Resistance mechanisms in Klebsiella pneumoniae molecular basis, epidemiology, and therapeutic implications: A comprehensive review | ||
| Microbes and Infectious Diseases | ||
| Articles in Press, Accepted Manuscript, Available Online from 04 October 2025 | ||
| Document Type: Review Article | ||
| DOI: 10.21608/mid.2025.387182.2816 | ||
| Authors | ||
| Poonamrani Mishra1; Alisha Sinha2; Debasish Sahoo3; Mahesh Chandra Sahu* 4 | ||
| 1Department of Microbilogy, IMS and SUM Hospital, SOA Deemed to be University, Kalinga Nagar, Bhubaneswar-751003, Odisha, India | ||
| 2Centre for Biotechnology, Siksha ‘O’ Anusandhan Deemed to be University, Kalinganagar, Bhubaneswar-751003, Odisha, India | ||
| 3Department of Microbiology, IMS and SUM Hospital, Kalinganagar, Bhubaneswar-751003, Odisha, India | ||
| 4Division of Microbiology, ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar-751023, Odisha, India. | ||
| Abstract | ||
| Background: Klebsiella pneumoniae has emerged as a critical opportunistic pathogen responsible for a range of healthcare-associated infections, particularly in immunocompromised individuals and hospitalized patients. Of growing concern is its resistance to carbapenems, a class of antibiotics often reserved as a last line of defense. This review explores the multifaceted mechanisms that drive carbapenem resistance in K. pneumoniae, with a particular focus on the production of β-lactamases such as KPC (Klebsiella pneumoniae carbapenemase) and NDM (New Delhi metallo-β-lactamase), as well as complementary mechanisms including porin channel loss and efflux pump activation. These adaptations significantly compromise the efficacy of available treatments, leading to elevated rates of morbidity and mortality. Recent advances in molecular diagnostics, including polymerase chain reaction (PCR) and whole-genome sequencing, have improved the detection and characterization of resistant strains. Although emerging therapeutic options, including new antibiotics and combination regimens, provide some hope, the rapid evolution of resistance even to drugs like colistin and tigecycline continues to challenge clinicians. The global dissemination of carbapenem-resistant K. pneumoniae (CRKP), often facilitated by mobile genetic elements and high-risk clonal lineages, necessitates urgent and sustained international action. Key priorities include strengthening antimicrobial stewardship programs, enhancing infection control measures, improving global surveillance, and fostering research into novel antimicrobial agents and vaccine development. Understanding the biological and clinical complexity of CRKP is vital for informing both public health responses and individualized patient care strategies. | ||
| Keywords | ||
| Carbapenem-resistant Klebsiella pneumoniae; β-lactamase; KPC; NDM; antimicrobial resistance | ||
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