Title : Epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacterales infections: Experience from a large tertiary care center in a developing country
Abstract:
Background: Carbapenem-resistant Enterobacterales (CRE) are a significant source of healthcare-associated infections. Because of high levels of antibiotic resistance, these bacteria are difficult to treat and have a high death rate. These pathogens are also linked to major outbreaks in healthcare institutions and a load on limited infection prevention and control (IPC) resources. Therefore, the aim of our study was to describe the epidemiology and clinical features of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country.
Methods: This was a cross-section study that included 218 patients admitted to An-Najah National University Hospital between January 1, 2021, and May 31, 2022. The target population was all patients with CRE infection or colonization in the hospital setting.
Results: Of the 218 patients, 135 were CRE- K. pneumoniae patients (61.9%), and 83 were CRE-E. coli patients (38.1%). Regarding sex, 135 were male (61.9%), and 83 were female (38.1%), with a median age of 51 years (interquartile range, 24-64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of the CRE patients were obtained from patients upon emergency department admission, which is the largest percentage among departments. The majority of CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, the most commonly used antimicrobial agent was colistin (13.3%). CRE- E.coli showed resistance to amikacin in 76.2% of the tested pathogens and 14.3% for trimethoprim/sulfamethoxazole compared to CRE- K. pneumonia, for which the resistance to trimethoprim/sulfamethoxazole was 25.9%, while for amikacin, it was 35.8%. Regarding meropenem MIC, 85.7% of CR- E.coli were above 16 µg/mL compared to 84.3% of the CR- K. pneumonia isolates.
Conclusion: This study found that CRE is frequently reported and spreading in tertiary care hospitals in our setting, implying the presence of selective pressure and healthcare-associated transmission. The antibiotics that were used showed a variety of resistance rates, increasing resistance to the available antibiotics and the significant threat to hospitalized patients.
Keywords: Carbapenem-Resistant Enterobacterales (CRE), Resistance, Meropenem
