Multimodal Interventions to Prevent and Control Carbapenem-Resistant Enterobacteriaceae and Extended-Spectrum β-Lactamase Producer-Associated Infections at a Tertiary Care Hospital in Egypt

Abstract

The current rise of multidrug-resistant (MDR) Gram-negative Enterobacteriaceae including the extended-spectrum β-lactamase (ESBL)-producing organisms and carbapenem-resistant Enterobacteriaceae (CRE) has been increasingly reported worldwide, posing new challenges to health care facilities. Accordingly, we evaluated the impact of multimodal infection control interventions at one of the major tertiary healthcare settings in Egypt for the aim of combating infections by the respective pathogens. During the 6-month pre-intervention period, the incidence rate of CRE and ESBL-producing clinical cultures were 1.3 and 0.8/1000 patient days, respectively. During the post-intervention period, the incidence of CRE and ESBL producers continued to decrease, reaching 0.5 and 0.28/1000 patient days, respectively. The susceptibility rate to carbapenems among ESBL producers ranged from 91.4% (ertapenem) to 98.3% (imipenem), amikacin (93%), gentamicin (56.9%), and tobramycin (46.6%). CRE showed the highest resistance pattern toward all of the tested β-lactams and aminoglycosides, ranging from 87.3% to 94.5%. Both CRE and ESBL producers showed a high susceptibility rate (greater than 85.5%) to colistin and tigecycline. In conclusion, our findings revealed the effectiveness of implementing multidisciplinary approaches in controlling and treating infections elicited by CRE and ESBL producers.

Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia

“…In terms of its accuracy in detecting antimicrobial resistance genes, BFPP showed relatively high agreement when compared to VITEK-2 breakpoints, with PPA [100%, 93%, not applicable], NPA [97%, 85%, 90%], and OPA [98%, 90%, 90%] for carbapenemase producers, ESBLs, and MRSA, respectively. In comparison to other studies [28,[39][40][41] that reported on the prevalence of carbapenemase producers and ESBLs among HAP patients, our results revealed a higher rate of detection. This higher resistance rate could be attributed to the large use of antimicrobial agents among ICU patients, leading to more selective pressure and the appearance of different resistant phenotypes.…”

Insights on the performance of phenotypic tests versus genotypic tests for the detection of carbapenemase-producing Gram-negative bacilli in resource-limited settings

“…Overnight cultures of tested isolates were grown in Luria Bertani (LB) broth containing 25 µg/mL meropenem. PCR detection and conditions of carbapenemaseencoding genes was carried out using PCR as previously described [25]. The set of 5 primers with the corresponding annealing temperatures and expected amplicon sizes was shown in supplementary file (Table S1).…”

The Role of Colistin in the Era of New β-Lactam/β-Lactamase Inhibitor Combinations

“…Comparing the efficacy of colistin with other agents for the treatment of CR-GNB infections is extremely difficult due to the large number of different treatment regimens in the comparator arms, the frequent use of combination regimens in both the colistin arm and the comparator arms, and the suboptimal dosing of colistin in many studies. Numerous studies have revealed that almost half of patients treated with colistin for CR-GNB infections develop AKI, and up to two-thirds of these patients have 30-day or in-hospital mortality [ 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. Similarly, poor clinical outcomes (e.g., high clinical failure and prolonged hospital stay) were documented with colistin-based regimens for treating CR-GNB infections [ 77 , 78 , 79 , 80 ].…”