Abstract
BackgroundCarbapenem-resistant Enterobacterales (CRE) is a global threat. Enterobacterales develops carbapenem resistance through several mechanisms, including the production of carbapenemases. We aim to describe the prevalence of Carbapenem-resistant Enterobacterales (CRE) with and without carbapenemase production and distribution of carbapenemase-producing (CP) genes in Thailand using 2016–2018 data from a national antimicrobial resistance surveillance system developed by the Thailand National Institute of Health (NIH).MethodsCRE was defined as any Enterobacterales resistant to ertapenem, imipenem, or meropenem. Starting in 2016, 25 tertiary care hospitals from the five regions of Thailand submitted the first CRE isolate from each specimen type and patient admission to Thailand NIH, accompanied by a case report form with patient information. NIH performed confirmatory identification and antimicrobial susceptibility testing and performed multiplex polymerase chain reaction testing to detect CP-genes. Using 2016–2018 data, we calculated proportions of CP-CRE, stratified by specimen type, organism, and CP-gene using SAS 9.4.ResultsOverall, 4,296 presumed CRE isolates were submitted to Thailand NIH; 3,946 (93%) were confirmed CRE. Urine (n = 1622, 41%) and sputum (n = 1380, 35%) were the most common specimen types, while blood only accounted for 323 (8%) CRE isolates. The most common organism was Klebsiella pneumoniae (n = 2660, 72%), followed by Escherichia coli (n = 799, 22%). The proportion of CP-CRE was high for all organism types (range: 85–98%). Of all CRE isolates, 2909 (80%) had one CP-gene and 629 (17%) had > 1 CP-gene. New Delhi metallo-beta-lactamase (NDM) was the most common CP-gene, present in 2392 (65%) CRE isolates. K. pneumoniae carbapenemase (KPC) and Verona integron-encoded metallo-β-lactamase (VIM) genes were not detected among any isolates.ConclusionCP genes were found in a high proportion (97%) of CRE isolates from hospitals across Thailand. The prevalence of NDM and OXA-48-like genes in Thailand is consistent with pattern seen in Southeast Asia, but different from that in the United States and other regions. As carbapenemase testing is not routinely performed in Thailand, hospital staff should consider treating all patients with CRE with enhanced infection control measures; in line with CDC recommendation for enhanced infection control measures for CP-CRE because of their high propensity to spread.
Highlights
Antimicrobial resistance (AMR) is a global health priority considering its association with high morbidity and mortality and increased healthcare costs [1,2,3]
A total of 4296 presumed Carbapenem-resistant Enterobacterales (CRE) isolates were submitted to National Institute of Health (NIH) by participating hospital laboratories and 3946 (92%) isolates from 3748 patients were confirmed by NIH as CRE [Fig. 1], with 224 patients having multiple CRE
While previous studies show that there is a high burden of CRE in Thailand [6, 7, 23], our analysis demonstrates a high prevalence of CP genes among CRE in Thailand, with 97% of CRE isolates submitted to Enhanced Incorporation of Global and National AMR (EIGNA) having a CP gene
Summary
Antimicrobial resistance (AMR) is a global health priority considering its association with high morbidity and mortality and increased healthcare costs [1,2,3]. Carbapenemase producing CRE (CP-CRE) are more virulent and are associated with higher levels of antimicrobial resistance, worse outcomes, and more rapid spread, while noncarbapenemase-producing CRE (non-CP-CRE) have been associated with asymptomatic carriage and perhaps less person-to-person transmission [12,13,14]. For this reason, CP-CRE have been identified as an important target for prevention sometimes warranting enhanced infection control interventions [15].
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