Antibiotic Resistance in Klebsiella pneumoniae in Iraq: A Narrative Review
Abstract
Antibiotic resistance in Klebsiella pneumoniae (K. pneumoniae) poses a significant public health challenge globally, with Iraq experiencing a notable rise in multidrug-resistant strains. This narrative review evaluates current evidence on antibiotic resistance patterns and genetic mechanisms underlying resistance in K. pneumoniae isolates across Iraq. The review highlights a high prevalence of B-lactam resistance, particularly to penicillins and cephalosporins, largely driven by extended-spectrum B-lactamase (ESBL) genes such as blaSHV, blaTEM, and blaCTX-M. Carbapenem resistance is alarmingly increasing and is mediated primarily by carbapenemase genes, including blaOXA-48, blaNDM, and blaVIM, with the blaKPC gene emerging in select regions. Aminoglycoside resistance remains moderate, with amikacin retaining efficacy, though resistance genes like strA and strB contribute to variability. Quinolone resistance is attributed to chromosomal mutations, efflux pumps, and plasmid-mediated genes such as qnrS and qnrB, with resistance rates varying significantly by region and clinical setting. The dissemination of resistance is further facilitated by efflux pumps, including acrAB, mdtK, and tolC and porin loss (ompK35, ompK36). Despite increased research, gaps remain due to limited sample sizes and regional disparities in individual studies. To combat this escalating threat, the review advocates for a coordinated national surveillance system, stringent antibiotic stewardship, enhanced…
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