Carbapenem-Resistant Enterobactericeae: ClinicoEpidemiological Perspective

Since its first discovery in 1996, Carbapenem-resistant Enterobactericeae (CRE) has been increasingly reported as a cause of infections particularly in immunocompromised patients. With limited treatment options, these multidrug-resistant organisms are associated with high mortality rates and are now recognized as an important cause of health-care associated infections. This study aimed to determine the prevalence of CRE at a 500-bedded tertiary hospital in Selangor, Malaysia. This study identified and analyzed CRE culture results from January 2015 to December 2016. The isolates were identified by conventional and Vitek 2® methods. Susceptibility tests were done by disk diffusion technique and confirmed by E-test. Polymerase chain reaction was performed to identify NDM-1, KPC, OXA-48, VIM and IMP genes. Demographic data and clinical characteristics were collected from the Hospital Information System. The prevalence of CRE in 2015 and 2016 was 0.3% (5/1590) and 1.2% (17/1402) respectively. 65% of the patients had underlying haematological disorders. Majority (81.8%) of the isolates were Klebsiella pneumoniae, followed by Serratia marcescens, Escherichia coli, and Citrobacter koseri. Klebsiella pneumoniae that co-produced NDM-1 and OXA48 genes were the most common encounter (41%), followed by OXA-48 (35%), NDM-1 (12%) and KPC (6%). All isolates were resistant to all generations of cephalosporin and carbapenem. The rate of resistance to tigecycline, polymyxin B and colistin were quite high; 46% (5 from 12 isolates), 17% (2/12) and 17% (3/17) respectively. The prevalence of CRE in this institution was relatively low. However, there is a high prevalence of OXA-48 and NDM co-producer amongst CRE isolates. Physicians should have high index of CRE suspicion in hematological patients.