Title : Carbapenem resistant organisms: Prevalence, Risk Factors for Mortality, and Trend Among In-patients in Divine Word Hospital from 2019 to 2021
Abstract:
Background. Carbapenem is a class of antibiotics with wide spectrum of activity used as drug of last resort reserved for suspected multidrug-resistant organisms. The increasing incidence of carbapenem-resistant organisms remains a growing concern worldwide. Although a national surveillance program exists, there are factors that can lead to over or underestimation. Consequently, the reported resistance rate may not be reflective of the local prevalence rate.
Methods. All adult patients with isolate of carbapenem-resistant organisms from January 2019 to December 2021 were included in the study. Risk factors for mortality were evaluated. Microbiologic data were analyzed including resistance rates for the top 5 isolates were computed and analyzed for trend.
Results. There was a total of 265 patients included in the study. The prevalence of carbapenem-resistant organisms in our center was 8.36%, 8.73%, and 7.13% from 2019 to 2021. The comorbidities associated with mortality were gastrointestinal, renal, and hematologic diseases. The invasive medical devices associated with mortality were urinary catheter, vascular dialysis catheter, mechanical ventilation, venous cutdown, tracheostomy tube, chest tube, and nasogastric tube. Intervention related factors associated with mortality were history of antibiotic use, history of surgery, and steroid use. Longer hospital stay and ICU admissions were also associated with mortality. The top carbapenem isolates in our center were Acinetobacter, Pseudomonas, Klebsiella, Enterobacter, and Burkholderia. Only Acinetobacter had a definite downward trend of resistance rate, although it was not significant. The resistance rate in our center was below the national resistance rate.
Conclusion. The presence of comorbidities, invasive devices, and medical interventions could increase the risk of mortality in patients with carbapenem resistant organisms.
