Epidemiology and risk factors for Carbapenem-Resistant Enterobacteriaceae infection: a study in Bamrasnaradura Infectious Diseases Institute

Abstract

       Background and Objectives: Carbapenem Resistant Enterobacteriaceae (CRE) are strains of enterobacteriaceae resist to carbapenem.  Nowadays, CRE has been spreading worldwide and become the leading cause of mortality and outbreaks in healthcare setting. Hence, active surveillance of CRE in hospital could contribute to effective infection management and control.  The aims of this study are to elucidate epidemiological data of CRE infection and to analyze risk factors related to the infection from medical records of patients admitted to the Bamrasnaradura Infectious Diseases Institute during 2014 – 2018.  Method: The data of confirmed CRE infection were collected form medical records of 5,917 Enterobacteriaceae-infected patients that admitted to the Bamrasnaradura Infectious Diseases Institute during 2014 – 2018. The data of resistance-accociated gene profile of CRE including blaNDM-1, blaOXA, blaIMP, blaKPC, and blaVIM were also collected and analyzed the accociation with age, gender and mortality rate in the patients.  Result: There were 68 CRE-infected patients were identified during 2014 – 2018. The identified CRE that were cabapenemase producing-CRE (CP-CRE) had a variety pattern of resistance-accociated gene profile i.e., carrying individual blaNDM-1, blaOXA and blaIMP, carrying blaNDM-1, mcr-1 and blaNDM-1 and blaIMP combinatorial genes, and carrying none of the five genes.  Among the CRE-infected patients, most of them were male (60.3%) and eldery, 60 years of age or older, (72.1%). The fatality rate found in the CRE-infected patients was 0.2%. Association between resistance-accociated gene profile and the above-mentioned parameters warrants further study.  Conclusion and Discussion: The prevalence of CRE infection in Bamrasnaradura Infectious Diseases Institute had increased from 0.4 % to 1.2 % since the year 2014 to 2018, of those, most of them were blaNDM-1 combined with blaOXA (27.9%).  The most common species isolated from the patients’s samples were K. pneumoniae.  Among them, Klebsiealla pneumoniae carbapenemase (KPC)-producing bacteria were not found.  Male elderies were vulnerable for CRE infection.  The gained data will be beneficial to implementation of policy for infection control and management in the healthcare setting.