In this study, the proportion of K. pneumoniae isolates was 150 of the total clinical bacterial isolates from July 2020 to December 2020. In hospital-acquired infections, Klebsiella pneumoniae is the main organism that causes highly contagious outbreaks with increased mortality rates and longer stays. These are all results in inflated health care costs .
Most of K. pneumoniae in this study were obtained from patients aged 18 to 65 years of age. K. pneumoniae isolates were mainly isolated from urine specimens followed by pus. Ashurst and Dawson  reported that K. pneumoniae colonizes typically in the urinary tract and in invasive infections. In the United States, Klebsiella pneumoniae is considered to be the most common cause of hospital-acquired infections. The people from the republic of China reported that the respiratory tract was the main site infection of Klebsiella pneumoniae was studied by wang et.al. In comparison, Seifi et al  who collected samples from two hospitals in Tehran reported that K. pneumoniae samples were isolated from urine, surgical wounds, sputum, and blood with the percentage of 61.7%, 18.1%, 11.7%, and 8.5% respectively. K. pneumoniae isolates in inpatients and outpatients were 47 and 18 and in blood 3 and in urine 40 and 42. In a total 0f 58 K. pneumoniae isolates, 22 isolates (37.9%) were female and 18 (31%) were from males. In another study 34 (58.6%) isolates from inpatients, which were obtained from intensive care unit 12 (20.7%), pediatrics 7 (12.1%), emergency 7 (12.1%), internal medicine 4 (6.9%), burn 1 (1.7%), surgery 1 (1.7%), ear, nose, and throat department 1 (1.7%) and neurology department 1 (1.7%). About 46.5% of the sample was collected from outpatients and 53.5% were from inpatients.
Table − 9: Lipase Test Percentage
We have compared the results of various authors’ findings in this research topic for Lipase production to our study in the form of the table in Table − 9. Results show that our study provides more positive results for Lipase production using the methods we discussed in our paper.
Most of K. pneumoniae isolates were resistant to various antibiotics with Ampicillin, Ceftriaxone/Ccefotaxime, and Cefepime + Tazobactam being the least effective for K. pneumoniae while piperacillin + tazobactam, Cefperazone + Sulbactam, nalidixic acid, and Meropenem had the most favorable profile.
This report is compared by the study conducted by Madahiah et al  that found K. pneumoniae isolates were 100% resistant to ampicillin and 100% sensitive to amikacin., Ciprofloxacin and Amoxicillin-clavulanic acid showed 38.75% and 36.69% resistance respectively. This finding is similar to Cepas et al  that reported 40% of K. pneumoniae strains were resistant to ciprofloxacin and amoxicillin-clavulanic acid.
The over use and prescription of antibiotics becomes a commonly known problem for antimicrobial resistance. Many factors such as the use of antibiotics in community, hospital, even in animal production, agriculture, and environment are involving the growth of antibiotic resistance. The antibiotics are used excessively since there is no control and/or restriction in purchasing antibiotics freely without prescription. The main underlying factor in the widespread transmission of difficult to cure antibiotic resistant nosocomial infections is intensive and prolonged use of antibiotics in health setting service.
In our study, in ESBL detection the third-generation Cephalosporin-resistant was 75(50%) and Carbapenem-resistant strains were 37 (25%) in a total number of isolates. After screening, ESBL and Carbapenem-resistant strains were 43 and 20. In that lipase positive has 30 (69.7%) isolates were ESBL positive and 13 (65%) isolates were Carbapenemase positive whereas in lipase negative 13 (30.23%) and 7(35%) isolates produce ESBL and Carbapenemase production.
ESBL s are now a problem in hospitalized patients worldwide. Their prevalence varies from one country to another and from institution to institution was studied by Asma et al. in Kuwait (2006) . First isolated in 1983 in Germany, ESBLs spread rapidly to Europe, the United States, and Asia and are now found all over the world was studied by Kumar et al in India. From India , the high prevalence of ESBL producing isolates showed ESBL production was studied by Jain A . In 2002, 68% of gram-negative bacteria were found to be ESBL producers in a study from New Delhi in which 80% of Klebsiella were ESBL s was studied by Gupta V in India in 2007. All 117 multidrug-resistant K. pneumoniae isolates were cefotaxime resistant. Out of these isolates, 91 isolates were ESBL positive by Ceftazidime clavulanic acid combined disc method, and 95 isolates positive in HI chrome ESBL agar .
Faizabad et al in Iran found that 66% of the isolates were Carbapenemase producers . Gupta et al in north India studied meropenem resistance was 6.9%  whereas Nagaraj et al 2012 observed 75% of the K. pneumoniae isolates were Carbapenemase resistant in their study in South India . Azeem et al stated that 35.3% of K. pneumoniae isolates in their study were resistant to Carbapenemase production in 2016 .
Carbapenems are not easily hydrolyzed beta-lactamase enzymes because they exhibit great affinity towards penicillin-binding proteins. Through porin channels, they can easily enter the gram-negative bacterial cell.
In our study 85 (56.6%) isolates showed lipase production in similar to our study (58%) isolates produce lipase production was studied by Kalaivani et al in Pondicherry . Gharrah et al encountered 6% and 10% lipase production among their ESBL and non- ESBL producers . Allam et al is reported in 76.9% lipase formation .
The survival of the pathogenic and commensal microbes regularly interfaces with their host. They do so through the production of myriad surface and secreted factors that facilitate the nutrient acquisition, adherence, and evasion of host antimicrobial defenses.
Lack of education about infection and antibiotic usage is the major cause of prescribing inappropriate antibiotics. In initial antibiotic therapy, one of the most relevant steps in prescribing antibiotics is an adjustment based on the clinical microbiology result. Therefore, it is necessary to perform antibiotic susceptibility testing. Collecting clinical samples before antibiotic administration is also a critical point. Adjusting the initial antimicrobial therapy based on the clinical microbiology result will diminish the selection pressure to the microorganism in hospital-based infections. Thus, it is of paramount importance for each hospital to have an antibiotic guidance or stewardship program for all pharmacists and physicians based on the most accurate microbiological data. In conjunction with this guidance, a continuous effort in hospital surveillance, infection control, and clinical audits must be conducted to fight against the rapid development of antibiotic-resistant pathogens.
In this study, the antibiotics like Nitrofurantoin, Nalidixic acid, Cotrimoxazole, Cefotaxime / Ceftriaxone, Ciprofloxacin/Norfloxacin, Amikacin, Imipenem, Meropenem, Cefoperazone, and sulbactam are statistically significant in inpatient when compared with outpatient.
Patients admitted to ICUs are at greatest risk of acquiring nosocomial infections, partly because of their serious underlying disease but also because of exposure to life-saving invasive procedures, prolonged use of in situ invasive devices, therapy with multiple antimicrobials, and extended hospital stays [27–28]. In the lipase test, drug-resistant pattern, the antibiotic nitrofurantoin was only statically significant in lipase positive compared with lipase negative isolates.