The Epidemiology, Risk Profiles, and Outcomes of Patients Infected with Carbapenem-Resistant Gram-Negative Bacterial Infections

Abstract

Background: Antimicrobial resistance (AMR) is a major public health problem that threatens economic security, puts health at risk, and jeopardizes global progress towards the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs). Limited data exist regarding risk factors, health outcomes, and treatment of carbapenem-resistant gram-negative bacteria (GNB) infections in Sri Lanka. The purpose of this study was to describe the epidemiology, risk factors, and outcomes among patients with infections due to carbapenem-resistant GNB. Methods: The study was conducted at Teaching Hospital Karapitiya (THK), the largest tertiary care hospital in the Southern Province of Sri Lanka from September 2019 through January 2020. The study population consisted of inpatients at THK. Laboratory-based surveillance was performed using routine clinical samples received by the clinical microbiology laboratory at THK to identify cases (carbapenem-resistant gram-negative isolates) and controls (carbapenem-susceptible gram-negative isolates) for case-control analysis. Three groups of GNB isolates were included in the study: Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. Prevalence of carbapenem resistance was calculated, and risk factors were assessed for association with resistance by logistic regression. Results: A total of 474 gram-negative bacterial isolates were screened for complete antibiotic susceptibility data at THK from October 2019 to November 2019. In total, 28.3% of Enterobacteriaceae isolates, 21.7% of Pseudomonas spp., and 66.7% ofAcinetobacter spp. exhibited carbapenem resistance. None of the sociodemographic or clinical factors explored was significantly associated with having a carbapenem-resistant isolate. Conclusions: Overall, a high prevalence of carbapenem resistance was noted. The present data justify the need for antimicrobial stewardship programs and the implementation of consistent surveillance. While these data do not identify risk factors associated with carbapenem resistance, future research should further explore potential risk factors specific to the Sri Lankan context.