Carbapenem-Resistant Enterobacteriaceae among In-Patients of Tertiary Hospitals in Southwest, Nigeria (original) (raw)
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Background: Carbapenem resistance Enterobacteriaceae (CRE) has emerged as global pathogen capable of widespread transmission and complicating treatment options for patients. CRE have been reported globally. However, there is dearth of study on knowledge for predictors of CRE in patients from our setting. We set out to determine predictors of infection among patients infected with CRE. Methodology: We isolated species of Enterobacteriaceae from patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) Maiduguri. We obtain data on socio-demographic characteristics, co-morbidities and some associated factors. We determined their CRE status and then classified them as CRE positiveor CRE negative based on the possession the resistance genes. We conducted univariate, bivariate and multivariate analyses to compute proportions and odd ratios with 95% CI using SPSS version 20. Results: The factors significantly associated with the acquisition of carbapenem resistance Enterobacteriaceae (CRE) based on chi-square test were; level of education (X 2 = 15.570, P-value = 0.004) of the patients, ward of admission (X 2 = 21.765, P-value = 0.000), number of days on admission (X 2 = 11.218, P-value = 0.004), use of medical device (X 2 = 26.893, P-value = 0.000) and prior antibiotic usage (X 2 = 35.729, P-value = 0.000). Predictors of CRE using multivariate analysis were; secondary school level of education (OR = 8.330, 95% CI = 3.000-50.401), admission in intensive care unit (OR = 11.135, 95% CI = 8.000-19.110), admission days greater than 20 days (OR = 2.580, 95% CI = 1.011-15.101), use of urethral catheter (OR = 3.518, 95% CI = 2.00-9.821) and prior administration of third generation cephalosporin's (OR = 15.303, 95% CI = 7.034-19.107). Conclusion: Our study shows that patients admitted in ICU, those with indwelling urinary catheter and those placed on third generation cephalosporin's are at higher risk of CRE acquisition. Consequently, we recommend that patient and caregiver education, antibiotic stewardship programs, enforcement of infection control practices and continuous surveillance should be given priority. www.jmscr.igmpublication.org Impact Factor 5.84 Index Copernicus Value: 83.27
Indian Journal of Microbiology Research, 2023
Introduction: Carbapenem Resistant Enterobacteriaceae (CRE) has gradually evolved as one of the serious global health concern due to its high mortality and limited treatment options. Overuse of the antibiotic and improper sanitation has led to its rapid spread. Aim: To determine the proportion of Carbapenem resistant Enterobacteriaceae from various clinical samples received in the Department of Microbiology, MIMS Mandya for Culture and sensitivity by using Meropenem and Imipenem disk. Materials and Methods: This is a retrospective study conducted over a period of 6 months from March 2021 to august 2021. The samples tested were all the clinical specimens like sputum, pus, urine, body fluids coming to our Microbiology laboratory. The specimens were processed by the standard laboratory methods. Bacteria was isolated and identified by standard biochemical reactions and antimicrobial susceptibility testing was done on Mueller Hinton Agar by Kirby Bauer disk diffusion method and interpreted according to CLSI guidelines. Results: total of 1624 samples were included in the study, among which 211 isolates were identified as members of Enterobacteriaceae family. 50 out of 211 isolates were confirmed as Carbapenem resistant giving a prevalence rate of 23.69%. Urine (42%) was the major contributor of CRE, followed by pus (34%). Among CRE, Escherichia coli (54%) was the major organism isolated followed by Klebsiella pneumoniae (20%). Conclusion: Our study showed high CRE prevalence rate of 23.69%, indicating the rapid emergence of CRE. Hence, a strict adherence to antibiotic policy and basic infection control measures to be applied in view of reducing the spread of CRE in the community. Keywords: Carbapenem resistant enterobacteriaceae, CRE, Escherichia Coli.
BMC Infectious Diseases
Background Carbapenem-resistant Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions especially those with limited resources in infection prevention and control (IPC). Therefore, our study aimed to describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country. Methods This was a retrospective cross-sectional 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 had CR-Klebsiella pneumoniae (61.9%), and 83 had CR-Escherichia coli (38.1%). Of these, 135 were male (61.9%...
Prevalence of Carbapenem Resistant Enterobacteriaceae- a Study in a Tertiary Care Hospital in Mumbai
BACKGROUND The global incidence of carbapenem resistant organisms is on the rise and can be attributed to indiscriminate use of carbapenem to tackle the Extended Spectrum Beta Lactamase (ESBL) producing organisms. Carbapenem resistance is associated with resistance to other group of antibiotics. The spread of resistance from one bug to another is not uncommon. The organism persists in the hospital environment and is identified as cause of hospital-acquired infections. This is not only a major concern in the healthcare setting but is also increasingly being recovered from community settings also. Limited availability of drugs to treat these infections is the biggest concern. Identifying carbapenem resistant organisms and implementing measures to prevent the spread is need of the hour. The aim of this study is to determine the prevalence and susceptibility pattern of Carbapenem resistant Enterobacteriaceae.
PLOS ONE, 2015
Introduction Carbapenemases have increasingly been reported in enterobacteriaceae worldwide. Most carbapenemases are plasmid encoded hence resistance can easily spread. Carbapenemresistant enterobacteriaceae are reported to cause mortality in up to 50% of patients who acquire bloodstream infections. We set out to determine the burden of carbapenem resistance as well as establish genes encoding for carbapenemases in enterobacteriaceae clinical isolates obtained from Mulago National Referral Hospital, Uganda. Methods This was a cross-sectional study with a total of 196 clinical isolates previously collected from pus swabs, urine, blood, sputum, tracheal aspirates, cervical swabs, endomentrial aspirates, rectal swabs, Vaginal swabs, ear swabs, products of conception, wound biopsy and amniotic fluid. All isolates were subjected to phenotypic carbapenemase screening using Boronic acid-based inhibition, Modified Hodge and EDTA double combined disk test. In addition, all the isolates were subjected to PCR assay to confirm presence of carbapenemase encoding genes.
Prevalence of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital
International Journal of Current Microbiology and Applied Sciences, 2019
Introduction Carbapenem resistance among Enterobacteriaceae is one of the foremost challenges that the medical world is facing since the past few years. [1] Carbapenems were suggested as the final drug of choice for treatment during the emergence of ESBLs and AmpCs, due to their unique molecular structure and wide spectrum of activity. [2] But the origin of carbapenemase enzyme in Enterobacteriaceae poses a major threat, creating a dilemma in therapeutic methods. [3] These bacteria have the potential to cause wide spread transmission of resistance even between the intestinal bacteria [4] through various intrinsic or extrinsic mechanisms. [5] One major cause of resistance in bacteria is the production of carbapenem hydrolyzing enzyme with several variants, along with porin loss, production of AmpC and acquired MBL. [6] Detection of these organisms is a difficult task due to the wide diversity in their
Gomal Journal of Medical Sciences
Background: Carbapenems are broad spectrum β-lactam antibiotics that were introduced in response to the emergence of ESBL-producing Gram-negative bacteria. This study aimed at determining the occurence of carbapenem resistant Enterobacterales isolates among patients attending five tertiary hospitals with southeastern region of Nigeria. Methods: A total of 400 Enterobacterales were isolated from different participants. Carbapenem-resistance was detected using Kirby-Bauer disc diffusion method with ertapenem, meropenem, imipenem, and doripenem. Results: A total of 117 isolates (29.2%) were resistant to the four carbapenems. When compared among the states, the prevalence were 33.6%, 29.1%, 28.8%, 26.9% and 24.7% for Enugu, Ebonyi, Imo, Anambra and Abia states respectively. The highest resistance was observed among P. mirabilis (52.6%) followed by K. oxytoca (35.7%), S. enterica (35.7%) and K. pneumoniae (33.8%). Conclusion: The overall prevalence was high and this is a cause for concer...
Journal of laboratory physicians, 2019
PURPOSE: The purpose of the study is to estimate the rate of infection with carbapenem-resistant Enterobacteriaceae (CRE) in the main governmental tertiary care hospital in Bahrain. MATERIALS AND METHODS: All clinical samples with positive growth of CRE over 6-year period (January 2012-December 2017) were collected from the microbiology laboratory data. RESULTS: The CRE incidence was high in the first half of study period (2012-2014) and then decreased between 2015 and 2017, after implementation of intensified CRE control measure bundle. About 49.4% of CRE-positive samples were isolated from the elderly age group (above 65 years old), most of them were admitted in the intensive care unit (ICU). The most common isolated organisms were Klebsiella pneumoniae (87.0%), followed by Escherichia coli (7.9%). Isolates from deep tracheal aspirate and midstream urine specimens were the most common source of CRE isolates (27.3%) and (26.3%), respectively. Bacteremia was documented in 21.2% of cases. CRE isolates in the study showed high rates of resistance to aminoglycosides (72.2% resistant to amikacin and 67.3% to gentamicin). Alternatively, most isolates retained their susceptibility to colistin and tigecycline with sensitivity of 83.9% and 85.7%, respectively. Combined resistance to both colistin and tigecycline was observed in 0.06% of total isolates. CONCLUSION: Elderly population and ICU admission were important risk factors for CRE acquisition. Most of CRE isolates were sensitive to both colistin and tigecycline, which make them the best combination for empiric frontline therapy for suspected serious CRE infection in our facility. Implementing CRE-bundled infection control measures significantly reduced the incidence of CRE infection in our hospital.
Antimicrobial Resistance & Infection Control
Objective To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system. Methods Design: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011–2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical charac...