Risk factors associated with colistin resistance in carbapenemase-producing Enterobacterales: a multicenter study from a low-income country

Annals of Clinical Microbiology and Antimicrobials

Research

Bombón Moreno Bryan¹  Chuzan J. John²  Gutierrez-Fernández José³  Diaz Andrés⁴  Cevallos-Apolo Kerly⁵  Miranda-Ayala Marcela⁶  Soria-Segarra Carmen⁷  Soria-Segarra Claudia⁸ 

[1] Department of Human Biology, University of Toronto, Toronto, Canada;Department of Microbiology, Hospital Alcívar, Guayaquil, Ecuador;Department of Microbiology, Hospital Virgen de las Nieves, Institute for Biosanitary Research-Ibs, Granada, Spain;Hospital Guayaquil, Guayaquil, Ecuador;Hospital de Infectología Dr. José Daniel Rodríguez Maridueña, Guayaquil, Ecuador;Omni Hospital, Guayaquil, Ecuador;Sosecali. Medical Services, 090308, Guayaquil, EC, Ecuador;Department of Internal Medicine, School of Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador;Sosecali. Medical Services, 090308, Guayaquil, EC, Ecuador;Faculty of Medical Sciences, Guayaquil University, Guayaquil, Ecuador;Department of Microbiology, School of Medicine and PhD Program in Clinical Medicine and Public Health, University of Granada & ibs, Granada, Spain;

关键词: Colistin;    Resistance;    Carbapenemase-producing;    Enterobacterales;    Risk factors;   

DOI  :  10.1186/s12941-023-00609-8

 received in 2023-01-31, accepted in 2023-07-05,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeThe aim of this study was to assess the risk factors for colistin-resistant carbapenemase-producing Enterobacterales (CR-CPE), and describe the mortality associated with this organism, in a low-income country.MethodsA descriptive, observational, and prospective multicenter study was carried out in Guayaquil, Ecuador. All patients with carbapenem-resistant Enterobacterales admitted between December 2021 and May 2022 were enrolled. Infection definitions were established according to the Centers for Disease Control and Prevention (CDC) protocols. The presence of carbapenemase-producing Enterobacterales was confirmed with a multiplex PCR for blaKPC,blaNDM,blaOXA-48,blaVIM, and blaIMP genes. MCR-1 production was studied molecularly, and MLST assays were carried out.ResultsOut of 114 patients enrolled in the study, 32 (28.07%) had at least one positive sample for CR-CPE. Klebsiella pneumoniae ST512-KPC-3 was the most frequent microorganism isolated. Parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure were all considered independent risk factors for carrying CR-CPE. A mortality of 41.22% was detected, but we could not find any difference between colistin-resistant and colistin-susceptible CPE. MCR-1 production was not detected in any of the isolates studied.ConclusionA significant burden for CR-CPE was found in a South American country that was mainly caused by the high-risk clone K. pneumoniae ST512-KPC-3 and not mediated by mcr-1 production. Its acquisition involved parenteral feeding, β-lactamase inhibitor use, recent hemodialysis, and renal failure as independent risk factors, demonstrating the critical need for infection prevention and stewardship programs to avoid dissemination to other countries in the region.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 5