Epidemiology and Antimicrobial Resistance of Klebsiella pneumoniae at a Tertiary Oncology Centre in Astana, Kazakhstan, 2022-2026: A Prospective Longitudinal Surveillance Study
- 1Kazakhstan Medical University "Higher School of Health Care Organization"
Abstract
O_ST_ABSBackgroundC_ST_ABSKlebsiella pneumoniae is a World Health Organization (WHO) critical priority pathogen, and carbapenem-resistant K. pneumoniae (CRKP) causes 50,000-100,000 attributable deaths annually worldwide. Systematic antimicrobial resistance (AMR) data from Central Asia are virtually absent from the global literature.
MethodsLongitudinal surveillance study of routine microbiological data from the National Research Oncology Centre (NROC), Astana, Kazakhstan (January 2022-March 2026). Four data sources were integrated: monthly microbial landscape reports (October 2022-September 2024; n=596 K. pneumoniae isolates), a full-year patient-level clinical register (2025; n=91 isolates), monthly landscape reports for first quarter 2026 (Q1 2026 n=50 isolates), and biannual antibiograms (2022, 2026). Isolates were classified as CRKP (4MRGN), 3MRGN, ESBL-producing, or susceptible.
ResultsA total of 737 K. pneumoniae isolates were identified across the full study period. CRKP (4MRGN) was the dominant phenotype throughout, peaking at 76.4% in January-September 2024 and remaining at 62.0% in Q1 2026. The aggregate MDR rate (CRKP + 3MRGN + ESBL) was 76-87% across all periods, consistently 2-3 times above the global pooled mean of 28.7%. The highest resistance burden was observed in the bone marrow transplantation department (86-98% MDR) and intensive care units (67-100% MDR). Between 2022 and 2026, a profound shift in reserve antibiotic susceptibility was documented: amikacin resistance rose from 8.5% (2022) to 38.1% (Q1 2026, whole institution) and 60% (Q1 2026, intensive care sector), nearly eliminating the sole previously active antibiotic class. In contrast, polymyxins (colistin R 0%, polymyxin B R 2%) and tigecycline (R 52%) emerged as the only agents with retained activity in 2026. Carbapenem resistance showed a modest partial improvement (meropenem R 72%[->]64%) but remained critically high. Simultaneously, Escherichia coli (ESBL+/MDR) emerged as the dominant pathogen in haematological and surgical departments by 2025-2026, reflecting a broader Enterobacterales resistance crisis beyond K. pneumoniae alone.
ConclusionsThis study provides the first systematic published AMR surveillance evidence from Kazakhstan over a four-year period. CRKP dominates the institutional microbiological landscape, and the progressive loss of aminoglycoside activity now leaves polymyxins and tigecycline as the last remaining active agents -- a development with profound implications for patient safety. These findings represent a critical call to action for antimicrobial stewardship implementation, carbapenemase genotyping, and integration into national and global AMR surveillance systems in Central Asia.
Related
- Epidemiology, microbiological characteristics, and antimicrobial resistance of device-associated healthcare-associated infections in a neonatal intensive care unit: a six-year surveillance study
- Spatiotemporal trajectories of antimicrobial resistance in bloodstream infections in China: a nationwide longitudinal surveillance study from 2014 to 2023
- Bloodstream Infections in Patients with Malignancy: Microbiological Epidemiology, Antimicrobial Resistance, and Factors Associated with Mortality in a Nine-Year Single-Center Retrospective Cohort
- Epidemiology, Clinical Profiles, Antimicrobial Resistance, and Inflammatory Risk Factors of Aeromonas Infections in Hospitalized Patients: A Retrospective Cohort Study from a Hospital in Zhoushan Archipelago, China
- Co-Circulation of ST11-KL30 and ST11-KL64 Carbapenem-Resistant Klebsiella pneumoniae in Urumqi, Xinjiang, China: Molecular Epidemiology, Antimicrobial Resistance, and Virulence
BibTeX
@misc{yessenbayeva2026epidemiology,
title = {{Epidemiology and Antimicrobial Resistance of Klebsiella pneumoniae at a Tertiary Oncology Centre in Astana, Kazakhstan, 2022-2026: A Prospective Longitudinal Surveillance Study}},
author = {G. A. Yessenbayeva and I. Y. Mukatova and Y. V. Zholdybayeva and Y. A. Merenkov and Y. S. Avakyan and G. S. Berdiyarova and S. B. Shalekenov and M. S. Khudaibergenova and Z. A. Burkitbayev},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.23.26366297},
url = {https://www.medrxiv.org/content/10.64898/2026.10.23.26366297v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Epidemiology and Antimicrobial Resistance of Klebsiella pneumoniae at a Tertiary Oncology Centre in Astana, Kazakhstan, 2022-2026: A Prospective Longitudinal Surveillance Study
AU - G. A. Yessenbayeva
AU - I. Y. Mukatova
AU - Y. V. Zholdybayeva
AU - Y. A. Merenkov
AU - Y. S. Avakyan
AU - G. S. Berdiyarova
AU - S. B. Shalekenov
AU - M. S. Khudaibergenova
AU - Z. A. Burkitbayev
PY - 2026
DA - 2026/10/23
PB - medRxiv
DO - 10.64898/2026.10.23.26366297
UR - https://www.medrxiv.org/content/10.64898/2026.10.23.26366297v1
AB - O_ST_ABSBackgroundC_ST_ABSKlebsiella pneumoniae is a World Health Organization (WHO) critical priority pathogen, and carbapenem-resistant K. pneumoniae (CRKP) causes 50,000-100,000 attributable deaths annually worldwide. Systematic antimicrobial resistance (AMR) data from Central Asia are virtually absent from the global literature. MethodsLongitudinal surveillance study of routine microbiological data from the National Research Oncology Centre (NROC), Astana, Kazakhstan (January 2022-March 2026). Four data sources were integrated: monthly microbial landscape reports (October 2022-September 2024; n=596 K. pneumoniae isolates), a full-year patient-level clinical register (2025; n=91 isolates), monthly landscape reports for first quarter 2026 (Q1 2026 n=50 isolates), and biannual antibiograms (2022, 2026). Isolates were classified as CRKP (4MRGN), 3MRGN, ESBL-producing, or susceptible. ResultsA total of 737 K. pneumoniae isolates were identified across the full study period. CRKP (4MRGN) was the dominant phenotype throughout, peaking at 76.4% in January-September 2024 and remaining at 62.0% in Q1 2026. The aggregate MDR rate (CRKP + 3MRGN + ESBL) was 76-87% across all periods, consistently 2-3 times above the global pooled mean of 28.7%. The highest resistance burden was observed in the bone marrow transplantation department (86-98% MDR) and intensive care units (67-100% MDR). Between 2022 and 2026, a profound shift in reserve antibiotic susceptibility was documented: amikacin resistance rose from 8.5% (2022) to 38.1% (Q1 2026, whole institution) and 60% (Q1 2026, intensive care sector), nearly eliminating the sole previously active antibiotic class. In contrast, polymyxins (colistin R 0%, polymyxin B R 2%) and tigecycline (R 52%) emerged as the only agents with retained activity in 2026. Carbapenem resistance showed a modest partial improvement (meropenem R 72%[->]64%) but remained critically high. Simultaneously, Escherichia coli (ESBL+/MDR) emerged as the dominant pathogen in haematological and surgical departments by 2025-2026, reflecting a broader Enterobacterales resistance crisis beyond K. pneumoniae alone. ConclusionsThis study provides the first systematic published AMR surveillance evidence from Kazakhstan over a four-year period. CRKP dominates the institutional microbiological landscape, and the progressive loss of aminoglycoside activity now leaves polymyxins and tigecycline as the last remaining active agents -- a development with profound implications for patient safety. These findings represent a critical call to action for antimicrobial stewardship implementation, carbapenemase genotyping, and integration into national and global AMR surveillance systems in Central Asia.
ER -