Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study

Abstract

Background Carbapenem-resistant Enterobacteriaceae (CRE) are often responsible for severe, life-threatening infections and they represent a critical threat to the available antibiotic agents and to global health. An understanding of the epidemiology of these infections will be indispensable to the development of appropriate case management as well as infection prevention and control (IPC) measures in any healthcare setting. Objectives The objective of this study was to investigate and describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and other gram-negative bacteria in a tertiary hospital in south west Nigeria using routinely collected microbiological laboratory data. Methods A retrospective collection of microbiological laboratory records from the January to June 2018 was performed. All culture and antimicrobial susceptibility test results of patients who required laboratory tests were collected. Other information collected include: patient demographics, clinical specimen types and the requesting hospital department. The data was analyzed using SPSS Windows version 24. Comparison between categorical variables was done using chi-square tests while independent sample t-test was used to determine significant mean differences between groups. A p < 0.05 was taken to be statistically significant. Results The prevalence of carbapenem-resistance among Enterobacteriaceae and gram-negative bacteria isolates was 22% (n = 39/177). Of these, 35.9% (n = 14) were Klebsiella pneumonia , 30.8% (n = 12) were Pseudomonas aeruginosa and 15.4% (n = 6) were Klebsiella oxytoca . 87.2% (n = 34) of these were also multi-drug resistant, with a mean total resistance score of 3.92 (SD = ± 1.44). There were differences observed in proportion of carbapenem-resistance across clinical specialties and age groups; however, these differences were not statistically significant. Independent sample t-test revealed that carbapenem-resistant isolates exhibited more drug resistance than carbapenem-sensitive isolates (3.93 vs. 2.30; p < 0.001). Conclusion Carbapenem resistance is an important threat to the current antibiotic armory. Active surveillance, particularly in the healthcare setting is required to identify high risk groups, inform better treatment options and infection prevention and control measures.

Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study

“…Similarly, a study from Nigeria reported as there is a difference in the proportion of age groups but not statistically associated. 42 In study conducted in Northwest Ethiopia showed that being female (OR 4.46; P = 0.018), age (OR 1.08; P = 0.001), hospitalization (OR 5.23; P = 0.006), and prior antibiotic use (OR 3.98; P = 0.04) were associated risk factors for MDRE. 42 Even though our study agrees as the rates of carbapenem resistance are high among age <5 years, with female sex and for those who had antibiotic usage before culture in general, but it is not statistically associated as p > 0.05.…”

“… 42 In study conducted in Northwest Ethiopia showed that being female (OR 4.46; P = 0.018), age (OR 1.08; P = 0.001), hospitalization (OR 5.23; P = 0.006), and prior antibiotic use (OR 3.98; P = 0.04) were associated risk factors for MDRE. 42 Even though our study agrees as the rates of carbapenem resistance are high among age <5 years, with female sex and for those who had antibiotic usage before culture in general, but it is not statistically associated as p > 0.05. This difference might be explained with female patients are more susceptible for UTI as a natural phenomenon more than half of CR-GNB was isolated from UTI patients, ie, 5 out of 8 patients.…”

The Emergence of Klebsiella pneumoniae with Reduced Susceptibility against Third Generation Cephalosporins and Carbapenems in Lagos Hospitals, Nigeria

“…Interestingly, the three CRKP strains were found in two different hospitals at a close distance of 20 km, an indication of the emergence and circulation of CRKP in Lagos, Nigeria. The prevalence of carbapenem-resistance in 177 isolates of Enterobacterales was 22% in South-West Nigeria in 2018; of them, 35.9% ( n = 14) were K. pneumoniae [ 21 ]. The emergence of ESBL due to bla CTX and bla SHV genes in K. pneumoniae has also been reported in other recent African studies.…”

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

“…Global reports demonstrated variation in the dissemination of CRE such as 52.0% CRE from Vietnam with K. pneumoniae (69.0%) and E. coli (59.0%) as prevalent species [ 73 ], 12.4% CRE from Indonesia [ 74 ], 2.9% CRE from Korea [ 75 ], 77.8% CRE from India [ 76 ], 54.1% CRE from Egypt with CR K. pneumoniae (53.7%) and E. coli (27.1%) [ 77 ], 22.0% CRE from Nigeria with CR K. pneumoniae (35.9%), P. aeruginosa (30.8%) [ 78 ]. While a European cohort study reported 55.0% (944/1717) CRE [ 79 ].…”