Abstract
Gram-negative organisms harbouring carbapenem resistance genes (CRGs) are spreading globally, including in Gulf Cooperation Council (GCC) countries. However, relatively few data are available about carriage of CRGs in hospitalized patients in this region. To determine prevalence of CRG carriage and risk factors for colonization among patients in GCC hospitals. Rectal swabs were obtained from ∼50 intensive care unit (ICU) patients from each of 11 hospitals in five GCC countries between March and November 2019. The swabs were tested for the presence of blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48 CRG using a commercial polymerase chain reaction test. Data on risk factors for colonization were collected and analysed. Of 529 specimens screened, 138 (26.1%) were positive for one or more CRGs. The positivity rates among the hospitals ranged from 8.0% to 67.3%; ∼20% of the positive specimens harboured ≥2 CRGs. The most common CRG detected was blaOXA-48, which was present in 82 specimens (15.5%). Additional CRGs included blaNDM, blaVIM, blaKPC, and blaIMP either alone or in combination. Overall, 31.1% of patients on antibiotics on admission to the ICU were positive for CRGs compared to 16.5% not on antibiotic therapy (P < 0.001). CRG detection was also more common among patients aged >65 years (P= 0.027) and increased with hospital length of stay (P= 0.025). The rate of CRGs detected in hospitalized patients in GCC countries varied considerably. Prior antibiotic exposure, increasing age, and prolonged length of stay were associated with CRG detection.
Highlights
Antimicrobial resistance continues to be a medical and public health challenge globally, including in the countries of the Gulf Cooperation Council (GCC) [1]
Action plans for controlling antimicrobial resistance, including those established for GCC countries, call for surveillance programmes to assess the spread of multidrug-resistant organisms as well as the establishment of antimicrobial stewardship programmes to reduce the selective pressure that facilitates development of antimicrobial-resistant organisms [5e7]
Rectal swab specimens were collected from hospitalized patients, primarily on admission to intensive care units (ICUs) and tested using a commercial polymerase chain reaction (PCR) assay to detect carbapenem-resistance genes (CRGs)
Summary
Antimicrobial resistance continues to be a medical and public health challenge globally, including in the countries of the Gulf Cooperation Council (GCC) [1]. There are published data on the classes of carbapenem resistance genes present in bacterial isolates from patients hospitalized in GCC countries, relatively few data are available on colonization rates with CRG-harbouring bacteria [1,11e13]. Rectal swab specimens were collected from hospitalized patients, primarily on admission to intensive care units (ICUs) and tested using a commercial polymerase chain reaction (PCR) assay to detect CRGs. Based on guidance documents from the US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (eCDC) and local infection control initiatives, this study focused on organisms with transmissible carbapenem resistance genes, as opposed to organisms with efflux, porin changes, or other modes of carbapenem resistance [14,15]. Gram-negative organisms harbouring carbapenem resistance genes (CRGs) are spreading globally, including in Gulf Cooperation Council (GCC) countries. 31.1% of patients on antibiotics on admission to the ICU were positive for CRGs compared to 16.5% not on antibiotic therapy
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