Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia

Agumas Shibabaw; Zenawork Sahle; Yeshi Metaferia; Asgdew Atlaw; Behailu Adenew; Alemu Gedefie; Mihret Tilahun; Endris Ebrahim; Yeshimebet Kassa; Habtu Debash; Shu-Hua Wang

doi:10.1016/j.ijregi.2023.02.008

Epidemiology and prevention of hospital-acquired carbapenem-resistant Enterobacterales infection in hospitalized patients, Northeast Ethiopia

IJID Reg. 2023 Mar 1:7:77-83. doi: 10.1016/j.ijregi.2023.02.008. eCollection 2023 Jun.

Authors

Affiliations

¹ Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
² Department of Medical Laboratory Sciences, Debre Berhan Health Science College, Debre Berhan, Ethiopia.
³ Department of Medical Laboratory Sciences, Debre Berhan Comprehensive Specialized Hospital, Debre Berhan, Ethiopia.
⁴ Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, and Global One Health initiative, The Ohio State University, Columbus, OH, USA.

Abstract

Objective: Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are usually healthcare associated. The aim of this study was to investigate the epidemiology of hospital-acquired CRE and multi-drug-resistant infections, and identify associated risk factors in hospitalized patients in Northeast Ethiopia.

Methods: This cross-sectional study was conducted in patients admitted with sepsis between January and June 2021. Demographic and clinical data were collected using questionnaires. In total, 384 samples were collected and cultured based on source of infection. Bacterial species identification was performed using biochemical tests, and drug susceptibility testing was done using the Kirby-Bauer disk diffusion method. The modified carbapenem inactivation method was employed for carbapenemase detection. Data were analysed using Statistical Package for the Social Sciences.

Results: The overall rate of CP-CRE infection was 14.6%. Bloodstream infections and urinary tract infections were the predominant hospital-acquired infections (HAIs). The majority of CP-CRE were Escherichia coli and Klebsiella pneumoniae, and accounted for 4.9%. Chronic underlying disease (adjusted odds ratio (AOR): 7.9, 95% confidence interval (CI): 1.9-31.5), number of beds per room (AOR: 11, 95% CI: 1.7-75) and eating raw vegetables (AOR: 11, 95% CI: 3.4-40) were significantly associated with hospital-acquired CRE infection.

Conclusions: The rate of CP-CRE infection found in this study is concerning. There is a need for further evaluation of risk factors and measures to decrease HAI. Hand hygiene, increased laboratory capacity, improved infection prevention measures, and antimicrobial stewardship programmes are needed in healthcare settings to halt the transmission of CP-CRE.

Keywords: Carbapenem-resistant Enterobacterales; Carbapenemase-producing Enterobacterales; Hospital-acquired infection; Hospitalized patients.