Carbapenem resistant organisms: A 9-year surveillance and trends at Saint George University Medical Center

Abstract

IntroductionCarbapenem resistant organisms (CRO) constitute a large group of bacteria with different mechanisms of resistance and recently increasing global incidence. This rise has ambiguous dynamics and essential local epidemiologic data is lacking. Materials and methodsIn this retrospective study at the 400-bed Saint George Hospital (SGH) in Beirut, Lebanon, we retrieved electronic laboratory records of all intrinsic and acquired CRO isolates from January 1, 2010 until June 30, 2018. Isolation density was calculated as: number of isolates/1000PD. Analysis carried out using WHOnet with a trend time series analysis. ResultsDuring the study period, a total of 2150 non-duplicate CRO were isolated. While Acinetobacter baumanii (AB), Pseudomonas aeruginosa (CRPa), and Stenotrophomonas maltophilia (Sm) constituted 85% of total CRO in the study period, the carbapenem resistant enterobacteriaceae (CRE) rose from few sporadic cases before 2016 to a solid 32% of total CRO in 2018. Our most concrete trends were as follows. The rate of AB bacteremia was at an average of 0.114/1000 PD from 2011 to 2014. In 2015, a sudden doubling of AB bacteremia to 0.23/1000 PD. In 2017, there was a significant decrease to 0.113/1,000PD (p < 0.0001) to reach 0.097/1000PD in 2018 with a continuously declining trend. The peak of Sm bacteremia was in 2016 at 0.121/1000PD after which it significantly decreased by 21% in 2017 to disappear in 2018 (p < 0.0001). There were no significant trends observed in the isolation density of the CRPa group from 2010 until June 2018. Klebsiella pneumonia (CRKp) bacteremia was isolated first in 2013, then in 2016 and continued to rise (p = 0.028). In 2017, carbapenem resistant KP bacteremia rate doubled to 0.05/1,000PD from 0.024/1000 (p = 0.0139). ConclusionIn conclusion, this 9-year study at SGH depicts the major trends and dynamics of local CRO isolation, mainly A. baumanii, P. aeruginosa and CRKp. Further efforts are warranted both locally and internationally for a richer understanding of this trend. Bearing in mind that understanding antimicrobial resistance is a complex, multifaceted process that is only feasible when all its aspects are combined: molecular, phenotypic and clinical.