Development of Guidelines for The Control of Carbapenem - Resistant Enterobacteriaceae Drug Resistance in Pathumthani Hospital

Abstract

Background: Currently, antimicrobial-resistant bacteria pose a significant global public health problems, including  Thailand. The number of patients infected with antimicrobial-resistant bacteria continue to increase annually, complicating treatment as stronger and more effective antibiotics are required, which in turn increases healthcare costs. Patients also need to stay in the hospital longer, which may lead to complications and increased risk of death. Carbapenem antibiotics are commonly used for treating hospital-acquired infections due to their high efficacy. However, as Enterobacteriaceae bacteria begin to develop carbapenem resistance, there is a growing concern that in the future, effective antibiotics for treating severe hospital infections may become unavailable.

Objective: The objective of this study was to assess the situation of Carbapenem-Resistant Enterobacteriaceae (CRE) infections in patients admitted to hospital and to develop strategies for controlling CRE infections in Pathumthani Hospital.

Methods: This study was a retrospective descriptive study involving patients admitted to Pathumthani Hospital between 2022 and 2024 who had bacterial cultures performed from various specimens and underwent testing for antimicrobial resistance genes. The data were analyzed to develop infection control guidelines.

Results: A total of 18,154 cases of Enterobacteriaceae bacteria were identified, with 2,161 cases of CRE, representing 32.25%, 33.82%, and 33.92% annually, respectively. CRE infections mostly caused issues in the respiratory system. The five most significant pathogens were Klebsiella pneumoniae (46.00%), Escherichia coli (38.72%), Klebsiella ozanae (6.91%), Enterobacter cloacae (5.63%), and Klebsiella aerogenes (2.73%). Males were more frequently affected than females, and the majority of affected patients were over 60 years old, accounting for 1,433 cases. The department with the highest incidence of CRE infections was the internal medicine department. Antibiotic susceptibility testing revealed that CRE was resistant to carbapenem antibiotics but still sensitive to amikacin. Gene testing showed that 68.75% of Escherichia coli isolates carried the blaNDM gene, and 80% of Klebsiella pneumoniae isolates carried the blaOXA48-like gene.

Conclusion: CRE infections in Pathumthani Hospital present a significant challenge that requires ongoing control and surveillance. Raising awareness and strict adherence to infection control protocols by all staff members are essential to enable the infection control committee to review processes and implement effective preventions and control measures.