Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010–2018

Moussally, Moustafa; Zahreddine, Nada; Kazma, Jamil; Ahmadieh, R.; Kan, Souha S.; Kanafan, Zeina A.

doi:10.1016/j.jiph.2020.11.006

Cited by 19 publications

(14 citation statements)

References 26 publications

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“…In our study herein, the incidence of CRE carriage among inpatients significantly increased from 0.21 cases per 1000 PD in 2015 to 1.89 cases per 1000 PD in 2019 (r = 0.893, r 2 = 0.789, P = 0.041). Our results are in line with previous findings reported in a retrospective study describing the temporal trends of antibiotic resistance of priority organisms among hospitalized patients at another tertiary care center in Lebanon 13 . Investigators reported a substantial increase in the incidence density of carbapenem-resistant E. coli from 0 per 10,000 PD in 2010 to 4.44 per 10,000 PD in 2018 (r = 0.91; P < 0.001) and in carbapenem-resistant K. pneumoniae from 0 per 10,000 PD in 2010 to 7.7 per 10,000 PD in 2018 (r = 0.54; P = 0.14) 13 .…”

Section: Discussionsupporting

confidence: 93%

“…Carbapenem-resistant Gram-negative pathogens have progressively disseminated to different countries worldwide, presenting a serious public health concern 10 . CRE is increasingly reported in Lebanon and in the whole Middle East region 2 , 3 , 10 , 13 . A compilation of antibiotic susceptibility data of different pathogenic bacteria isolated from various types of clinical specimens from 13 Lebanese hospital laboratories during 2015 and 2016 showed that 40% of the isolated Enterobacteriaceae were resistant to 3GCs and that 3% were resistant to carbapenems 2 .…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Carbapenem resistant Enterobacterales (CRE) are increasingly reported worldwide 10 . Lebanon is at risk for this alarming situation where an acute increase in prevalence has been seen in the country since identification of its first cases in 2008 2 , 3 , 11 – 13 . This problem is not only confined to the clinical setting in hospitals but is also being disseminated to the environment and community as well 2 , 3 , 11 – 15 .…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Moghnieh

Abdallah

Jadayel

et al. 2021

Sci Rep

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In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical significance (P < 0.05) were included in the forward stepwise multiple logistic regression analysis. To develop the CRE acquisition risk score, variables that maintained statistical significance in the multivariate model were assigned a point value corresponding to the odds ratio (OR) divided by the smallest OR identified in the regression model, and the resulting quotient was multiplied by two and rounded to the nearest whole number. Summation of the points generated by the calculated risk factors resulted in a quantitative score that was assigned to each patient in the database. Predictive performance was determined by assessing discrimination and calibration. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. The incidence of CRE acquisition significantly increased with time from 0.21 cases/1000 patient-days (PD) in 2015 to 1.89 cases/1000PD in 2019 (r2 = 0.789, P = 0.041). Multivariate analysis of matched data revealed that the history of cerebrovascular disease (OR 1.96; 95% CI 1.04–3.70; P = 0.039), hematopoietic cells transplantation (OR 7.75; 95% CI 1.52–39.36; P = 0.014), presence of a chronic wound (OR 3.38; 95% CI 1.73–6.50; P < 0.001), endoscopy done during the 3 months preceding the index hospitalization (OR 2.96; 95% CI 1.51–4.73; P = 0.01), nosocomial site of acquisition of the organism in question (OR 2.68; 95% CI 1.51–4.73; P = 0.001), and the prior use of meropenem within 3 months of CRE acquisition (OR 5.70; 95% CI 2.61–12.43; P < 0.001) were independent risk factors for CRE acquisition. A risk score ranging from 0 to 25 was developed based on these independent variables. At a cut-off of ≥ 5 points, the model exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 64.5%, 85.8%, 82%, 70.7% and 75%, respectively. We also showed that only meropenem consumption intensity and CRE acquisition incidence density showed a strong positive correlation(r = 0.798, P = 0.106), unlike imipenem (r = − 0.868, P = 0.056) and ertapenem (r = 0.385, P = 0.522). Patients with a score of ≥ 5 points in our model were likely to acquire CRE. Only meropenem was associated with CRE carriage. Our proposed risk prediction score would help target surveillance screening for CRE amongst inpatients at the time of hospital admission and properly guide clinicians on using anti-CRE therapy.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Moghnieh

Abdallah

Jadayel

et al. 2021

Sci Rep

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“…Carbapenem consumption has been found to be associated with increasing rates of CRAb [ 48 ]. CRAb is a pathogen of concern in our hospital, where according to targeted surveillance efforts, the rates of CRAb sharply increased from 52% in 2010 to peak at 92% in 2012 [ 49 ]. A prospective study conducted at our center between 2007 and 2014 showed that the most common site for isolating CRAb was the respiratory tract, notably in patients with ventilator-associated pneumonia (VAP) [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Rizk

Zahreddine²,

Haddad³

et al. 2022

Antibiotics

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Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.

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“…Resistance to carbapenem in K. pneumoniae increased with time to reach 6.5% as shown by a study that covered the period between 2010-2018 and included 2494 isolates recovered from a Lebanese tertiary care center ( Moussally et al, 2021). The first metalloβ-lactamase producing K. pneumoniae in Lebanon was identified in 2008 and was found to carry the bla IMP-1 gene (Daoud et al, 2008).…”

Section: Carbapenemasesmentioning

confidence: 99%

Phenotypic and Molecular Characterization of Multi-drug Resistant Klebsiella spp. Isolates Recovered from Clinical Settings. (c2021)

Diab¹

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Klebsiella pneumoniae is a Gram-negative bacterium that colonizes the gastrointestinal tract and nasopharynx with the vast majority associated with hospitalization and causing human nosocomial infections. Extended-spectrum β-lactamases (ESBL)-producing and carbapenem-resistant K. pneumoniae is recognized by the World Health Organization (WHO) as a serious public health concern. In this study, whole-genome sequencing (WGS) – based analysis was performed to understand the molecular epidemiology of multi-drug resistant Klebsiella spp. clinical isolates. Genome comparison, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and whole-genome-SNP-based phylogenetic analysis (wg-SNP) were used to determine the relatedness of the isolates. in silico typing was used to determine the resistance genes, virulence factors, Inc groups, and capsular types. All except one isolate were non-susceptible to meropenem and 89% were non-susceptible to ertapenem and imipenem. blaNDM, blaOXA-48, and blaKPC were the carbapenemase-linked genes with blaNDM-1 being detected in half of the sequenced isolates. Resistance to colistin was detected in one and was correlated to mutations in ccrB, pmrB, and pmrC genes. The most common plasmid type was IncFIB followed by IncR, and the Type 3 fimbriae, chromosomally encoded by the mrkABCDF operon, was conserved among the sequenced Klebsiella spp. The most common sequence (ST) and K-type detected were ST147 and K64. A nosocomial outbreak linked to a carbapenem-resistant ST147 K. pneumoniae supported by SNPs-based analysis, PFGE clustering, and genome comparison was also detected. This study provides crucial insights into antimicrobial resistance and the virulence of an increasingly important global pathogen. It also confirms that whole-genome sequencing data should be integrated into routine and targeted pathogen surveillance, outbreak detection, and infection control.

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Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010–2018

Cited by 19 publications

References 26 publications

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales

The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon

Phenotypic and Molecular Characterization of Multi-drug Resistant Klebsiella spp. Isolates Recovered from Clinical Settings. (c2021)

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