Abstract / Summary
Abstract Klebsiella spp. are World Health Organization critical-priority pathogens owing to their remarkable ability to acquire and disseminate antimicrobial resistance determinants, particularly extended-spectrum β-lactamases (ESBLs) and carbapenemases. Although antimicrobial resistance is increasing across West Africa, comprehensive molecular epidemiological data describing resistance determinants in clinical Klebsiella isolates remain scarce in Togo. This study aimed to provide the first multi-centre molecular characterization of ESBL-producing and carbapenem-resistant Klebsiella spp. circulating in the country. A multi-center cross-sectional study was conducted from October 2024 to June 2025 in 16 healthcare facilities in Togo. A total of 161 non-duplicate clinical Klebsiella isolates, including 153 ESBL-producing and 8 carbapenem-resistant strains, were recovered from urine and wound specimens. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method according to CLSI guidelines. Eighteen antimicrobial resistance genes were detected using real-time PCR. Klebsiella pneumoniae subsp. pneumoniae was the predominant species (78.9%), followed by K. oxytoca (12.4%), K. pneumoniae subsp. ozaenae (7.5%), and K. pneumoniae subsp. rhinoscleromatis (1.2%). Multi-drug resistance was observed in 99.4% of isolates, whereas one isolate (0.6%) exhibited an extensively drug-resistant phenotype. The most prevalent β-lactamase genes were bla SHV (62.1%), bla CTX-M (38.5%), and bla TEM (25.5%). Carbapenemase genes included bla NDM (14.3%), bla KPC (8.1%), bla OXA-48 (6.2%), and bla VIM (0.6%). The quinolone resistance genes qnrA and qnrB were detected in 49.1% and 32.9% of isolates, respectively. The colistin resistance gene mcr-1 was identified in 11.2% of isolates and was correlated with bla KPC (ρ = 0.75). Resistance was highest to trimethoprim-sulfamethoxazole (85.1%) and ceftriaxone (81.4%), whereas amikacin, carbapenems, and nitrofurantoin remained largely effective. Clinical Klebsiella spp. isolates in Togo exhibit an alarming burden of multi-drug resistance and harbor diverse resistance determinants, including carbapenemase and colistin resistance genes. These findings highlight the need for routine molecular surveillance and strengthened antimicrobial stewardship programs in Togo and across West Africa.