Epidemiology and Mortality Analysis Related to Carbapenem-Resistant Enterobacterales in Patients After Admission to Intensive Care Units: An Observational Study

Abstract

Purpose The prevalence of carbapenem-resistant Enterobacterales (CRE) is rapidly increasing worldwide. Patients in the intensive care unit (ICU) are susceptible to CRE infections, and the related mortality rate is increased. It is necessary to understand CRE strains and risk factors for CRE infection in the ICU, to facilitate development of effective prophylactic strategies and treatments for ICU patients. Patients and Methods This observational study was conducted in a tertiary hospital between 2016 and 2021. The subjects were patients with CRE cultured from specimens obtained after ICU admission. Genotypes of strains of CRE and carbapenemase-producing Enterobacterales (CPE) were identified, CRE infection was distinguished from mere colonization, and the clinical course of these patients was investigated. Results Among 327 CRE cases, 84 (25.7%) showed infection and 243 (74.3%) showed colonization. Of these patients, 138 (42.2%) died. The CRE strains were Klebsiella pneumoniae (253 cases, 77.4%), Enterobacter cloacae (44 cases, 13.5%), and Escherichia coli (15 cases, 4.6%). Among CRE cases, CPE was found in 249 (76.1%), including Klebsiella pneumoniae carbapenemase (KPC) in 164 (65.9%), and Guiana extended-spectrum (GES) in 64 (25.7%). A bedridden state, longer ICU stay, chronic kidney disease, malignancy, connective tissue disease, ICU admission for cardiac arrest, and CRE infection were associated with higher mortality, but cerebrovascular disease and ICU admission for trauma were associated with lower mortality. GES outbreak was caused by person-to-person transmission and was controlled through active surveillance. Conclusion The frequency of K. pneumoniae and KPC was the highest, but E. cloacae and GES was characteristically high in this study. Active CRE surveillance can be helpful for controlling outbreak.

Novel insights into genetic characteristics of blaGES-encoding plasmids from hospital sewage

“…The incidence of carbapenemase-producing infections significantly increases mortality and medical costs ( Gasink et al, 2009 ; Otter et al, 2017 ). GES-type carbapenemase producers are present in hospitals for prolonged time, causing outbreaks within hospitals ( Boyd et al, 2015 ; Yamasaki et al, 2017 ; Ellington et al, 2020 ; Literacka et al, 2020 ; Nakanishi et al, 2022 ; Yoo et al, 2023 ). However, the genetic features of resistant isolates are not well understood, and their diffusion capabilities could be underestimated.…”

“…The emergence of carbapenemase producers threatens the effective treatment of gram-negative bacterial infections, owing to their resistance to the most β-lactams, which are commonly used antibiotics, thus limiting therapeutic options ( Gasink et al, 2009 ; Otter et al, 2017 ; Bonomo et al, 2018 ). Guiana extended-spectrum (GES)-type carbapenemase producers are prevalent in both clinical and environmental settings and are known to cause nosocomial outbreaks ( Boyd et al, 2015 ; Naas et al, 2016 ; Yamasaki et al, 2017 ; Ellington et al, 2020 ; Literacka et al, 2020 ; Nakanishi et al, 2022 ; Yoo et al, 2023 ). The bla GES genes are essentially linked to mobile genetic elements, which promote the spread of resistance genes to clinically relevant pathogenic bacteria and have been observed within integron gene cassettes on plasmids with diverse types of replicons ( Naas et al, 2016 ).…”

In vitro activity of novel apramycin-dextran nanoparticles and free apramycin against selected Dutch and Pakistani Klebsiella pneumonia isolates

“…Klebsiella pneumoniae is a Gram-negative bacterial member of the Enterobacteriaceae family that is frequently associated with catheter-associated urinary tract infection and lower respiratory tract infections [ 1 ]. Unfortunately, the extensive use of antibiotics has resulted in the isolation of multi-drug resistant K. pneumoniae , which is linked to high patient mortality rates [ [2] , [3] , [4] , [5] , [6] ]. However, the use of combinations of antibiotics, including the use of aminoglycosides, have been shown to be potentially effective against carbapenem resistant K. pneumoniae [ 7 ], of which plazomicin and apramycin may be most effective [ 8 ].…”