Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare-associated Infections Surveillance Data, 2011-2017

Sara Kotb; Meghan Lyman; Ghada Ismail; Mohammad Abd El Fattah; Samia A Girgis; Ahmed Etman; Soad Hafez; Jehan El-Kholy; Maysaa El Sayed Zaki; Hebat-Allah G Rashed; Ghada M Khalil; Omar Sayyouh; Maha Talaat

doi:10.1186/s13756-019-0639-7

Epidemiology of Carbapenem-resistant Enterobacteriaceae in Egyptian intensive care units using National Healthcare-associated Infections Surveillance Data, 2011-2017

Antimicrob Resist Infect Control. 2020 Jan 3;9(1):2. doi: 10.1186/s13756-019-0639-7. eCollection 2020.

Authors

Affiliations

¹ Division of Global Health Protection, US Centers for Disease Control and Prevention, Cairo, Egypt.
² 2Centers for Disease Control and Prevention, Atlanta, GA USA.
³ Supreme Council of Universities, Cairo, Egypt.
⁴ 4Ministry of Health and Population, Cairo, Egypt.
⁵ 5Ain Shams University Hospitals, Cairo, Egypt.
⁶ 6Alexandria University Hospitals, Alexandria, Egypt.
⁷ 7Cairo University Hospitals, Cairo, Egypt.
⁸ 8Mansoura University Hospitals, Mansoura, Egypt.
⁹ 9Assiut University Hospitals, Assiut, Egypt.
¹⁰ 10Zagazig University Hospital, Benha, Egypt.

Abstract

Objective: To describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) healthcare-associated infections (HAI) in Egyptian hospitals reporting to the national HAI surveillance system.

Methods: Design: Descriptive analysis of CRE HAIs and retrospective observational cohort study using national HAI surveillance data. Setting: Egyptian hospitals participating in the HAI surveillance system. The patient population included patients admitted to the intensive care unit (ICU) in participating hospitals. Enterobacteriaceae HAI cases were Klebsiella, Escherichia coli, and Enterobacter isolates from blood, urine, wound or respiratory specimen collected on or after day 3 of ICU admission. CRE HAI cases were those resistant to at least one carbapenem. For CRE HAI cases reported during 2011-2017, a hospital-level and patient-level analysis were conducted using only the first CRE isolate by pathogen and specimen type for each patient. For facility, microbiology, and clinical characteristics, frequencies and means were calculated among CRE HAI cases and compared with carbapenem-susceptible Enterobacteriaceae HAI cases through univariate and multivariate logistic regression using STATA 13.

Results: There were 1598 Enterobacteriaceae HAI cases, of which 871 (54.1%) were carbapenem resistant. The multivariate regression analysis demonstrated that carbapenem resistance was associated with specimen type, pathogen, location prior to admission, and length of ICU stay. Between 2011 and 2017, there was an increase in the proportion of Enterobacteriaceae HAI cases due to CRE (p-value = 0.003) and the incidence of CRE HAIs (p-value = 0.09).

Conclusions: This analysis demonstrated a high and increasing burden of CRE in Egyptian hospitals, highlighting the importance of enhancing infection prevention and control (IPC) programs and antimicrobial stewardship activities and guiding the implementation of targeted IPC measures to contain CRE in Egyptian ICU's .

Keywords: Antimicrobial resistance; Carbapenem resistance Enterobacteriaceae; Healthcare-associated infections.

Publication types

Observational Study
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Adult
Antimicrobial Stewardship
Blood / microbiology
Carbapenem-Resistant Enterobacteriaceae / classification*
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
Child
Child, Preschool
Cross Infection / blood
Cross Infection / epidemiology*
Cross Infection / urine
Databases, Factual
Egypt
Enterobacteriaceae Infections / blood
Enterobacteriaceae Infections / epidemiology*
Enterobacteriaceae Infections / urine
Female
Humans
Infant
Intensive Care Units
Male
Middle Aged
Population Surveillance
Retrospective Studies
Risk Factors
Urine / microbiology
Young Adult