Carbapenem-Resistant Enterobacteriaceae among In-Patients of Tertiary Hospitals in Southwest, Nigeria

Abstract

The study assessed the incidence and risk factor associated with the occurrence of carbapenem-resistant Enterobacteriaceae (CRE) among hospitalized patients at three tertiary hospitals in Southwest, Nigeria. A cross-sectional study was performed over a six-month surveillance period in the locations with a total of 300 blood and urine samples. A structured close-ended questionnaire was also administered to all subjects for review of demographics and potential risk factors. Fifty-nine isolates belonging to genera Escherichia (52.5%), Enterobacter (23.8%), Klebsiella (10.2%) and Proteus (13.6%) were isolated. All the isolates were multi-drug resistant with a notable resistance (100%) to cephalosporins and significant sensitivity to nitrofurantoin. A total of 23 isolates including Escherichia coli (n = 8), Enterobacter aerogenes (n = 9), Klebsiella pneumoniae (n = 1) and Proteus mirabilis (n = 5) exhibited resistance to one or both of imipenem and meropenem. The overall incidence of CRE in the three locations at the time of study was 7.7%. Age (p = 0.01) and exposure to invasive devices were significant risk factors for CRE colonization. Although at low incidence, the occurrence of CRE among this group calls for active monitoring because of its implication fatality of infections as well as the propensity to spread.

Generic Salmonella in Asymptomatic Adult Volunteers: Occurrence, Antibiogram, Extended-Spectrum β-Lactamase Production and Carbapenem Resistance

“…Antibacterial-resistant (ABR) salmonellae represent a huge threat to global public health (Lugito and Cucunawangsi, 2017). Although most non-typhoidal Salmonella (NTS) infections are self-limiting, ABR non-typhoidal salmonellae, the most frequent cause of foodborne illness in humans and animals are associated with 93.8 million cases of invasive gastroenteritis resulting in up to 35% hospitalization and 28% mortality rates per year worldwide while ABR typhoidal salmonellae are associated with 26 million cases with and without fever) is uncontrolled (Akinyemi et al, 2015;Anyanwu et al, 2017;Anibijuwon et al, 2018). Previous treatment with different types of antibacterial agents, including 3GCs and carbapenems, and visitation to hospitals, are factors that facilitate colonization of individuals by ABR salmonellae (Lugito and Cucunawangsi, 2017;Whistler et al, 2018;Adikwu et al, 2018).…”

Antibiotic Resistance Patterns among Gram-negative Bacteria from Patients with Urinary Tract Infection at a Healthcare Center in Ekiti-State, Nigeria

“…Reduced susceptibility to carbapenems are also increasingly reported even though for now, resistance among bacterial infections to carbapenems has not attained any crisis level but their presence is considered an emerging threat to health care (Eshetie et al, 2015). There are reports of increasing incidence of resistance to carbapenems in core clinical settings in Nigeria [31,32]. The bacteria also demonstrated diversity in their ability to resist multiple antibiotics of different groups.…”

Prevalence of Phenotypic Carbapenem-Resistant Enterobacterales Isolates and Their Distribution by Sex, Age Groups, State and Species in South-East Nigeria

“…They produce difficult to treat infections of all types with associated increase in morbidity, prolonged hospital stay, increased cost of treatment and a mortality rate that is greatly increased to about 50%. 5,6 Different mechanisms for carbapenem resistance in Enterobacterales have been reported. They include; reduced outer membrane permeability due to loss of porins, over-expression efflux pumps and production of carbapenemase enzymes.…”