Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010-2020) in Oman

Faryal Khamis; Ibrahim Al-Zakwani; Mariya Molai; Jalila Mohsin; Samta Al Dowaiki; Maher Al Bahrani; Eskild Petersen

doi:10.1016/j.ijregi.2022.08.001

Demographic, clinical, and outcome characteristics of carbapenem-resistant Enterobacteriaceae over a 10-year period (2010-2020) in Oman

IJID Reg. 2022 Aug 4:4:165-170. doi: 10.1016/j.ijregi.2022.08.001. eCollection 2022 Sep.

Authors

Faryal Khamis¹, Ibrahim Al-Zakwani², Mariya Molai¹, Jalila Mohsin³, Samta Al Dowaiki¹, Maher Al Bahrani⁴, Eskild Petersen^{1

5}

Affiliations

¹ Infectious Diseases Unit, Department of Internal Medicine, Royal Hospital, Muscat, Oman.
² Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman.
³ Department of Microbiology, Royal Hospital, Muscat, Oman.
⁴ Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman.
⁵ Institute for Clinical Medicine, Faculty of Health Science, University of Aarthus, Denmark.

Abstract

Purpose: The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has increased in the last two decades, causing significant morbidity and mortality. Our study investigated the factors associated with mortality from CRE bloodstream infection in a single center in Oman.

Methods: Data from adult patients with CRE bacteremia, over a 10-year period, were retrospectively collected. Demographic and clinical characteristics were compared according to intensive care unit (ICU) admission status and mortality. A logistic regression model was used to evaluate factors associated with mortality.

Results: 169 cases of CRE bacteremia were identified, of whom 93 (55%) required ICU admission and 96 (56.8%) died. Patients who required ICU care were more likely to require organ transplant (15% vs 4.0%; p = 0.02), be on immunosuppressants (31% vs 17%; p = 0.035), be transferred from other hospitals (40% vs 14%; p < 0.001), be colonized with CRE (73% vs 43%; p < 0.001), have vascular lines (85% vs 42%; p < 0.001), be on mechanical ventilation (91% vs 9.2%; p < 0.001), require a longer stay (37 vs 17 days; p < 0.001), and have increased mortality (80% vs 29%; p < 0.001). In the multivariate analysis, mechanical ventilation (adjusted odds ratio (aOR) 15.3; 95% confidence interval 5.39-43.2; p < 0.001) and prior use of the broad-spectrum antibiotics meropenem (p = 0.01) and piperacillin/tazobactam (p = 0.026) were associated with CRE mortality.

Conclusion: CRE bacteremia carries a high mortality rate in patients requiring ICU care. Implementation of infection control measures and antimicrobial stewardship programs are essential in reducing the rates of CRE BSI.

Keywords: Enterobacteriaceae; Klebsiella pneumoniae; Klebsiella pneumoniae carbapenemase; bacteremia; bloodstream infection; carbapenem resistance; carbapenem-resistant Enterobacteriaceae; carbapenemase; carbapenemase-producing; deaths; mortality; outcome; prognostic factor.