Purpose: The aim of the study is to estimate the prevalence rate of carbapenem-resistant Enterobacteriaceae (CRE) and to determine the types of carbapenemase genes present in patients admitted to King Abdulaziz Medical City (KAMC-J) and King Abdulaziz University Hospital (KAUH), both in Jeddah, Saudi Arabia.Methods: A total of 180 isolates were analyzed which were included on the basis of retrospective chart review of patients from KAMC-J and KAUH between 1 st April 2017 to 30 th March 2019. The prevalence of carbapenemase genes ( bla IMP, bla VIM, bla KPC, bla NDM-1, and bla OXA-48) was evaluated by Xpert® Carba-R (Cepheid, Sunnyvale, CA, USA). We assessed the CRE prevalence and described their susceptibility to antimicrobial agents based on antibiogram reports.Results: Klebsiella pneumoniae showed a higher frequency of bla OXA-48 (79%) than bla NDM (11.7%) genes (p=0.007). The CRE prevalence in KAUH was 8% in 2017 and increased to 13% in 2018. In KAMC-J, the prevalence was 57% in 2018 and 61% in 2019. K. pneumoniae was found to be the most frequently isolated causative organism followed by Escherichia coli. The bla OXA-48 (76.1%) gene was predominant among overall isolates followed by bla NDM (13.9%); both genes coexisted in 6.1% of the isolates.Conclusion: During the study period, the prevalence of CRE considerably rose in the two tertiary care institutions from western Saudi Arabia. In the CRE isolates, bla OXA-48 was discovered to be the most common gene. We recommend an antimicrobial resistance surveillance system to detect the emergence of resistant genes through use of new rapid diagnostic tests and monitor antimicrobial use in order to improve clinical outcomes of CRE infections given the severity of infection associated with the CRE isolates as well as the limited treatment options available.
Background: Carbapenemase-producing bacteria are a major health problem because of its limited treatment options. Carbapenem-Resistant Enterobacteriaceae (CRE) are non-susceptible to carbapenem, which serves as the most potent class of antimicrobial agents available for multidrug-resistant bacterial infections. The aim of our study was to determine the prevalence of CRE and determine the type of carbapenemase genes present among patients in tertiary care hospitals in Jeddah, Saudi Arabia.Methods: We performed a retrospective chart review on 180 patients in two sites. Primarily, we evaluated the prevalence of KPC, NDM, VIM, OXA-48, and IMP genes of CRE from clinical isolates tested by Xpert® Carba-R. Secondly, we assessed the prevalence of CRE based on antibiogram reports and described the susceptibility of CRE and the aforementioned CRE genes to antimicrobial agents.Results: CRE clinical isolates showed no occurrence of KPC, VIM, and IMP genes. OXA-48 gene was predominantly prevalent, with 76.1%, followed by NDM 13.9%, and both genes co-existed in 6.1% of the isolates. The CRE percent prevalence in one site in 2017 was 3.8%, and increased to 6.03% in 2018, whereas in the second site, the percentage was much higher, reaching 22.9% in 2018 and 18.9% in 2019. The CRE prevalence was dominated by Klebsiella pneumoniae (K. pne), occurring in 92.8% of the isolates, followed by E. coli in 6.7%. K. pne showed a higher frequency of OXA-48 (79%) than NDM (11.7%) genes, with a p-value of 0.007, while E. coli showed an equal frequency of both genes (41.7%). K. pne and E. coli showed high antimicrobial resistance to imipenem, meropenem, tazocin, and ciprofloxacin. However, they showed less resistance to amikacin, gentamycin, and tigecycline. NDM and OXA-48 genes showed 100% resistance to imipenem, meropenem, tazocin, ciprofloxacin and amikacin and the lowest resistance to gentamycin, tigecycline, and colistin.Conclusion: Over the two year retrospective study period, the CRE percent prevalence in the evaluated clinical isolates has remarkably increased. K. pne and E. coli were the most prevalent CRE organisms with OXA-48 and NDM as the predominant genes. CRE organisms and genes showed high antimicrobial resistance to imipenem, meropenem and tazocin, and lower resistance to gentamycin and tigecycline.
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