Abstract
ObjectiveTo describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system.MethodsDesign: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011–2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13.ResultsThere were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09).ConclusionsThis analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU’s .
Highlights
Antimicrobial resistance (AMR) is being increasingly recognized as a global health security threat that requires integrated action across government sectors and society as a whole [1]
Using data from Egypt’s national healthcare-associated infections (HAI) surveillance program, we described HAIs caused by Carbapenem-resistant Enterobacteriaceae (CRE) to examine burden, trends, and risk factors associated with CRE HAIs in intensive care unit (ICU) patients compared to those with carbapenem-susceptible Enterobacteriaceae (CSE) HAIs
Definitions HAI surveillance definitions used for bloodstream infections (BSI), urinary tract infections (UTI), PNA, and surgical site infections (SSI) were derived from the Centers for Disease Control and Prevention’s (CDC) 2012 National Healthcare Safety Network (NHSN) [16], with minor adaptations for the primary BSI case definition
Summary
Antimicrobial resistance (AMR) is being increasingly recognized as a global health security threat that requires integrated action across government sectors and society as a whole [1]. Healthcare-related risk factors associated with CRE infection include prolonged hospital stay, presence of invasive medical devices, admission to an intensive care unit (ICU), and previous exposure to antimicrobials [9,10,11,12]. Data on these risk factors are useful to guide CRE prevention and control efforts, but most data describing CRE epidemiology are reported from high resource settings [13]. Using data from Egypt’s national HAI surveillance program, we described HAIs caused by CRE to examine burden, trends, and risk factors associated with CRE HAIs in ICU patients compared to those with carbapenem-susceptible Enterobacteriaceae (CSE) HAIs
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