Carbapenem- and colistin-resistant Enterobacterales in intensive care unit patients in Mediterranean countries, 2019
- Citation:
- Dos Santos, S., S. M. Diene, A. Benouda, K. Zerouali, D. M. Ghaith, R. H. El-Mahdy, S. H. M. El Tayeb, I. Boutiba, A. Hammami, R. Chrabieh, et al., "Carbapenem- and colistin-resistant Enterobacterales in intensive care unit patients in Mediterranean countries, 2019", Frontiers in Microbiology, vol. 15, 2024.
Abstract:
{\textless}sec{\textgreater}{\textless}title{\textgreater}Introduction{\textless}/title{\textgreater}{\textless}p{\textgreater}The colonization of patients by carbapenemase-producing {\textless}italic{\textgreater}Enterobacterales{\textless}/italic{\textgreater} ({CPE}) has been associated with heightened mortality, especially in vulnerable individuals within intensive care units ({ICUs}). Our study aimed to comprehensively assess {CPE} prevalence among {ICU} patients across the Mediterranean region pre-{COVID}-19, conducting a multicenter prevalence study in the first quarter of 2019.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Methods{\textless}/title{\textgreater}{\textless}p{\textgreater}We collected clinical data and rectal or fecal samples from 256 {ICU} patients for {CPE} testing. Additionally, we performed whole-genome sequencing on 40 representative {CPE} strains to document their molecular characteristics.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Results{\textless}/title{\textgreater}{\textless}p{\textgreater}Among the 256 patients, {CPE} was detected in 73 samples (28.5%), with prevalence varying from 3.3 to 69.0% across participating centers. We observed 13 colistin-resistant {CPE} strains, affecting three {ICUs}. Genetic analysis revealed highly diverse {\textless}italic{\textgreater}E. coli{\textless}/italic{\textgreater} and {\textless}italic{\textgreater}K. pneumoniae{\textless}/italic{\textgreater} strains, predominantly from international high-risk clones. Notably, {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{OXA}-48}}$ and {\textless}italic{\textgreater}bla{\textless}/italic{\textgreater}$_{\textrm{{NDM}-1}}$ were the most prevalent carbapenemase genes. Molecular typing uncovered potential patient clusters in six centers. Significantly, longer hospital stays were associated with increased {CPE} carriage ({\textless}italic{\textgreater}p{\textless}/italic{\textgreater} < 0.001). Nine centers across Morocco, Tunisia, Egypt, and Lebanon voluntarily participated.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}{\textless}sec{\textgreater}{\textless}title{\textgreater}Discussion{\textless}/title{\textgreater}{\textless}p{\textgreater}Our study provides {CPE} prevalence in Mediterranean {ICUs} and reaffirms established {CPE} presence in this setting but also provides updates on the molecular diversity of {CPE} strains. These findings highlight the imperative of reinforcing infection control measures in the participating {ICUs} to curtail escalated mortality rates, and of strictly applying isolation measures around patients originating from the Mediterranean region when transferred to other healthcare institutions.{\textless}/p{\textgreater}{\textless}/sec{\textgreater}
Notes:
Publisher: Frontiers