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CC BY-NC-ND 4.0 · J Lab Physicians 2019; 11(02): 111-117
DOI: 10.4103/JLP.JLP_101_18
Original Article

Epidemiology of carbapenem-resistant Enterobacteriaceae in a Tertiary Care Center in the Kingdom of Bahrain

Nermin Kamal Saeed
Department of Pathology, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
,
Safaa Alkhawaja
Department of Infection Control, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
,
Nashawa Fawzy Abd El Moez Azam
Department of Microbiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
,
Khalil Alaradi
Departments of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Manama, Kingdom of Bahrain
,
Mohammed Al-Biltagi
Department of Pediatrics, Tanta University, Egypt and Arabian Gulf University, Bahrain, Kingdom of Bahrain
› Author Affiliations Financial support and sponsorship: Nil
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Abstract

PURPOSE: The purpose of the study is to estimate the rate of infection with carbapenem-resistant Enterobacteriaceae (CRE) in the main governmental tertiary care hospital in Bahrain.

MATERIALS AND METHODS: All clinical samples with positive growth of CRE over 6-year period (January 2012–December 2017) were collected from the microbiology laboratory data.

RESULTS: The CRE incidence was high in the first half of study period (2012–2014) and then decreased between 2015 and 2017, after implementation of intensified CRE control measure bundle. About 49.4% of CRE-positive samples were isolated from the elderly age group (above 65 years old), most of them were admitted in the intensive care unit (ICU). The most common isolated organisms were Klebsiella pneumoniae (87.0%), followed by Escherichia coli (7.9%). Isolates from deep tracheal aspirate and midstream urine specimens were the most common source of CRE isolates (27.3%) and (26.3%), respectively. Bacteremia was documented in 21.2% of cases. CRE isolates in the study showed high rates of resistance to aminoglycosides (72.2% resistant to amikacin and 67.3% to gentamicin). Alternatively, most isolates retained their susceptibility to colistin and tigecycline with sensitivity of 83.9% and 85.7%, respectively. Combined resistance to both colistin and tigecycline was observed in 0.06% of total isolates.

CONCLUSION: Elderly population and ICU admission were important risk factors for CRE acquisition. Most of CRE isolates were sensitive to both colistin and tigecycline, which make them the best combination for empiric frontline therapy for suspected serious CRE infection in our facility. Implementing CRE-bundled infection control measures significantly reduced the incidence of CRE infection in our hospital.

Key words

Bahrain - carbapenem-resistant Enterobacteriaceae - Escherichia coli - Klebsiella pneumoniae


Publication History

Received: 24 July 2018

Accepted: 27 March 2019

Article published online:
06 April 2020

© 2019.

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