Multidrug-resistant and Extensively Drug-resistant Enterobacteriaceae: Prevalence, Treatments, and Outcomes: A Retrospective Cohort Study

Abstract

Background. Highly resistant gram-negative bacteria (GNB) is a global public health threat, especially in intensive care units (ICU). The purpose of this study is to explore the prevalence of drug resistant Enterobacteriaceae infections at an Intensive Care Unit (ICU) in Saudi Arabia. It also aims to assess the appropriateness of therapies used and whether these therapies improved clinical outcomes. Methods. A retrospective study was conducted from 2015 to 2018 in a tertiary hospital ICUs in Saudi Arabia. Positive cultures for multidrug-resistant (MDR), extensive drug resistant (XDR), and pan drug-resistant (PDR) Enterobacteriaceae: Klebsiella pneumoniae (K. pneumonia), Escherichia coli (E. coli), and Enterobacter species were included. Primary outcome was microbiological cure and 30 days in hospital mortality rates; while secondary outcome was length of hospital stay (LOS). Regression models were used to assess the relationship between appropriateness of therapy and outcomes. Results. This study included 227 Enterobacteriaceae cultures in which 60% were either MDR (n=130) or XDR (n=8) infections; no PDR Enterobacteriaceae cultures were identified. The average subjects’ age was 60.1±17.7 years and 54% were females. Half of the MDR/XDR cultures were E. coli, followed by 33% K. pneumoniae, and 16% Enterobacter infection. The most common antibiotics used were piperacillin/tazobactam (53%), followed by carbapenems (47%) and cephalosporins (21.3%). Antibiotic therapy was considered appropriate in 85 out of 138 (61.59%) subjects only. In-hospital death was 84%, microbiological cure rate was achieved in 40% of cases, and the average LOS was 27 days. Appropriateness of antibiotic therapy prescribed was not a predictor of any of the study clinical outcomes. Conclusion. In this study, there was a high prevalence of resistant Enterobacteriaceae infections, which were associated with a high mortality rate. This warrants the need to assess the effectiveness of antimicrobial stewardship program and infection prevention and control practices particularly in critically ill patients.

Effect of Colistin, Fosfomycin and Meropenem/Vaborbactam on Carbapenem-Resistant Enterobacterales in Egypt: A Cross-Sectional Study

“…[34][35][36] Of 200 Enterobacterales isolates, 105 isolates (52.5%) were MDR, including all CRE strains acquiring non-susceptibility to at least one agent in three or more antimicrobial categories. 37 Similar results were also reported from Ethiopia, 31 Egypt 38 and Saudi Arabia, 39 while, a higher percentage of MDR was reported in other studies 30,[40][41][42] and a lower percentage was documented in some Arab countries 43 and USA. 44 The high prevalence of MDR in Egypt emphasizes the importance of implementing effective infection control strategies and antibiotic stewardship programs, in addition to the education of healthcare workers for early surveillance and preventive measures of MDR isolates to control their spread.…”

Identification and characterization of multidrug‐resistant ESBL‐producing Salmonella enterica serovars Kentucky and Typhimurium isolated in Tunisia CTX‐M‐61/TEM‐34, a novel cefotaxime‐hydrolysing β‐lactamase of Salmonella

“…In this study, the isolates were tested for ESBL phenotype by the double‐disc synergy method (Okoko et al, 2020). Multidrug resistance was defined as acquired nonsusceptibility to at least one agent in three or more antimicrobial categories (Alkofide et al, 2020). The multiple antibiotic resistance index (MARI) for each strain was calculated according to the method described by Krumperman (Krumperman, 1983; Nyandjou et al, 2019).…”

Molecular mechanisms of multidrug resistance in clinically relevant enteropathogenic bacteria (Review)

“…Depending on the number or type of antimicrobials, resistant bacteria can be classified as MDR, which occurs when clinically relevant microorganisms have developed resistance to three or more classes of commonly used antibiotics and/or antimicrobials (18,19); extensively drug-resistant (XDR), microorganisms resistant to at least one agent of all antimicrobial classes; and pandrug-resistant, which includes microorganisms resistant to all agents in all antimicrobial classes (20). Most of these multidrug-resistant bacteria are typically gram-negative enterobacteria representing an important therapeutic challenge in the treatment of life-threatening infections (12,15).…”