This extensive investigation dealt with carbapenem-resistant Enterobacterales (CREs), a considerable cause of healthcare-associated infections, particularly in healthcare institutions with limited resources devoted to infection prevention and control. Additionally, these bacterial strains are notably challenging to treat, resulting in high mortality rates due to their significant levels of antibiotic resistance. The investigation focused on describing the epidemiology and clinical characteristics of patients infected with CRE in a referral hospital located in a developing country.
To ensure an extensive, informative study, a retrospective, cross-sectional analysis was conducted. It involved 218 patients admitted to the An-Najah National University Hospital over approximately a year and a half period. The aim was to focus on patients with CRE infection or colonization within this healthcare setting. With 61.9% of the patients presenting with CR-Klebsiella pneumoniae and 38.1% with CR-Escherichia coli, these bacteria sourced the majority of CRE-related cases. Interestingly, the gender ratio of the patients was equivalent to the bacterial infection ratio, with 61.9% male and 38.1% female.
The investigation observed malignancy as a prevalent comorbid condition amongst 36.7% of the patients. Emergency department patients comprised the greatest percentage of acquired CREs, at 18.3%. In terms of bacteria detection, the majority of CRE pathogens were found in rectal swabs, accounting for 61.3% of isolated bacteria. The antibiotic most frequently used to treat the patients was colistin at 13.3%.
Resistance to antibiotics varied, with CR-K. pneumoniae being more resistant than CR-E. coli. The study concluded that the persistence of CRE in this healthcare environment suggests a selective pressure and healthcare-associated transmission. Additionally, the resistant patterns towards accessible therapy options were strikingly high.
Contending with gram-negative infections resulting from multidrug-resistant organisms (MDR) showcases some of the challenges faced in healthcare systems worldwide. This is particularly true for CREs, as these organisms present high levels of antibiotic resistance. Treating infections resulting from carbapenem resistance typically employs established regimens, incorporating antibiotics such as colistin, aminoglycosides, and tigecycline. However, these treatments often come with side effects like ototoxicity and nephrotoxicity.
This study in summary has provided vital epidemiological information and highlighted the importance of effective infection control and prevention. It contributes greatly to our understanding of CRE colonization and infection, offering healthcare professionals a clear assessment of associated risks and enabling the selection of appropriate empiric antimicrobials for treatment.