A retrospective study on molecular epidemiology trends of carbapenem resistant Enterobacteriaceae in a teaching hospital in Malaysia

• Published in: PeerJ (San Francisco, CA) Vol. 10; p. e12830
• Main Authors: Kong, Zhi Xian, N Karunakaran, Rina, Abdul Jabar, Kartini, Ponnampalavanar, Sasheela, Chong, Chun Wie, Teh, Cindy Shuan Ju
• Format: Journal Article
• Language: English
• Published: United States PeerJ. Ltd 22.02.2022; PeerJ, Inc; PeerJ Inc
• Subjects: Antibiotics; Antimicrobial agents; Bacterial pneumonia; Beta lactamases; Carbapenem resistant Enterobacteriaceae; Carbapenem-Resistant Enterobacteriaceae - genetics; Carbapenemase; Carbapenems - pharmacology; Catheters; Colistin; Drug resistance in microorganisms; E coli; Enterobacteriaceae; Epidemiology; Ethics; Hospitalization; Hospitals, Teaching; Humans; Imipenem; Klebsiella pneumoniae; Laboratories; Malaysia; Medical research; Meropenem; Microbiology; Minimum inhibitory concentration; Molecular Biology; Molecular Epidemiology; Mortality; Nosocomial infections; Pathogens; Patients; Pneumonia; Porins; Pulse-field gel electrophoresis; Retrospective Studies; Risk factors; Software; Statistical analysis; Teaching hospitals; Thailand; Malaysia; Thailand; United States > US; Indonesia; Carbapenem resistant Enterobacteriaceae; Carbapenemase; Pulse-field gel electrophoresis; Epidemiology; Porins
• ISSN: 2167-8359; 2167-8359
• DOI: 10.7717/peerj.12830

Carbapenem resistant (CRE) has rapidly disseminated worldwide and has become a global threat to the healthcare system due to its resistance towards "last line" antibiotics. This study aimed to investigate the prevalence of CRE and the resistance mechanism as well as the risk factors associated with in-hospital mortality. A total of 168 CRE strains isolated from a tertiary teaching hospital from 2014-2015 were included in this study. The presence of carbapenemase genes and minimum inhibitory concentration of imipenem, meropenem and colistin were investigated. All carbapenem-resistant ( ) strains were characterised by PFGE. The risk factors of patients infected by CRE associated with in-hospital mortality were determined statistically. The predominant CRE species isolated was . The carbapenemases detected were OXA-48, OXA-232, VIM and NDM of which OXA-48 was the predominant carbapenemase detected among 168 CRE strains. A total of 40 CRE strains harboured two different carbapenemase genes. A total of seven clusters and 48 pulsotypes were identified among 140 CRKp strains. A predominant pulsotype responsible for the transmission from 2014 to 2015 was identified. Univariate statistical analysis identified that the period between CRE isolation and start of appropriate therapy of more than 3 days was statistically associated with in-hospital mortality.