Carbapenem Sensitivity vs Resistance to Gram Negative Organisms: Clinical Outcomes from a Single Center Tertiary Care Hospital in Low and Middle Income Country (LMIC)

Abstract

Introduction: The treatment of bacterial infections has become increasingly intricate due to the ability of the microorganisms to develop resistance to the current regimen of antibiotics. Carbapenems provide enhanced anaerobic and gram negative coverage as compared with other beta lactams. Due to their stability against extended spectrum beta-lactamases, they have proven to be an effective antimicrobial agent. This study looks at the impact of carbapenem resistance on the inpatient outcomes at our center. Methods: This is a retrospective study which includes all in-patient admissions at our institute between the years 2015 and 2019. All the patients who had their antibiotic sensitivity cultures done at our center were included in the sample. Fifty shortlisted patients were then divided into two groups. Group A: those who were carbapenem resistant (CRE) and Group B: those with an ESBL infection sensitive to Carbapenem (B). Results: The mean age of the sample was 56.54±16.93 years with 31 (62%) of the patients being male, 30 (60%) diabetic, 29 (58%) hypertensive and 26 (52%) having renal dysfunction. There were 31 (62%) patients in group A and 19 (38%) in Group B. CRE isolates from blood and tracheal aspirate had a higher diagnostic value than urine samples (19 vs 6, p= 0.78). The average length of stay in CRE infections was significantly more than the inpatient stay of patients with an ESBL infection (>10 days, CRE= 20, ESBL= 3, p= <0.05). A total of 24 (77.42%) patients in Group A developed complications during inpatient stay as opposed to 9 (47.4%) patients in Group B. The study showed a mortality rate of 21.1% in Group B infections as opposed to a higher, 38.7% in Group A infections. Conclusion: With an increased resistance being developed against antimicrobials around the world, judicious use of antibiotics is recommended in light of the data presented in the paper. Funding Statement: No funding was obtained for this study, either in cash or kind. Declaration of Interests: All the authors affirm that there is no conflict of interest associated with this study. Ethics Approval Statement: An ethics exemption was obtained from the IRB: Ethics and Review Committee of Aga Khan University, Karachi, Pakistan.