Environmental colonization and transmission of carbapenem-resistant enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii in intensive care unit

Abstract

Background and Objectives: Health care-associated infections (HAI) are one of the most common adverse events in health-care delivery and an endemic burden as major health-care problem. Carbapenems have broad-spectrum antibacterial activity and thus known as Extended-spectrum β-lactamases. Therefore, the emergence of carbapenem-resistant bacteria poses great significance in HAI. Methods: The study was undertaken to see the prevalence of carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant enterobacteriaceae (CRE) in patient samples and surrounding environment. During the study, all the patients' clinical samples sent to the microbiology department for culture sensitivity were considered. All isolates were processed according to standard microbiological protocols and reported according to the Clinical and Laboratory Standards Institute guidelines. Environmental swabs were taken from HI-touch areas from all intensive care unit (ICU)-admitted patients' rooms. Results: Around 290 isolates were reported during the study from concerned ICUs. Out of which 80 samples were carbapenemase producers. Environmental samples were collected from ICUs from Hi-Touch areas showed growth in 23 samples out of a total of 270. Carbapenem-resistant isolates identified in the study belonged equally to Enterobacteriaceae (most common-Klebsiella pneumoniae and Escherichia coli) and nonfermenters classes (CRAB and Pseudomonas aeruginosa), were of similar concern and also difficult to treat, and further compounds the morbidity and mortality of associated infections. The majority of carbapenem-resistant pathogens in this study were resistant to extended-spectrum cephalosporins, fluoroquinolones, and piperacillin-tazobactam (multidrug-resistant [MDR]). Interpretation and Conclusions: In a setting where CRE and CRAB persist, environmental contamination is common. Screening of patients, ensuring strict contact precautions, and strictly following decontamination guidelines in ICUs can be a powerful tool in discerning HAI caused due to CRE and CRAB.