{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:58:05Z","timestamp":1791622685882,"version":"4.3.4"},"reference-count":49,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009687","name":"Medical University statutory funding","doi-asserted-by":"publisher","award":["SUBZ.E090.23.015"],"award-info":[{"award-number":["SUBZ.E090.23.015"]}],"id":[{"id":"10.13039\/501100009687","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In recent years, we have witnessed a growing drug resistance among bacteria, which is associated with the use and availability of an increasing number of broad-spectrum antimicrobial agents, as well as with their irrational and excessive use. The present study aims to analyze changes in the drug resistance of Gram-negative Enterobacterales: Escherichia coli and Klebsiella pneumoniae, isolated from infections in a multi-profile hospital over five years (from 2017 to 2021). Among the practical outcomes of the evaluation of these data will be the possibility of determining changes in susceptibility to the antibiotics used in the hospital. In turn, this will help propose new therapeutic options, especially for empirical therapy that is necessary in severe infections. The analysis of the use of individual groups of antibiotics allowed for identification of the causes of the increasing resistance of Gram-negative bacilli. The highest number of infections whose etiological agent was K. pneumoniae ESBL(+) and E. coli ESBL(+) was observed in 2018. In the analyzed five-year period, the number of multi-resistant (MDR) K. pneumoniae strains increased successively, which seems to be related to the growing use, especially in the pandemic period, of broad-spectrum antibiotics, mainly penicillins with inhibitors, third-generation cephalosporins, and carbapenems.<\/jats:p>","DOI":"10.3390\/jcm12062414","type":"journal-article","created":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T06:56:48Z","timestamp":1679381808000},"page":"2414","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Evolution of Antibiotic Resistance in Escherichia coli and Klebsiella pneumoniae Clinical Isolates in a Multi-Profile Hospital over 5 Years (2017\u20132021)"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6388-7970","authenticated-orcid":false,"given":"Beata","family":"M\u0105czy\u0144ska","sequence":"first","affiliation":[{"name":"Department of Pharmaceutical Microbiology and Parasitology, Faculty of Pharmacy, Medical University, 50-367 Wroclaw, Poland"},{"name":"Department of Hygiene and Epidemiology, Lower Silesian T. Marciniak Specialist Hospital-Center for Emergency Medicine, 54-049 Wroc\u0142aw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Frej-M\u0105drzak","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Sarowska","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystyna","family":"Woronowicz","sequence":"additional","affiliation":[{"name":"Medical Laboratory Synevo, Fieldorfa 2, 50-049 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irena","family":"Choroszy-Kr\u00f3l","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnieszka","family":"Jama-Kmiecik","sequence":"additional","affiliation":[{"name":"Department of Basic Sciences, Faculty of Health Sciences, Medical University, 50-367 Wroclaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Pilmis, B., Le Monnier, A., and Zahar, J.R. (2020). Gut Microbiota, Antibiotic Therapy and Antimicrobial Resistance: A Narrative Review. Microorganisms, 8.","DOI":"10.3390\/microorganisms8020269"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"156","DOI":"10.4065\/mcp.2010.0639","article-title":"General principles of antimicrobial therapy","volume":"86","author":"Leekha","year":"2011","journal-title":"Mayo Clin. Proc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jiph.2021.10.020","article-title":"Antibiotic resistance in microbes: History, mechanisms, therapeutic strategies and future prospects","volume":"14","author":"Uddin","year":"2021","journal-title":"J. Infect. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/jac\/dkv282","article-title":"NDM-producing Enterobacteriaceae in Poland, 2012\u20132014: Inter-regional outbreak of Klebsiella pneumoniae ST11 and sporadic cases","volume":"71","author":"Baraniak","year":"2016","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_5","first-page":"35","article-title":"Occurrence of alert pathogens in hospital environment. Part I. ESBL-producing Enterobacteriaceae strains","volume":"64","author":"Paluchowska","year":"2012","journal-title":"Med. Dosw. Mikrobiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105040","DOI":"10.1016\/j.micpath.2021.105040","article-title":"Genetic basis of molecular mechanisms in \u03b2-lactam resistant gram-negative bacteria","volume":"158","author":"Hussain","year":"2021","journal-title":"Microb. Pathog."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6235","DOI":"10.3390\/ijerph10126235","article-title":"Escherichia coli in Europe: An Overview","volume":"10","author":"Allocati","year":"2013","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/nyas.12830","article-title":"Mechanisms of drug resistance: Quinolone resistance","volume":"1354","author":"Hooper","year":"2015","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4137\/PMC.S14459","article-title":"Antibiotics and bacterial resistance in the 21st century","volume":"6","author":"Fair","year":"2014","journal-title":"Perspect. Medicin. Chem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e01976-16","DOI":"10.1128\/mBio.01976-16","article-title":"Evolution and Epidemiology of Multidrug-Resistant Klebsiella pneumoniae in the United Kingdom and Ireland","volume":"8","author":"Moradigaravand","year":"2017","journal-title":"mBio"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"738223","DOI":"10.3389\/fcimb.2021.738223","article-title":"Antibiotic Resistance and Virulence Profiles of Klebsiella pneumoniae Strains Isolated From Different Clinical Sources","volume":"11","author":"Gabasa","year":"2021","journal-title":"Front. Cell. Infect. Microbial."},{"key":"ref_12","first-page":"295","article-title":"Extended spectrum beta-lactamases (ESBL) in Escherichia coli and Klebsiella pneumoniae: Trends in the hospital and community settings","volume":"3","author":"Khanfar","year":"2009","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"De Angelis, G., Del Giacomo, P., Posteraro, B., Sanguinetti, M., and Tumbarello, M. (2020). Molecular Mechanisms, Epidemiology, and Clinical Importance of \u03b2-Lactam Resistance in Enterobacteriaceae. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21145090"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e00184-21","DOI":"10.1128\/AAC.00184-21","article-title":"Antimicrobial Resistance Conferred by OXA-48 \u03b2-Lactamases: Towards a Detailed Mechanistic Understanding","volume":"65","author":"Hirvonen","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Khalifa, S.M., Abd El-Aziz, A.M., Hassan, R., and Abdelmegeed, E.S. (2021). \u03b2-lactam resistance associated with \u03b2-lactamase production and porin alteration in clinical isolates of E. coli and K. pneumoniae. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251594"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"74","DOI":"10.3389\/fmed.2019.00074","article-title":"Treatment of Infections Due to MDR Gram-Negative Bacteria","volume":"6","author":"Bassetti","year":"2019","journal-title":"Front. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107","DOI":"10.33073\/pjm-2021-010","article-title":"Clonal Dissemination of KPC-2, VIM-1, OXA-48-Producing Klebsiella pneumoniae ST147 in Katowice, Poland","volume":"70","author":"Dobrut","year":"2021","journal-title":"Pol. J. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Giamarellou, H., and Karaiskos, I. (2022). Current and Potential Therapeutic Options for Infections Caused by Difficult-to-Treat and Pandrug Resistant Gram-Negative Bacteria in Critically Ill Patients. Antibiotics, 11.","DOI":"10.3390\/antibiotics11081009"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Altayb, H.N., Elbadawi, H.S., Alzahrani, F.A., Baothman, O., Kazmi, I., Nadeem, M.S., Hosawi, S., and Chaieb, K. (2022). Co-Occurrence of \u03b2-Lactam and Aminoglycoside Resistance Determinants among Clinical and Environmental Isolates of Klebsiella pneumoniae and Escherichia coli: A Genomic Approach. Pharmaceuticals, 15.","DOI":"10.3390\/ph15081011"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0040-1716478","article-title":"Fluoroquinolone Resistance in Clinical Isolates of Klebsiella Pneumonia e","volume":"12","author":"Geetha","year":"2020","journal-title":"J. Lab. Physicians"},{"key":"ref_21","unstructured":"(2021, May 31). Criteria for Diagnosis of an Outbreak in a Hospital\/Health Care Facility Caused by Carbapenamase-Producing Strains of Enterobacteriaceae (CPE). Guidelines of the National Antibiotic Protection Program. Available online: http:\/\/antybiotyki.edu.pl\/wpcontent\/uploads\/dokumenty\/CPE_NDM-Ognisko-epidemiczne.pdf."},{"key":"ref_22","unstructured":"EUCAST (2020). The European Committee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and Zone Diameters, The European Committee on Antimicrobial Susceptibility Testing. Version 10.0."},{"key":"ref_23","unstructured":"EUCAST (2020). The European Committee on Antimicrobial Susceptibility Testing. Routine and Extended Internal Quality Control for MIC Determination and Disk Diffusion as Recommended by EUCAST, The European Committee on Antimicrobial Susceptibility Testing. Version 10.0."},{"key":"ref_24","unstructured":"Skov, R., and Skov, G. (2022, June 01). EUCAST Guidelines for Detection of Resistance Mechanisms and Specific Resistances of Clinical and\/or Epidemiological Importance. Available online: https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Resistance_mechanisms\/EUCAST_detection_of_resistance_mechanisms_170711.pdf."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1111\/1469-0691.12322","article-title":"A disc diffusion assay for detection of class A, B and OXA-48 carbapenemases in Enterobacteriaceae using phenyl bo ronic acid, dipicolinic acid and temocillin","volume":"20","author":"Voets","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"5493","DOI":"10.1128\/AAC.05118-11","article-title":"Molecular characteristics of KPC-producing Enterobacteriaceae at the early stage of their dissemination in Poland, 2008\u20132009","volume":"55","author":"Baraniak","year":"2011","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1128\/JCM.00594-14","article-title":"CarbAcineto NP test for rapid detection of carbapenemase-producing Acinetobacter spp.","volume":"52","author":"Dortet","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"20140083","DOI":"10.1098\/rstb.2014.0083","article-title":"Antimicrobial resistance in humans, livestock and the wider environment","volume":"370","author":"Woolhouse","year":"2015","journal-title":"Philos. Trans. R. Soc. Lond. B Biol. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1179\/2047773215Y.0000000030","article-title":"Antimicrobial resistance: A global multifaceted phenomenon","volume":"109","author":"Prestinaci","year":"2015","journal-title":"Pathog. Glob Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1038\/s41579-021-00649-x","article-title":"Antibiotic resistance in the environment","volume":"20","author":"Larsson","year":"2022","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1007\/s10096-020-04140-y","article-title":"Changes in antimicrobial resistance and outcomes of health care-associated infections","volume":"40","author":"Azak","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/S1473-3099(15)00350-3","article-title":"Public founding for research on antibacterial resistance in the JPIAMR countries, the European Commission, and related European Union agencies: A systematic observational analysis","volume":"16","author":"Kelly","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1038\/nm1145","article-title":"Antibacterial resistance worldwide: Causes, challenges and responses","volume":"10","author":"Levy","year":"2004","journal-title":"Nat. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"4065603","DOI":"10.1155\/2016\/4065603","article-title":"Multidrug Resistant and Extensively Drug Resistant Bacteria: A Study","volume":"2016","author":"Basak","year":"2016","journal-title":"J. Pathog."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.jgar.2013.03.010","article-title":"Global antibacterial resistance: The never-ending story","volume":"1","author":"Theuretzbacher","year":"2013","journal-title":"J. Glob. Antimicrobal Resist."},{"key":"ref_36","unstructured":"European Centre for Disease Prevention and Control (2018). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2017."},{"key":"ref_37","unstructured":"European Centre for Disease Prevention and Control (2019). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2018."},{"key":"ref_38","unstructured":"European Centre for Disease Prevention and Control (2020). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2019."},{"key":"ref_39","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial Resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2020."},{"key":"ref_40","unstructured":"European Centre for Disease Prevention and Control (2022). Antimicrobial resistance in the EU\/EEA (EARS-Net)\u2014Annual Epidemiological Report 2021."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13099-019-0290-0","article-title":"Virulence factors, prevalence and potential transmission of extraintestinal pathogenic Escherichia coli isolated from different sources: Recent reports","volume":"11","author":"Sarowska","year":"2019","journal-title":"Gut Pathog."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Yang, P., Chen, Y., Jiang, S., Shen, P., Lu, X., and Xiao, Y. (2020). Association between the rate of fluoroquinolones-resistant gram-negative bacteria and antibiotic consumption from China based on 145 tertiary hospitals data in 2014. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-04981-0"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1853","DOI":"10.1093\/infdis\/jiv279","article-title":"The Rise of Fluoroquinolone-Resistant Escherichia coli in the Community: Scarier Than We Thought","volume":"212","author":"Spellberg","year":"2015","journal-title":"J. Infect. Dis."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1093\/cid\/ciy657","article-title":"Current Status and Trends of Antibacterial Resistance in China","volume":"67","author":"Hu","year":"2018","journal-title":"Clin. Infect. Dis."},{"key":"ref_45","unstructured":"European Centre for Disease Prevention and Control (2013). Antimicrobial resistance surveillance in Europe 2012, Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net)."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Maczynska, B., Paleczny, J., Oleksy-Wawrzyniak, M., Choroszy-Krol, I., and Bartoszewicz, M. (2021). In Vitro Susceptibility of Multi-Drug Resistant Klebsiella pneumoniae Strains Causing Nosocomial Infections to Fosfomycin. A Comparison of Determination Methods. Pathogens, 10.","DOI":"10.3390\/pathogens10050512"},{"key":"ref_47","first-page":"1900633","article-title":"Healthcare workers\u2019 knowledge, attitudes and behaviours with respect to antibiotics, antibiotic use and antibiotic resistance across 30 EU\/EEA countries in 2019","volume":"26","author":"Hopkins","year":"2021","journal-title":"Euro. Surveill."},{"key":"ref_48","unstructured":"(2021). Global-Antimicrobial-Resistance-Surveillance-System-Glass, World Health Organization."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s40249-022-01016-5","article-title":"Global antimicrobial resistance: A system-wide comprehensive investigation using the Global One Health Index","volume":"11","author":"Zhou","year":"2022","journal-title":"Infect. Dis. Poverty"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2414\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:59:38Z","timestamp":1760122778000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/6\/2414"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,21]]},"references-count":49,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["jcm12062414"],"URL":"https:\/\/doi.org\/10.3390\/jcm12062414","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,21]]}}}