 2019 Jul 5;14(1):20. DOI: 10.1186/s40248-019-0185-4
  41. Gao X, Cai S, Li X, Wu G. Sepsis-induced immunosuppression: mechanisms, biomarkers and immunotherapy. Front Immunol. 2025;16:1408273. DOI: 10.3389/fimmu.2025.1408273
  42. Silva EE, Skon-Hegg C, Badovinac VP, Griffith TS. The calm after the storm: implications of sepsis immunoparalysis on host immunity. J Immunol. 2023 Sep 1;211(5):711-9. DOI: 10.4049/jimmunol.2300171
  43. D'Onofrio V, Meersman A, Magerman K, Waumans L, van Halem K, Cox JA, et al. Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes. Int J Antimicrob Agents. 2021 Sep;58(3):106379. DOI: 10.1016/j.ijantimicag.2021.106379
  44. Strich JR, Heil EL, Masur H. Considerations for empiric antimicrobial therapy in sepsis and septic shock in an era of antimicrobial resistance. J Infect Dis. 2020 Jul 21;222(Suppl 2):S119-31. DOI: 10.1093/infdis/jiaa221
  45. Kadri SS, Lai YL, Warner S, Strich JR, Babiker A, Ricotta EE, et al. Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities: a retrospective cohort analysis of prevalence, predictors, and mortality risk in US hospitals. Lancet Infect Dis. 2021 Feb;21(2):241-51. DOI: 10.1016/S1473-3099(20)30477-1
  46. Martínez ML, Plata-Menchaca EP, Ruiz-Rodríguez JC, Ferrer R. An approach to antibiotic treatment in patients with sepsis. J Thorac Dis. 2020 Mar;12(3):1007-21. DOI: 10.21037/jtd.2020.01.47
  47. Huang W, Qiao F, Zhang Y, Huang J, Deng Y, Li J, et al. In-hospital medical costs of infections caused by carbapenem-resistant Klebsiella pneumoniae. Clin Infect Dis. 2018 Nov 13;67(Suppl 2):S225-30. DOI: 10.1093/cid/ciy642
  48. Xiao S, Zhou S, Cao H, Han L, Zhao S, Wang X. Incidence, antimicrobial resistance and mortality of Klebsiella pneumoniae bacteraemia in Shanghai, China, 2018–2022. Infect Dis. 2024;56(12):1021-30. DOI: 10.1080/23744235.2024.2380352
  49. Capsoni N, Bellone P, Aliberti S, Sotgiu G, Pavanello D, Visintin B, et al. Prevalence, risk factors and outcomes of patients coming from the community with sepsis due to multidrug resistant bacteria. Multidiscip Respir Med. 2019 Jul 5;14(1):20. DOI: 10.1186/s40248-019-0185-4
  50. Kim JY, Lee HY, Lee J, Oh DK, Lee SY, Park MH, et al. Pre-sepsis length of hospital stay and mortality: a nationwide multicenter cohort study. J Korean Med Sci. 2024;39(9):e80. DOI: 10.3346/jkms.2024.39.e80

Last update:

No citation recorded.

Last update:

No citation recorded.