Macrolides: a novel risk factor for carbapenemase-producing Enterobacterales in intensive care units.

Carmen Soria-Segarra,Angel Catagua-González,Miguel Chung-Sang,Raquel Quijano-Grunauer,Claudia Soria-Segarra,César Narváez-Peñaloza,José Gutiérrez-Fernández,Franklin Vega-Franco,Marcia Apolo-Matamoros

doi:10.3855/jidc.13319

Abstract

Carbapenemase-producing Enterobacterales (CPE) have emerged as a substantial cause of morbi-mortality worldwide, with a prevalence of approximately 5% in areas with high endemicity. However, available data may not be representative of developing countries, such as Ecuador. In this study, the incidence of CPE in Ecuador and risk factors for infection/colonisation were evaluated. A prospective cohort study was performed from February to April 2016 in seven intensive-care units of Guayaquil, Ecuador. Samples were processed according to the Centers for Disease Control and Prevention laboratory protocol and the CHROMagar mSuper CARBA agar method. Resistance to carbapenems was defined according to Clinical and Laboratory Standards Institute breakpoints. A modified carbapenemase inactivation method was used to identify carbapenamase production phenotypically with molecular confirmation by multiplex polymerase chain reaction. In total, 640 patients were enrolled. The incidence of CPE was 36.4% (N = 233). A multivariate analysis indicated that several factors were associated with CPE acquisition, included a long intensive care unit stay (OR 1.05; 95% CI 1.03-1.08; p < 0.01), tracheostomy (OR 3.52; 95% CI 1.90-6.75; p < 0.01), hospitalisation 3 months prior to admission (OR 2.07; 95% CI 1.17-3.71; p < 0.01), vancomycin use (OR 3.31; 95% CI 2.02-5.18; p < 0.01), and macrolide use (OR 3.31; 95% CI 1.43-7.76; p < 0.01). Macrolide use was a risk factor for CPE acquisition. This association should be evaluated further, especially in developing countries.

Highlights

Carbapenemase-producing Enterobacterales (CPE) have emerged as a substantial cause of morbi-mortality worldwide, with a prevalence of approximately 5% in areas with high endemicity
Klebsiella pneumoniae was identified in 90.65% (N = 223), Proteus mirabilis in 2.85% (N = 7), Enterobacter cloacae in 2.44% (N = 6), Escherichia coli in 1.63% (N = 4), Klebsiella aerogenes in 1.2% (N = 3), and Klebsiella oxytoca in 1.22% (N = 3) of cases
Risk factors for infection or colonisation with CPE before current admission in patients who tested positive after enrolment included previous hospitalisation (RR 1.44; 95% confidence intervals (CIs) 0.86–1.58; p < 0.01), use of invasive procedures (RR 1.17; 95% CI 0.86–1.58; p = 0.33), haemodialysis (RR 1.05; 95% IC 0.60–1.83; p = 0.87), long-term care (RR 0.6; 95% CI 0.13–3.75; p = 0.63), immunosuppression

Summary

Introduction

Carbapenemase-producing Enterobacterales (CPE) have emerged as a substantial cause of morbi-mortality worldwide, with a prevalence of approximately 5% in areas with high endemicity. Conclusions: Macrolide use was a risk factor for CPE acquisition This association should be evaluated further, especially in developing countries. Have emerged as a substantial cause of morbi-mortality worldwide [1], with a prevalence of approximately 5% in high endemicity areas These statistics may not be representative of developing countries, such as Ecuador, where CPE has shown rapid dissemination since 2010 [2,3,4]. The aims of this study were to determine the incidence of CPE colonisation/infection and related risk factors in patients in intensive-care units (ICUs) in Guayaquil, Ecuador

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