CARBAPENEM RESISTANT ENTEROBACTERALES COLONIZATION & RISK OF INFECTION IN ICU PATIENTS IN A TERTIARY CARE CENTRE

Abstract

Intro: Carbepenems resistance(CRE) among microorganisms is a global public-health problem with limited treatment options Asymptomatic gastrointestinal carriage of CRE in ICU patients is common and may be associated with increased risk of CRE infection. Methods: The cross-sectional hospital based study was done to evaluate the prevalence of CRE colonization and hospital care associated infection(HCAI) in ICU patients. Per-rectal swabs of patients were collected within 24 hours of admission and patients were followed up weekly for CRE colonization and for development of HCAI until discharge/transfer from the ICU. Samples processing, identification of isolates was done as per standard microbiological techniques. Antibiotic susceptibility & phenotypic screening and confirmation for MBL producers was done as per CLSI guidelines. Detection of bla genes (blaNDM, blaVIM, blaOXA, blaKPC, blaIMP) was done by multiplex Polymerase Chain Reaction. Findings: Total 120 patients were admitted in ICU during the study period. Of these 45(37.9%) patients were found to be colonized with CRE within 24 hours of their admission. Duration of hospital stay(n=24; 53.3%, P<0.05), HAI rates(n=23; 51%, P<0.05) and mortality(n=13;28.8%, P<0.05) was found to be higher in patients with CRE colonization. Among the CRE, Escherichia coli (n=20; 44%) was the commonest organism, followed by Klebsiella oxytoca (n=8;18%). On follow-up, 16 (21%) patients in CRE non-colonized group became CRE colonized. On phenotypic confirmation by mCIM & eCIM method, 37 isolates were found to be carbapenemase producers, whereas 7 isolates were MBL producers respectively. Total 16 (43%) bla genes were detected among 37 isolates. blaKPC(n=5) and blaOXA(n=4) were the most common genes identified. Conclusion: CRE colonization rate were alarming in our study, which were associated with higher HCAI and higher mortality rates. The clinical implication of our findings is that effective screening strategies may be planned and implemented for CRE carriers for better infection control strategies.