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AIMS Public Health

2020, Volume 7, Issue 4: 804-815. doi: 10.3934/publichealth.2020062
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Research article

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

  • 1.
    Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
  • 2.
    Department of Clinical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
  • Received: 10 July 2020 Accepted: 25 September 2020 Published: 16 October 2020

  • 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.

    Citation: Oluwafolajimi Adetoye Adesanya, Hilda Amauche Igwe. Carbapenem-resistant Enterobacteriaceae (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study[J]. AIMS Public Health, 2020, 7(4): 804-815. doi: 10.3934/publichealth.2020062

    Related Papers:

  • 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.


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    Conflict of interest


    The authors declare they have no competing interests.

    [1] (2014) World Health Organisation (WHO)Antimicrobial Resistance: Global Report on Surveillance. Geneva: . Available from: https://apps.who.int/iris/bitstream/handle/10665/112642/9789241564748_eng.pdf;jsessionid=DF1DFD88C7B094F3DD20B313C898B4D5?sequence=1
    [2] Tamma PD, Goodman KE, Harris AD, et al. (2017) Comparing the Outcomes of Patients With Carbapenemase-Producing and Non-Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Bacteremia. Clin Infect Dis 64: 257-264. doi: 10.1093/cid/ciw741
    [3] Queenan AM, Bush K (2007) Carbapenemases: The versatile β-lactamases. Clin Microbiol Rev 20: 440-458. doi: 10.1128/CMR.00001-07
    [4] Ruppé É, Woerther PL, Barbier F (2015) Mechanisms of antimicrobial resistance in Gram-negative bacilli. Ann Intensive Care 5: 21. doi: 10.1186/s13613-015-0061-0
    [5] Giakoupi P, Maltezou H, Polemis M, et al. (2009) KPC-2-producing Klebsiella pneumoniae infections in Greek hospitals are mainly due to a hyperepidemic clone. Euro Surveill 14.
    [6] Woodford N, Tierno PM, Young K, et al. (2004) Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A β-lactamase, KPC-3, in a New York Medical Center. Antimicrob Agents Chemother 48: 4793-4799. doi: 10.1128/AAC.48.12.4793-4799.2004
    [7] Nordmann P, Cuzon G, Naas T (2009) The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infec Dis 9: 228-236. doi: 10.1016/S1473-3099(09)70054-4
    [8] Woodford N, Turton JF, Livermore DM (2011) Multiresistant Gram-negative bacteria: The role of high-risk clones in the dissemination of antibiotic resistance. Fems Microbiol Rev 35: 736-755. doi: 10.1111/j.1574-6976.2011.00268.x
    [9] Cantón R, Akóva M, Carmeli Y, et al. (2012) Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 18: 413-431. doi: 10.1111/j.1469-0691.2012.03821.x
    [10] Gupta N, Limbago BM, Patel JB, et al. (2011) Carbapenem-Resistant Enterobacteriaceae: Epidemiology and Prevention. Clin Infect Dis 53: 60-67. doi: 10.1093/cid/cir202
    [11] Nordmann P, Naas T, Poirel L (2011) Global spread of carbapenemase producing Enterobacteriaceae. Emerg Infect Dis 17: 1791-1798. doi: 10.3201/eid1710.110655
    [12] Zhang YW, Wang Q, Yin YY, et al. (2018) Epidemiology of Carbapenem-Resistant Infections: Report from the China CRE Network. Antimicrob Agents Chemother 62: e01882.
    [13] Freeman R, Moore LSP, García Álvarez L, et al. (2013) Advances in electronic surveillance for healthcare-associated infections in the 21st Century: A systematic review. J Hosp Infect 84: 106-119. doi: 10.1016/j.jhin.2012.11.031
    [14]  The University College Hospital. Available from: https://www.uch-ibadan.org.ng.
    [15] Chester B, Moskowitz L (1987) Rapid Catalase Supplemental Test for Identification of Members of the Family Enterobacteriaceae. J Clin Microbiol 25: 439-441. doi: 10.1128/JCM.25.2.439-441.1987
    [16] Clinical and Laboratory Standards Institute (2015)  M02-A12 Performance Standards for Antimicrobial Disk Susceptibility Tests. Approved Standard-Twelfth Edition. Available from: https://clsi.org/media/1631/m02a12_sample.pdf.
    [17] Morrill HJ, Pogue JM, Kaye KS, et al. (2015) Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections. Open Forum Infect Dis 2: 1-15. doi: 10.1093/ofid/ofv130.01
    [18] Ampaire L, Katawera V, Nyehangane D, et al. (2015) Epidemiology of Carbapenem Resistance among Multi-drug Resistant Enterobacteriaceae in Uganda. Br Microbiol Res J 8: 418-423. doi: 10.9734/BMRJ/2015/17055
    [19] Mushi MF, Mshana SE, Imirzalioglu C, et al. (2014) Carbapenemase Genes among Multidrug Resistant Gram Negative Clinical Isolates from a Tertiary Hospital in Mwanza, Tanzania. Biomed Res Int 2014: 6. doi: 10.1155/2014/303104
    [20] Mohanty S, Gajanand M, Gaind R (2017) Identification of carbapenemase-mediated resistance among Enterobacteriaceae bloodstream isolates: A molecular study from India. Indian J Med Microbiol 35: 421-425. doi: 10.4103/ijmm.IJMM_16_386
    [21] Messaoudi A, Mansour W, Jaidane N, et al. (2019) Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia. Afr Health Sci 19: 2008-2020. doi: 10.4314/ahs.v19i2.24
    [22] Shettima SA, Tickler IA, Dela Cruz CM, et al. (2019) Characterisation of carbapenem-resistant Gram-negative organisms from clinical specimens in Yola, Nigeria. J Glob Antimicrob Resist 21: 42-45. doi: 10.1016/j.jgar.2019.08.017
    [23] Ogbolu DO, Webber MA (2014) High-level and novel mechanisms of carbapenem resistance in Gram-negative bacteria from tertiary hospitals in Nigeria. Int J Antimicrob Agents 43: 412-417. doi: 10.1016/j.ijantimicag.2014.01.014
    [24] Olalekan A, Onwugamba F, Iwalokun B, et al. (2020) High proportion of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae among extended-spectrum β-lactamase-producers in Nigerian hospitals. J Glob Antimicrob Resist 21: 8-12. doi: 10.1016/j.jgar.2019.09.007
    [25] Freeman R, Moore LSP, Charlett A, et al. (2015) Exploring the epidemiology of carbapenem-resistant Gram-negative bacteria in west London and the utility of routinely collected hospital microbiology data. J Antimicrob Chemother 70: 1212-1218.
    [26] Thomas TS, Duse AG (2018) Epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and comparison of the phenotypic versus genotypic screening tests for the detection of carbapenemases at a tertiary level, academic hospital in Johannesburg, South Africa. South African J Infect Dis 0: 1-7.
    [27] Van Duin D, Perez F, Rudin SD, et al. (2014) Surveillance of carbapenem-resistant Klebsiella pneumoniae: Tracking molecular epidemiology and outcomes through a regional network. Antimicrob Agents Chemother 58: 4035-4041. doi: 10.1128/AAC.02636-14
    [28] Patel N, Harrington S, Dihmess A, et al. (2011) Clinical epidemiology of carbapenem-intermediate or-resistant Enterobacteriaceae. J Antimicrob Chemother 66: 1600-1608. doi: 10.1093/jac/dkr156
    [29] Wang Q, Zhang Y, Yao X, et al. (2016) Risk factors and clinical outcomes for carbapenem-resistant Enterobacteriaceae nosocomial infections. Eur J Clin Microbiol Infect Dis 35: 1679-1689. doi: 10.1007/s10096-016-2710-0
    [30] Onofrio VD, Conzemius R, Varda-brkić D, et al. (2020) Epidemiology of colistin-resistant, carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Croatia. Infect Genet Evol 81: 104263. doi: 10.1016/j.meegid.2020.104263
    [31] Hashemi MM, Rovig J, Weber S, et al. (2017) Susceptibility of colistin-resistant, gram-negative bacteria to antimicrobial peptides and ceragenins. Antimicrob Agents Chemother 61: e00292. doi: 10.1128/AAC.00292-17
    [32] Gordillo Altamirano FL, Barr JJ (2019) Phage therapy in the postantibiotic era. Clin Microbiol Rev 32: e00066-e00068. doi: 10.1128/CMR.00066-18
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