High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

doi:10.1186/s13756-017-0200-5

. 2017 May 2:6:42.

doi: 10.1186/s13756-017-0200-5. eCollection 2017.

High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

Abdul Rahman Zaidah¹, Nurul Izzah Mohammad¹, Siti Suraiya¹, Azian Harun¹

Affiliations

PMID: 28473912
PMCID: PMC5414356
DOI: 10.1186/s13756-017-0200-5

High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

Abdul Rahman Zaidah et al. Antimicrob Resist Infect Control. 2017.

. 2017 May 2:6:42.

doi: 10.1186/s13756-017-0200-5. eCollection 2017.

Authors

Abdul Rahman Zaidah¹, Nurul Izzah Mohammad¹, Siti Suraiya¹, Azian Harun¹

Affiliation

¹ Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia.

PMID: 28473912
PMCID: PMC5414356
DOI: 10.1186/s13756-017-0200-5

Abstract

Background: Infections by multidrug-resistant gram-negative bacteria (MDR-GNB) have been continuously growing and pose challenge to health institution globally. Carbapenem-resistant Enterobacteriacea (CRE) was identified as one of the MDR-GNB which has limited treatment options and higher mortality compared to those of sensitive strains. We report an increased burden of CRE fecal carriage at a hospital in the North-eastern region of Malaysia.

Methods: A retrospective descriptive study from August 2013 to December 2015 was conducted in the Medical Microbiology & Parasitology laboratory of Hospital Universiti Sains Malaysia, which is a tertiary teaching hospital with more than 700 beds. This hospital treats patients with various medical and surgical conditions. Suspected CRE from any clinical specimens received by the laboratory was identified and confirmed using standard protocols. Polymerase chain reaction (PCR) assay was performed to determine the genotype.

Results: Altogether, 8306 Enterobacteriaceae was isolated from various clinical specimens during the study period and 477/8306 (5.74%) were CRE. Majority of the isolated CRE were Klebsiella [408/477, (85.5%)], of which Klebsiella pneumoniae was the predominant species, 388/408 (95%). CRE were mainly isolated from rectal swab (screening), 235/477 (49.3%); urine, 76/477 (15.9%); blood, 46/477 (9.6%) and about 7.1% from tracheal aspirate. One hundred and thirty-six isolates were subjected to genotype determination and., 112/136 (82.4%) showed positive detection of New Delhi metallo-β-lactamase 1 (NDM-1) gene (bla_NDM1).

Conclusion: The study noted a high numbers of CRE isolated especially from rectal swabs. Active screening results in significant cost pressures and therefore should be revisited and revised, especially in low resource settings.

Keywords: Carbapenem-resistant Enterobacteriacea; Klebsiella pneumoniae; Screening.

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**Fig. 1**
Carbapenem-resistant Enterobacteriacea isolated from various clinical specimens at Hospital Universiti Sains Malaysia, 2011–2014

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References

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[1] Duin DV, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence. 2016;11:1–10. doi: 10.1080/21505594.2016.1222343. - DOI - PMC - PubMed

[2] Duin DV, Doi Y. The global epidemiology of carbapenemase-producing Enterobacteriaceae. Virulence. 2016;11:1–10. doi: 10.1080/21505594.2016.1222343. - DOI - PMC - PubMed

[3] Xu Y, Gu B, Huang M, et al. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000–2012 in Asia. J Thorac Dis. 2015;7(3):376–385. - PMC - PubMed

[4] Xu Y, Gu B, Huang M, et al. Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000–2012 in Asia. J Thorac Dis. 2015;7(3):376–385. - PMC - PubMed

[5] Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the national healthcare safety network at the centers for disease control and prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14. doi: 10.1086/668770. - DOI - PubMed

[6] Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the national healthcare safety network at the centers for disease control and prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14. doi: 10.1086/668770. - DOI - PubMed

[7] Lyman M, Walters M, Lonsway D, Rasheed K, Limbago B, Kallen A. Notes from the field: carbapenem-resistant Enterobacteriaceae producing OXA-48-like carbapenemases—United States, 2010–2015. Morb Mortal Wkly Rep. 2015;64(47):1315–1316. doi: 10.15585/mmwr.mm6447a3. - DOI - PubMed

[8] Lyman M, Walters M, Lonsway D, Rasheed K, Limbago B, Kallen A. Notes from the field: carbapenem-resistant Enterobacteriaceae producing OXA-48-like carbapenemases—United States, 2010–2015. Morb Mortal Wkly Rep. 2015;64(47):1315–1316. doi: 10.15585/mmwr.mm6447a3. - DOI - PubMed

[9] Hamzan NI, Yean CY, Rahman RA, Hasan H, Rahman ZA. Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia. Emerg Health Threats J. 2015;8:26011. - PMC - PubMed

[10] Hamzan NI, Yean CY, Rahman RA, Hasan H, Rahman ZA. Detection of blaIMP4 and blaNDM1 harboring Klebsiella pneumoniae isolates in a university hospital in Malaysia. Emerg Health Threats J. 2015;8:26011. - PMC - PubMed

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High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

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High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting

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